Understanding Adult Failure to Thrive (AFTT)
Adult failure to thrive (AFTT) is a clinical syndrome characterized by a decline in an older person's health, often including weight loss, reduced appetite, malnutrition, and decreased activity. It is seen as an indicator of underlying medical, psychological, or social issues rather than a normal consequence of aging. A thorough diagnostic process is needed because it is not a single disease, requiring exploration of various factors contributing to the decline.
The Comprehensive Diagnostic Process
Diagnosing AFTT relies on clinical evaluation, patient history, and various assessments rather than a single test. Healthcare providers begin by reviewing symptoms and health history to identify patterns of decline.
The Initial Clinical Assessment
The diagnostic process starts with a detailed conversation and physical examination.
Medical History and Interviews
- Patient interview: The physician inquires about eating habits, daily activities, recent life changes, and general well-being.
- Family/Caregiver interview: Input from family or caregivers is crucial as they may observe subtle changes the patient hasn't noticed, such as appetite changes, weight loss, mobility issues, or mood shifts.
Physical Examination A complete physical exam is conducted to check for signs of underlying conditions like infection or muscle loss.
Medication Review Reviewing all medications is essential, as many can cause side effects affecting appetite, energy, or mood. Polypharmacy increases this risk.
Lab and Imaging Evaluations
Tests are ordered to identify underlying medical issues and deficiencies.
- Blood and urine tests: These screen for infection, assess organ function, and check nutritional status. Common tests include CBC, chemistry panel, TSH, and indicators of malnutrition like serum albumin and cholesterol.
- Imaging tests: Chest X-rays, CT scans, or MRIs may be used to check for conditions like infections or tumors.
Psychological and Social Screening
Assessing psychosocial factors is a vital part of the AFTT diagnosis.
- Depression screening: Depression is common in AFTT and impacts appetite and motivation. Screening tools are used to evaluate mood.
- Cognitive assessment: Tests for memory and cognitive function help identify conditions like dementia or delirium.
- Social assessment: Evaluating social support, living situation, and financial resources is important, as isolation and poverty can affect health.
The "11 D's" of Geriatric Failure to Thrive
A mnemonic is sometimes used to help systematically investigate potential causes of AFTT. The table below provides a summary of these areas:
| Assessment Area | Cause (The 11 D's) | Example Conditions |
|---|---|---|
| Medical Conditions | Diseases | Cancer, heart failure, chronic lung disease, kidney disease |
| Mental Health | Dementia, Depression, Delirium | Cognitive impairment, mood disorders, acute confusion |
| Medication | Drugs | Side effects from polypharmacy |
| Physical Function | Dysphagia, Deafness/Blindness | Difficulty swallowing, sensory deficits |
| Social/Environmental | Desertion, Destitution | Lack of social support, financial insecurity |
| Psychological State | Despair | Giving up hope or will to live |
| Substance Abuse | Drinking | Alcohol or substance abuse |
Differentiating AFTT from Other Diagnoses
AFTT is a diagnosis of exclusion, meaning other specific, treatable conditions must be ruled out. Symptoms like weight loss and fatigue can be caused by various diseases such as cancer or heart failure. A thorough differential diagnosis ensures the correct cause is identified and treated appropriately.
For further information on geriatric failure to thrive, the American Academy of Family Physicians provides a detailed review AAFP.
What Happens After a Diagnosis?
Following an AFTT diagnosis, treatment focuses on addressing the root causes through a multidisciplinary approach. This may include:
- Nutritional Support: Working with a dietitian to improve diet or use supplements.
- Mental Health Support: Treating depression with therapy and medication.
- Physical Therapy: Enhancing strength and mobility.
- Social Work: Connecting individuals with social and financial resources.
Conclusion: A Holistic Approach to Diagnosis
Diagnosing adult failure to thrive is a comprehensive effort involving family observations, medical evaluation, and assessment of physical, mental, and social factors. Identifying and addressing the underlying causes can significantly improve an individual's quality of life.
