Failure to Thrive
Joy Stouffer
Frailty: Syndrome of physiological decline in late life, characterized by exhaustion, weakness, weight loss, low gait speed, and decreased physical activity leading to marked vulnerability and adverse health outcomes. Frailty can be further quantified by evaluation of baseline functional status, which is defined as the ability to perform activities necessary in daily life (ADLs).
ADLs
Basic ADLs |
Instrumental ADLs |
Advanced ADLs |
|---|---|---|
|
Dressing Eating Ambulating/transfer Toileting/continence Hygiene (bathing) |
Shopping Housekeeping & laundry Handling medications Accounting (finance) Food preparation Telephone Transportation (driving) |
Full social, community and family role Participate recreational task(s) |
Frailty Work Up
- History is important to look for precipitants or social contributors: recent surgery/hospitalization, new medication, new immobility or pain, support system, food insecurity, dysphagia
- Nutritional labs: Magnesium, Phosphorus, Calcium, vitamin D, B12, and if CBC shows anemia, then copper and zinc
- Screen for depression (in HPI questions, can also use PHQ-2 and then 9)
- Infectious work up (only if demonstrating clinical symptoms or meeting SIRS criteria): CXR , +/- blood cultures, UA if indicated (note that UA only for new mental alteration goes against IDSA guidelines)
Plan
- PT/OT consult
- Consult nutrition if evidence of malnutrition
- Correct nutritional deficiencies and consider IV thiamine 500 TID x 3 days if patient is malnourished and has altered mental status
- May need to check refeeding labs (K, Phos, Mg daily)
- If evidence of cognitive impairment, then outpatient referral to SLP Cognitive
- Vulnerable Elders Scale-13 can identify community-dwelling patients at risk of decline over 5 years