Failure to thrive nutritional assessment a failure to

Failure to Thrive (Nutritional Assessment)
A failure to thrive and nutritional deficiencies are significant problems among the elderly. It is estimated
that a failure to thrive occurs at a rate of more than 5% in a community setting, more than 25% in a
nursing home, and more than 50% in a hospital. Depression, cognitive impairment, delirium, falls,
anorexia, decreased immunity, weight loss, and an inability to perform ADLs all contribute to the
incidence of a failure to thrive. Other factors include acute or chronic medical problems, medications, and
infections. There may be cultural values that contribute to a failure to thrive; please be aware of or at
least able to inquire about possible cultural influences.
Diagnostic testing should include a CBC, a CMP, the B12 level, a TSH, an ESR, a chest x-ray, and
urinalysis. Consider a CT scan or an MRI. A colonoscopy may be ordered if you suspect possible
malabsorption or colon lesions.
Correct any underlying problems, such as infections and depression, or optimize chronic illnesses as much
as possible. Minimize medications by eliminating unnecessary ones. Try to understand and assist with
cultural conflicts. Encourage mobility—the patient should be up in a chair, if at all possible, for all meals.
Utilize physical therapy for exercise as well.
Optimize nutritional intake as much as possible. The estimated mortality rate due to a failure to thrive is
almost 16% (Buttaro et al., 2012). It is prudent to address advanced directives with these patients to
ensure that their wishes are known.
Advanced Directives
Page 16 of 2
Practicum I: Adult Health - Adults & Gerontology
©2016 South University

Neurological Conditions
Week 9
Advanced directives, such as a living will and a health care power of attorney, should be addressed before
the patient becomes unable to make reliable decisions and before an urgent situation arises. Take the
opportunity to ask your patients about their advanced directives on an annual basis, such as when you
conduct functional assessments and yearly physicals.
A living will documents the patient's end-of-life care wishes in case he or she is not able to speak for
himself or herself. A living will usually covers life-sustaining treatments that the patient may or may not
want in the event of a terminal condition, for example, using a feeding tube or being put on a ventilator if
the patient has been declared terminal.
Below is a link to the CDC on Advanced Care Planning:
Palliative Care
A palliative care referral should be considered for any patient with a serious illness that is facing poor
symptom management. Although palliative care should be considered for all patients with a serious
illness often cancer is the diagnosis clinician’s think of for the referral. Below is a link to the NIH noting
that introducing palliative care can improve a patient quality of life in a cancer patient. Another link is