Introduction to Adult Failure to Thrive (AFTT)
Adult failure to thrive (AFTT), sometimes called geriatric failure to thrive, is not a specific disease but a syndrome describing a state of progressive physical, cognitive, and functional decline in older adults [1.2.3, 1.4.2]. It manifests as a collection of symptoms, including unintentional weight loss (often defined as more than 5% of baseline), decreased appetite, inactivity, and social withdrawal [1.3.4, 1.2.6]. While the term originated in pediatrics, it is now commonly used to describe this multifaceted decline in the elderly population [1.2.6]. It's crucial to understand that AFTT is not considered a normal part of aging; it signals underlying problems that require investigation and management [1.3.4]. The prevalence increases with age and is significantly higher in long-term care settings and among hospitalized veterans, reaching up to 40% and 60% respectively [1.7.1].
The Four Core Domains of Causation
Failure to thrive stems from a complex interplay of issues that can be grouped into four main areas. A helpful mnemonic for some of the specific causes is the "11 D's," which includes diseases, dementia, delirium, drugs, drinking alcohol, dysphagia (difficulty swallowing), deafness/blindness, depression, desertion (social isolation), destitution (poverty), and despair [1.2.3].
1. Medical and Physical Causes
Chronic diseases are a primary driver of AFTT. Conditions like cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, and chronic kidney disease can lead to a state of decline [1.3.3]. The metabolic demands of these illnesses, coupled with symptoms like pain and fatigue, contribute significantly. Malnutrition is a key component, often resulting from these chronic conditions, medication side effects, or dental issues that make eating difficult [1.2.3, 1.3.2].
Other physical factors include:
- Medication Side Effects: Polypharmacy (the use of multiple medications) is common in older adults. Drugs like diuretics, opioids, benzodiazepines, and antidepressants can cause side effects such as anorexia, cognitive changes, or dry mouth, all of which can lead to reduced intake and decline [1.3.3, 1.3.4].
- Sensory Deficits: Impaired vision or hearing can lead to social isolation, difficulty preparing meals, and a reduced quality of life, pushing an individual towards failure to thrive [1.2.3].
- Dysphagia: Difficulty swallowing, whether from a stroke or other neurological or mechanical causes, directly impacts nutritional intake and can lead to weight loss and dehydration [1.2.3].
2. Psychological and Cognitive Factors
Mental and cognitive health are inextricably linked to physical well-being. Four syndromes are particularly predictive of adverse outcomes in AFTT: impaired physical function, malnutrition, depression, and cognitive impairment [1.3.4, 1.3.5].
- Depression: This is one of the most common and treatable causes of AFTT. Depression can lead to apathy, loss of appetite, and a lack of interest in self-care activities [1.2.6].
- Dementia and Cognitive Impairment: Conditions like Alzheimer's disease can cause individuals to forget to eat, lose the ability to prepare food, or develop changes in taste and smell, leading to poor nutrition [1.2.3]. Delirium, an acute state of confusion, is also a significant contributor [1.2.3].
- Despair: A sense of hopelessness or giving up, often linked to chronic pain, loss of independence, or bereavement, can manifest as a refusal to eat or engage in life [1.2.3].
3. Social and Environmental Factors
An individual's environment and social support system play a critical role in their health. Social determinants are powerful contributors to failure to thrive.
- Social Isolation (Desertion): The loss of a spouse, friends, or family support can lead to loneliness and depression. Eating is often a social activity, and those who live and eat alone may have poorer nutritional habits [1.2.3, 1.3.1].
- Financial Hardship (Destitution): Limited income can restrict access to nutritious food, healthcare, and necessary medications, directly impacting health and leading to decline [1.2.3, 1.2.6].
Distinguishing AFTT from Similar Conditions
It is important to differentiate AFTT from other geriatric syndromes like frailty and cachexia, although they can overlap.
| Feature | Failure to Thrive (AFTT) | Frailty | Cachexia |
|---|---|---|---|
| Definition | A broad syndrome of weight loss, decreased appetite, inactivity, and often cognitive and mood decline [1.2.3, 1.3.4]. | A distinct clinical syndrome of decreased physiologic reserve and increased vulnerability to stressors [1.6.4]. | A complex metabolic syndrome associated with an underlying illness, characterized by loss of muscle with or without fat loss [1.6.3]. |
| Primary Driver | Multifactorial: medical, psychological, and social causes [1.2.3]. | Primarily age-related physiological decline [1.6.4]. | Underlying inflammatory disease (e.g., cancer, heart failure) [1.6.2]. |
| Muscle vs. Fat Loss | Involves both muscle and fat loss, primarily from undernutrition [1.2.3]. | Primarily involves loss of muscle mass and strength (sarcopenia) [1.6.2]. | Primarily loss of muscle, but can also involve fat loss [1.6.2, 1.6.3]. |
Diagnosis and Management
Diagnosing AFTT involves a comprehensive assessment to uncover the underlying causes. There is no single test [1.4.2]. A physician will conduct a full medical history, review medications, perform a physical exam, and order tests like blood work, urine tests, and imaging to screen for infections, organ dysfunction, or malignancies [1.4.1, 1.4.2]. Mental health and cognitive screenings are also essential to identify depression or dementia [1.4.1].
Management is multidisciplinary and focuses on addressing the identified root causes [1.5.1, 1.5.6].
- Treat Underlying Medical Conditions: Optimizing management of chronic diseases.
- Nutritional Support: Working with a dietitian to increase caloric and protein intake, often with nutritional supplements [1.5.1]. Appetite stimulants may be considered [1.5.6].
- Address Psychological Issues: Treating depression with antidepressants and/or psychotherapy is critical [1.5.1].
- Physical and Occupational Therapy: To improve strength, mobility, and safety, helping to combat sarcopenia and prevent falls [1.5.6].
- Social Intervention: Connecting the individual with social services, support groups, or arranging for in-home care to combat isolation and assist with daily activities [1.5.2].
For more in-depth information from a leading health authority, you can review resources on geriatric syndromes. An excellent starting point is the National Institute on Aging (NIA), a part of the U.S. National Institutes of Health. Visit the NIA website for more information on healthy aging.
Conclusion
The cause of failure to thrive in adults is not a single entity but a constellation of interconnected physical, psychological, and social issues. It is a critical warning sign that an older adult's health is in jeopardy. By identifying and addressing the specific, often reversible, contributing factors through a compassionate, multidisciplinary approach, it is possible to improve an individual's quality of life and, in many cases, reverse the trajectory of decline.
