What is considered FTT in older adults?

According to the American Academy of Family Physicians, Failure to Thrive (FTT) affects a significant portion of older adults, with prevalence increasing with age. So, what is considered FTT? It is a serious geriatric syndrome marked by a significant decline in an elderly person's physical, psychological, and functional health.

Quick Summary

FTT, or Failure to Thrive, is a geriatric syndrome defined by weight loss, decreased appetite and nutrition, and inactivity, often accompanied by social withdrawal, depression, and cognitive impairment. It is a cluster of symptoms reflecting a decline in overall health, not a specific disease, and requires thorough medical evaluation.

Key Points

• Not a single disease: FTT is a syndrome of decline, not a specific diagnosis, encompassing multiple physical and mental symptoms in older adults.

• Hallmark symptoms: Key signs include unexplained weight loss (>5%), decreased appetite, inactivity, and social withdrawal.

• Diverse causes: FTT results from a mix of physical, psychological, and social factors, including chronic diseases, depression, medication side effects, and isolation.

• Comprehensive diagnosis: No single test exists; diagnosis involves a thorough geriatric assessment, physical exam, medication review, and screenings for depression and cognitive issues.

• Multidisciplinary care: Effective management relies on a team approach involving doctors, dietitians, and social workers to address the underlying contributors.

• Reversible with intervention: FTT can often be reversed with targeted treatments, though prognosis depends on the underlying cause.

• Distinct from frailty: While related, FTT represents a more advanced state of decline compared to the broader concept of frailty.

Defining Failure to Thrive (FTT) in the Elderly

Failure to Thrive (FTT) is a geriatric syndrome affecting older adults, involving a complex decline in physical, psychological, and functional health. It is not a single disease but indicates a significant shift from an individual's usual health state, often due to underlying medical issues or age-related vulnerabilities. The Institute of Medicine defines geriatric FTT by weight loss over 5% of baseline, reduced appetite, poor nutrition, and inactivity, potentially with dehydration, depression, and weakened immune function.

The Key Indicators: Symptoms of FTT

Recognizing FTT symptoms is vital for prompt help. Common signs include unexplained weight loss, decreased appetite leading to poor nutrition, and reduced physical activity. Social withdrawal and isolation are frequent, as are symptoms of depression and cognitive impairment. Difficulty with daily tasks also signals functional decline.

A Multifaceted Issue: Causes of FTT

FTT arises from a mix of medical, psychological, and social factors.

Physical and Medical Factors

Worsening chronic diseases, multiple medications, sensory problems, and oral health issues can all contribute. Swallowing difficulties (dysphagia) also significantly impact nutrition.

Psychological and Social Factors

Depression, dementia, social isolation, and financial difficulties can negatively affect appetite, activity, and overall well-being.

The '11 Ds of Geriatric Failure to Thrive'

This mnemonic highlights common causes:

1. Diseases
2. Dementia
3. Delirium
4. Drinking (alcohol) and substance abuse
5. Drugs (medication side effects)
6. Dysphagia
7. Deafness and other sensory deficits
8. Depression
9. Desertion (social isolation)
10. Destitution (poverty)
11. Despair.

FTT vs. Frailty: Key Differences

While related, FTT and frailty differ. Frailty is a broader age-related decline, which can lead to FTT.

Feature	Failure to Thrive (FTT)	Frailty
Core Concept	A syndrome of decline with defined symptoms: weight loss, decreased appetite, inactivity.	A state of increased vulnerability to stressors due to diminished physiological reserve.
Symptom Profile	Often includes psychological factors like depression and social withdrawal.	Primarily physical, including unintentional weight loss, weakness, slowness, low physical activity, and exhaustion.
Relationship	FTT can be seen as an advanced stage or endpoint of frailty syndrome.	Frailty can exist without all the components of FTT, but is a strong risk factor for its development.
Onset	Often has a more rapid onset, sometimes triggered by an acute medical event.	Typically a slower, more progressive decline associated with aging.

Diagnosis and Management of FTT

Diagnosing FTT involves a comprehensive geriatric assessment, not just one test.

The Diagnostic Process

Doctors will take a detailed history, perform a physical exam, and may use screening tools for depression or cognitive issues. Laboratory tests and imaging can help identify underlying medical conditions.

Interventions and Management

A team of healthcare professionals is needed to create a personalized care plan. Treatment focuses on addressing underlying conditions, improving nutrition, reviewing medications, encouraging physical activity, providing mental health support, and promoting social engagement.

The Prognosis for FTT

FTT prognosis varies based on the cause and treatment success. While it increases health risks, FTT is often reversible with early intervention, improving quality of life. In some cases of advanced illness, FTT may indicate the final stages, and care shifts to comfort. FTT should be seen as a signal of a treatable issue, not an unavoidable part of aging. A comprehensive approach can enhance well-being.

What You Can Do as a Caregiver

If you suspect FTT, seek a medical evaluation. Work with the healthcare team on a care plan. Your support in social activities, providing nutritious meals, and offering companionship is crucial. For more information, visit the American Academy of Family Physicians.

Conclusion: FTT is a Signal, Not a Sentence

FTT is a serious geriatric syndrome defined by decline in physical and mental health. Symptoms like weight loss, poor appetite, inactivity, and social withdrawal require evaluation. Addressing the medical, psychological, or social causes through a team approach can manage or reverse FTT, preserving the quality of life for elderly adults. It's a signal needing attention, not a predetermined outcome.

Frequently Asked Questions

What is the primary indicator of FTT in an older adult?

The primary indicators include significant, unexplained weight loss (over 5% of baseline), decreased appetite, and a noticeable reduction in physical activity, often combined with social withdrawal.

Is FTT the same as frailty?

No, while related, they are distinct. Frailty is a broader state of age-related vulnerability, whereas FTT is a specific syndrome of decline that can be an outcome or advanced stage of frailty.

Can Failure to Thrive in adults be reversed?

Yes, FTT is often reversible with the right interventions, especially if caught early. Treatment focuses on addressing the specific underlying causes, such as managing chronic diseases or providing nutritional support.

What are the first steps if I suspect my loved one has FTT?

The first step is to seek a comprehensive medical evaluation from their physician. Be prepared to discuss changes in their eating habits, activity levels, and mood, as these are critical clues.

How do medical professionals diagnose FTT?

Diagnosis is based on a clinical assessment, not a single test. This includes a thorough medical history, physical exam, review of medications, and often screenings for conditions like depression and cognitive impairment.

What kind of treatments are used for FTT?

Treatment is holistic and often involves a multidisciplinary team. It can include dietary changes, nutritional supplements, medication adjustments, physical activity, and psychological support.

Are there any specific medical conditions that cause FTT?

Many conditions can contribute, including chronic illnesses like cancer, heart disease, diabetes, and dementia. Medication side effects, infections, and sensory impairments can also play a role.