Failure to Thrive Flashcards
Fraility:
- definition
- characteristics
Def: a state of age related physiologic vulnerability resulting from impaired homeostatic reserve and reduced capacity to withstand stress.
Characteristics:
- extremes of old age
- unstable disability
- function fluctuates with minor stressors*
- multiple chronic dz and/or geriatric syndromes
The study of osteoporotic fx index discovered what three things increase risk of osteoporotic fxs?
How many of the 3 need to be considered a predictor of falls, disability, fxs, and death?
weight loss of 5% or more over 2 years
inability to stand from a chair 5x without using arms to push up
negative response to the question: “do you feel full of energy?”
*2 of 3 positives is considered a predictor of risk of falls, disability, fxs, and death.
What are some adverse outcomes of fraility?
falls
acute illness
hospitilizations
disability
dependency
institutionalization
death
What are the key components of frailty?
Musculoskeletal function
cognitive/integrative neurological function (alzheimers, dementia)
nutritional reserve
aerobic capacity
Failty:
- sx
- signs
- contributing factors
Sx:
- weakness
- fatigue
- anorexia
- inactivity
Signs:
- weight loss/malnutrition
- decreased muscle mass
- decreased bone mass
- anemia
Contributing factors:
- heavy drinking
- cigarette smoking
- physical inactivity
- depression
- social isolation
- multiple chronic medical problems
- poor perceived health
Triggering Events of fraility?
- chronic dz
- inactivity
- infection
- hip fx
Define failure to thrive.
What are the three components of failure to thrive?
Failure to thrive is often accompanied by?
def: the near irreversible end of the natural hx of the syndrome of frailty.
National Institute of aging definition: A syndrome of weight loss, decreased appetite and poor nutrition and inactivity.
Components:
- physical frailty
- disability (loss of greater than 1 ADL)
- impaired neuropsychiatric function (depression,etc)
- no immediate explanation for the condition (no underlying terminal dz) ?
accompanied by:
- dehydration
- depressive sx
- impaired immune function
- low cholesterol
Define disability.
Define impaired neuropsychiatric function. Causes of this?
Disability: difficulty or dependency in completing tasks essential for self-care and independent living. (ADLs and IADLs)
Neuropsychiatric:
-delirium, depression, and dementia are the MC conditions affecting cognitive status in older adults.
Causes of impaired neuropsych function:
- result of medical comorbidities
- medication effects
T/F, disability is an independent risk factor for mortality, hospitilization and need for long term care?
Geriatricians believe that this condition may be a cause of failure to thrive? What is this?
What type of weight loss is correlated with decline and mortality?
True.
Sarcopenia:
- 5-1% loss per year after the age of 25:
- loss of muscle with age
- loss of lean body mass
- diminishes the acute phase response to physiological stress
- decreases immune competence
Muscle mass loss is correlated with decline and mortality.
Failure to thrive:
- signs and sx
- H&P
signs and sx:
- impaired physical functioning
- malnutrition
- depression
- cognitive impairment
H&P:
- hx provided by the patient and caregiver is key in establishing the onset of the condition and uncovering potential triggers
- make sure to R/O acute medical problems:
- -infection
- -constipation
- -exacerbation of chronic dz:
- CHF, COPD, CAD, CA, TB, Dementia, Depression
-drug review; pts using more than 14Rx in a year
- psychosocial hx:
- -increased memory loss
- -change in social structure:
- –death of person or pet
- –moving away of a friend or family member
- –caregiver burnout
- –financial concerns
Comprehensive PE:
-VS, hearing, eyes/vision, oral health, swallowing, JVD, breast mass, abd exam, skin, motor, mental status
Failure to Thrive:
-standard labs used to evaluate
Labs:
-CBC: anemia, vit deficiency, infection, hematopoietic disorder
- serum lytes, BUN, creatinine, calcium:
- -hyper-hyponatremia
- -acid base disorder
- -osmolality
- -renal function
- -dehydration
- glucose:
- -DM, hypoglycemia
- serum bilirubin and transaminase levels
- albumin and cholesterol (markers for malnutrition)
- TSH
- fecal occult blood
- U/A
- Vit B12 and D level
- ESR
- PPD
Failure to thrive
-tx
Tx:
- life expectancy of pt should be assessed
- risk-benefit assessment should be included in all interventions
- palliative measure can be initiated
- address advanced directives
