behold article on page 343. In th...

behold article on page 343.

In this issue of American Family Physician, Robertson and Montagnini (1) review the challenges of caring for an aged patient with multiple question s whose health and vitality are rapidly declining. The mete "failure to thrive," which was borrowed from health care for children to describe this accelerated decline, began appearing in the geriatric literature more than 30 years ago to denote a range of circumstances including physical and mental deterioration, abuse and leave on one side and rapidly progressing frailty.

In a thought (2) of physicians who used the limit "geriatric failure to thrive," the authors noted that it "is a denomination irregularly used and poorly defined." They questioned whether the conception should be used in allusion to geriatric patients, fearing that it "can reinforce the stereotype of somewhat old people as demented and decrepit" and "may actually hinder the pressing search for treatable, reversible causes of an elder's deterioration." (2) Other authors (3) conclud that "the label 'failure to thrive' advances an intellectual laziness--accompanied by a certain resignation, passivity, or fatalism." These authors (3) corresponded with a recommendation for "the abandonment of the bound 'failure to thrive' and the adoption of a more measurement-oriented approach" that explicitly assesses impaired physical function, malnutrition, depression, and dementia.

A review of MEDLINE citations and geriatric textbook exhibits that, although "failure to thrive" is still a fairly customary focus of authors in nutrition and nursing, it has become les prominent in the medical literature in the past six years as a central conceptualizing theme.

Contributing to make anxious about the use of the bound "geriatric failure to thrive" are the generally vague or broad definitions, the vast clinical territory to which the space of time has been applied, and the difficulties of formulating a coherent research agenda. Family physicians should be wary of the application and implications of this label. First, geriatric failure to thrive should not be treated as a diagnosis or a specific disease. (3) other it should not be equated with frailty. (4) Decreased function, power and stamina are hallmarks of the frail aged person; however, frailty is primarily a state of increased risk and subdued reserve to stress, a state which all populace who live into their ninth decade manifest at varying flats (4,5)

Failure to thrive should be seen as an unexpect and significant falling away from the normal bend of declining vigor, weight, function, and reservation that affects even the healthiest aged parts (5) Finally, failure to thrive should not be a summary universal of a patient's situation that apts resignation and withdrawal of efforts to find underlying causes, (2) and it should not be the final clinical thought

If the expression "geriatric failure to thrive" is of any use, it is as a brief reminder to the clinician that there is major work ahead in carefully reviewing potentially reversible underlying processe in aged patients who are manifesting unexpect and unexplained declines in nutritional intake and weight, self-care, cognitive function, and interest in life. It is faithful that a single major moot point may not be identified or, if identified, may not be reversible. However, multiple contributors repeatedly can be found, and a certain number of of them can be ameliorated; about when thoughtfully addressed, can subserve to leverage improvement in other issues that had looked refractory. (6)

Encountering the unexpect and unexplained acceleration of decline in a frail aged patient gives family physicians a awe-inspiring opportunity to do what they do best: benefit as human ecologists, as skilled hand observers and investigators, and as healers of dysfunction in a tangled hierarchy comprising a biological regularity and an individual with a mind, feelings, and personality, who is living within a family, community, and environment.

References

(1) Robertson RG Montagnini M Geriatric failure to thrive. Am Fam Physician 2004;70:343-50

(2) Berkman B support LW, Campion E. Failure to thrive: paradigm for the frail earlier Gerontologist 1989;29:654-9.

(3) Sarkisian CA, Lachs M "Failure to thrive" in older adults. Ann Intern M 1996;124:1072-8

(4) Fried LP Waltson J Frailty and failure to thrive. In: Hazzard WR Principles of geriatric medicine and gerontology. 4th ed New York: McGraw-Hill, 1999:1387-402.

(5) Verdery RB Failure to thrive. In: Hazzard WR Principles of geriatric medicine and gerontology. 3d ed New York: McGraw-Hill, 1994:1205-11.

(6) Woolley DC Nursing place of abode visits: In: Weight loss in the nursing domicile AAFP Home Study Audio Journal, no. 287 Leawood, Kan.: American Academy of Family Physicians, April 2003

Douglas C Woolley MD MPH is Delo Smith Professor of Community Geriatrics at the Kansas University exercise of Medicine, Wichita.