How to treat failure to thrive in adults with a multidisciplinary care plan

According to a study published in The Lancet, up to one in four adults ages 65 and older are malnourished or at risk for malnutrition, a key component of failure to thrive. Effectively managing this decline requires a multidisciplinary approach that addresses the physical, psychological, and social factors contributing to the condition. This guide explains how to treat failure to thrive in adults through coordinated care, nutritional strategies, and emotional support.

Quick Summary

This guide details the comprehensive, multidisciplinary approach necessary for managing adult failure to thrive. Treatment involves addressing underlying medical conditions, enhancing nutrition, supporting mental and emotional health, promoting physical activity, and ensuring a supportive social environment.

Key Points

• Start with a thorough medical evaluation: A doctor must first identify and treat any underlying medical conditions, such as chronic diseases or medication side effects, that may be contributing to the decline.

• Focus on nutrition and hydration: Work with a dietitian to create a personalized meal plan rich in calories and protein, and ensure the patient is drinking enough fluids to prevent dehydration.

• Address mental and emotional health: Screen for and treat depression and anxiety with professional guidance, which may involve medication and psychotherapy.

• Encourage physical and mental activity: Promote safe, regular physical activity and mentally stimulating hobbies to improve strength, appetite, and mood.

• Ensure a supportive social network: Combat social isolation by encouraging interaction with family and friends and utilizing community resources or in-home care.

• Review all medications regularly: A pharmacist should review all prescription and over-the-counter medications for potential side effects or interactions that affect appetite or function.

• Make the living environment safe: Adapt the home to reduce the risk of falls and make daily activities more manageable.

Failure to thrive (FTT) in adults is a complex syndrome marked by a gradual decline in physical and mental health, often presenting as weight loss, decreased appetite, and poor functional status. Unlike the predictable growth issues in infants, adult FTT is a multi-faceted condition requiring a coordinated, holistic strategy. A team-based approach, involving doctors, dietitians, social workers, and therapists, is critical for addressing the varied causes and improving overall well-being.

Assess and address underlying medical conditions

Before implementing a care plan, it is crucial to perform a thorough medical assessment to identify any reversible medical issues contributing to the decline. Many chronic conditions, such as cancer, heart failure, and chronic lung disease, can lead to FTT. The initial evaluation includes reviewing the patient's full medical history and current medication regimen, as drug side effects or interactions can often be a culprit.

• Medication review: Pharmacists and doctors should review all prescriptions and over-the-counter drugs. Certain medications, like benzodiazepines, opioids, or some antidepressants, can cause side effects that impact appetite, cognition, and mood. Adjusting dosages or changing medications can significantly improve symptoms.
• Dental health: Poor oral health, ill-fitting dentures, or difficulty swallowing (dysphagia) can severely affect a person's ability and desire to eat. A dental check-up and swallowing evaluation by a speech and language therapist are often necessary steps.
• Infection management: Recurrent infections, such as pneumonia or urinary tract infections, can worsen FTT and may require specific treatment.

Implement a robust nutritional strategy

Malnutrition is a central feature of adult FTT and requires immediate and sustained intervention to reverse weight loss and muscle wasting. A registered dietitian can create a personalized and appealing dietary plan.

• Increase caloric and protein density: Fortify foods with extra calories and protein by adding things like cheese, nuts, nut butters, or olive oil to meals. High-protein shakes or supplements can also be used between meals to boost nutritional intake.
• Enhance flavor and presentation: Changes in taste and smell perception are common with age. Using a variety of herbs, spices, and flavor enhancers can make food more appetizing.
• Small, frequent meals: For those with a poor appetite, offering several small meals and nutritious snacks throughout the day can be more manageable than three large meals.
• Address dehydration: Encourage the intake of fluids between meals, as a reduced sense of thirst is common. Dehydration is closely linked to malnutrition and can lead to complications.
• Meals as social events: Encourage shared mealtimes with friends or family, or arrange for meals at a senior center. Social interaction during meals can improve appetite.

Provide psychological and social support

Failure to thrive is often accompanied by and worsened by psychological and social factors, including depression, anxiety, and isolation. A comprehensive treatment plan must address these mental and emotional components.

• Depression screening and treatment: Depression is a significant contributor to FTT. Healthcare providers should screen for depressive symptoms using tools like the Geriatric Depression Scale. Treatment may involve a combination of antidepressant medication and psychotherapy.
• Counseling and therapy: Structured psychotherapy can provide seniors with tools to manage emotional distress, improve coping skills, and enhance their overall quality of life.
• Social engagement: Combating loneliness and isolation is essential. Arrange regular visits with friends and family, explore opportunities at community centers, or arrange for companionship services through home care.
• Meaningful conversations: Encourage open communication about feelings of loss or sadness. A sympathetic ear can make a significant difference for someone feeling despair.

Comparison of interventions for adult FTT

Intervention Category	Examples	Benefits	Considerations
Nutritional Support	Meal fortification, supplements, frequent small meals, dietitian guidance	Reverses malnutrition, improves energy levels, builds muscle mass	Requires consistent monitoring and may need adjustments based on appetite and taste changes.		Psychological Care	Antidepressant medication, psychotherapy, counseling	Addresses underlying depression, reduces anxiety, improves motivation and mood	May require careful monitoring of medication side effects and patient response. Psychotherapy depends on patient engagement.		Physical Activity	Light exercise, physical therapy, walking, balance exercises	Stimulates appetite, improves strength and mobility, boosts mood	Should be tailored to the individual's abilities and risk of falls; often requires supervision.		Environmental/Social	Home safety modifications, social outings, companionship, meal delivery services	Increases safety, reduces isolation, improves mental well-being	Funding and accessibility may be barriers; requires involvement from caregivers or community support.		Medication Management	Regular review of prescriptions, adjusting dosages, monitoring for side effects	Minimizes adverse drug effects that cause anorexia or functional decline	Requires expert oversight by a physician and pharmacist; patients taking many medications are high-risk.

Promote physical activity and functional independence

Physical inactivity exacerbates the decline in FTT patients, leading to further muscle atrophy and frailty. Regular, safe physical activity is a core component of treatment, even for frail or bedbound individuals.

• Physical and occupational therapy: A physical therapist can develop a routine to improve strength, mobility, and balance, helping to prevent falls. An occupational therapist can help with assistive devices and adaptive strategies to make daily activities easier.
• Light exercise: Encourage low-impact activities like walking, gentle stretching, or gardening. Even seated exercises or simple movements can be beneficial.
• Engaging activities: For those with limited mobility, cognitive exercises such as puzzles, reading aloud, or board games can keep the mind engaged and boost mood.

Create a supportive and safe environment

The patient's living situation can profoundly impact their ability to thrive. Ensuring a safe and supportive home environment is a critical part of the care plan.

• Home modifications: Simple changes can improve safety and independence, such as installing handrails, improving lighting, and removing tripping hazards like loose rugs.
• Home care services: In-home care can provide assistance with daily living activities, meal preparation, and companionship, reducing the burden on family caregivers.
• Community resources: Local senior centers, meals-on-wheels programs, and social clubs can provide access to nutritious meals and opportunities for social engagement.

Conclusion

Treating adult failure to thrive requires a holistic, multidisciplinary approach that addresses the root causes of the decline, which are often a combination of medical, nutritional, psychological, and social issues. Early identification and timely intervention focusing on nutritional support, psychological care, physical activity, and a supportive environment can lead to significant improvements in an adult’s health and quality of life. Effective treatment is rarely a single solution but rather a coordinated, compassionate effort from an entire care team and support network. Caregivers and loved ones play a vital role in monitoring a patient's progress and advocating for their needs with the medical team.

How to get more information

If you are concerned about an adult or loved one, the first step is to consult their primary care physician. For additional resources and information on caregiver support, organizations like the National Institutes of Health and the American Academy of Family Physicians provide useful guidance.

Frequently Asked Questions

What are the first steps to take when you suspect an adult has failure to thrive?

The first step is to schedule a comprehensive medical evaluation with their primary care physician. This is crucial for identifying and addressing any underlying health issues, medication problems, or nutritional deficiencies contributing to their decline.

Can diet alone treat adult failure to thrive?

No, while nutritional support is a critical part of the treatment plan, it is rarely sufficient on its own. Adult failure to thrive is a complex syndrome caused by multiple factors, including medical, psychological, and social issues. A multidisciplinary approach is always best.

Are there medications to help with adult failure to thrive?

There are no specific medications for FTT, but doctors may prescribe medications to address underlying issues like depression (antidepressants) or poor appetite (appetite stimulants). A medication review can also identify and change drugs causing negative side effects.

How can caregivers help manage adult failure to thrive?

Caregivers can play a vital role by monitoring nutritional intake, encouraging physical and social activity, making sure the living environment is safe, and providing emotional support and companionship.

Is adult failure to thrive always reversible?

Adult FTT is often reversible with timely and appropriate medical interventions. However, in some cases, particularly late-stage illness, interventions may be focused on palliative care and enhancing the patient's quality of life rather than reversal.

What role does social interaction play in treatment?

Social interaction is essential for combating loneliness and depression, which are significant factors in adult FTT. Encouraging engagement with family, friends, and community can improve overall mental well-being.

When should hospice be considered for adult failure to thrive?

Hospice care may be considered when a patient's health continues to decline despite medical interventions, especially if they have a limited life expectancy. Hospice focuses on providing comfort and support to enhance the quality of life during the end stages of illness.