Failure to thrive, a geriatric syndrome.

Geriatric "failure to thrive" (FTT) is characterized by a gradual decline in physical and/or cognitive function, usually accompanied by decreased appetite, weight loss, and social withdrawal. Although geriatric FTT is commonly found in hospitalized and institutionalized patients, the initial encounter is typically made in the ambulatory setting. A frail 80-year-old woman with osteoporosis presented to the primary care clinic with back pain due to compression fractures sustained from a mechanical fall. She also endorsed worsening abdominal pain and constipation refractory to stool softeners and fiber. Recent intake of food and liquids had been poor. Her husband also noted decreased interest in social activities. A chart review revealed an eight-pound (10%) weight loss since her last office visit 4 months prior. Physical exam was significant for dry mucous membranes, firmness and pain in the right lower quadrant, and tenderness along the L4 and L5 vertebrae. Gastrointestinal workup was negative. Tramadol was prescribed for pain control and home physical therapy was initiated. Anorexia was treated with megestrol and a dietitian was consulted for a nutritional assessment and treatment plan. The patient returned 2 months later pain-free with resolution of constipation and abdominal complaints. The patient's oral intake was increased resulting in a 7-pound weight gain. Physical therapy and use of a walker greatly improved ambulation. She also had renewed interest in social activities and shown improvement in her activities of daily living. Geriatric FTT is a common syndrome, especially in the frail elderly. The combined effects of normal aging, malnutrition, and specific social, physical, and psychological precipitants can present both a diagnostic and therapeutic challenge. Early recognition and intervention of geriatric FTT can reduce the risk of functional deterioration, hospitalization, or nursing home placement.

Jason F. Okulicz, MD, and Robert M. Kruger, MD. Wilford Hall Medical Center, Lackland AFB, San Antonio, TX, and IPC Hospitalists, San Antonio, TX.