Failure to Thrive (FTT) in adults is a multifaceted syndrome characterized by a decline in physical and psychological health, leading to significant nutritional deficits, diminished functional capacity, and often, a depressed mood state. This condition is especially prevalent among the elderly, but it can also affect adults with chronic illnesses. Understanding FTT is crucial for nursing care, as it requires a holistic approach that encompasses medical, psychological, and social dimensions. This paper explores the definition, clinical categorization, underlying factors, and nursing considerations related to adult failure to thrive.

Definition of Failure to Thrive (Adult)

Adult failure to thrive is defined as a syndrome involving a lower-than-expected level of functioning due to nutritional deficits, a depressed mood, and social isolation. This definition is derived from various theoretical, clinical, and research sources, emphasizing the need for a comprehensive understanding of the factors contributing to this syndrome (Newbern & Krowchuk, 1994; Verdery, 1996).

Clinical Categorization

Clinically, FTT can be identified through various terms, such as cachexia, frailty, dwindling, nonspecific presentation of illness, and decompensation. While often associated with older adults (Egbert, 1996), the condition may extend to other populations suffering from chronic illnesses like multiple sclerosis, AIDS, or diabetes.

The clinical presentation of FTT includes unintentional weight loss, poor nutrition, inactivity, and a decline in physical and cognitive abilities. Additionally, patients may exhibit signs of depression and social withdrawal, which can further exacerbate their condition.

Level In Disease Classification

In the International Classification of Diseases, 10th revision (ICD-10), FTT is frequently classified under pediatric diagnoses. In children, FTT is broadly defined as deviations from expected growth patterns based on age and sex (Frank & Zeisel, 1988). Pediatric FTT is typically categorized as:

1. Organic: Associated with a known underlying medical condition (e.g., chronic illnesses).
2. Nonorganic: Arising from psychosocial factors (e.g., neglect, abuse).
3. Mixed: Involving both medical and psychosocial elements.

While much of the literature surrounding FTT has focused on pediatric populations, understanding adult FTT through this classification framework offers valuable insights for nursing practice.

Verdery Propositions About Etiology

Verdery (1996) proposed two significant ideas regarding the etiology of adult FTT based on extensive clinical and research experience with elderly populations.

Trigger Events

The first proposition posits that FTT may occur in response to a specific trigger event that leads to an accelerated decline in health. These triggers could be physiological (e.g., a hip fracture), psychological (e.g., the death of a spouse), or environmental (e.g., relocation to a nursing home). The notion of a trigger event as a precursor to FTT warrants further investigation, as understanding these triggers can enhance preventive measures and interventions.

Primary and Secondary FTT

The second proposition differentiates between two categories of adult FTT:

1. Primary Adult FTT: In this category, the reasons for the patient’s decline are ambiguous or obscure. The causes may not be immediately identifiable, making diagnosis and treatment challenging.
2. Secondary Adult FTT: This type involves identifiable and potentially treatable reasons for decline. Possible underlying factors include:
   • Medical history and treatment, such as immune function and polypharmacy.
   • Psychological problems, primarily depression.
   • Nutritional factors, including eating disorders.
   • Social and environmental factors, such as isolation or alcohol intake.

Understanding these categories can help nurses develop targeted interventions that address specific causes of FTT.

Nursing Home Care and FTT

Nursing home care often presents unique challenges when managing adult FTT. Although there is no universally accepted definition, adult FTT can be more accurately characterized as a syndrome rather than a discrete medical diagnosis (Verdery, 1997).

Multidimensional Concept

Adult FTT is a multidimensional concept that encompasses physical, psychological, and social domains. It is crucial for nursing home staff to recognize that FTT is not merely a consequence of aging or chronic illness but rather a complex interplay of various factors.

Nursing Responsibilities

Nurses play a pivotal role in the assessment, diagnosis, and management of adult FTT. They must adopt a holistic approach that considers:

1. Nutritional Assessment: Regularly evaluating dietary intake and nutritional status is vital. This includes identifying potential barriers to adequate nutrition, such as physical disabilities or cognitive impairments that hinder self-feeding.
2. Psychological Support: Understanding the psychological dimensions of FTT is essential. Screening for depression and anxiety, providing emotional support, and facilitating access to mental health resources can significantly impact patient outcomes.
3. Social Engagement: Encouraging social interactions and addressing isolation are critical components of care. Activities that promote socialization, such as group activities or outings, can enhance the overall well-being of residents.
4. Collaboration with Multidisciplinary Teams: Effective management of adult FTT requires collaboration with dietitians, social workers, and mental health professionals. An interdisciplinary approach ensures comprehensive care tailored to the individual’s needs.

Implications for Nursing Research

Despite the importance of adult FTT, relatively little research has been published in recent years, particularly concerning its etiology and effective interventions. Future research should focus on:

• Developing standardized definitions and criteria for diagnosing adult FTT.
• Conducting longitudinal studies to explore the progression of FTT and its impact on health outcomes.
• Investigating the effectiveness of nursing interventions aimed at improving nutritional status, mental health, and social engagement among residents with FTT.

Conclusion

Adult failure to thrive is a complex syndrome that requires comprehensive nursing assessment and intervention. By understanding the multifactorial nature of FTT and employing holistic approaches, nurses can significantly impact the quality of care and overall well-being of affected individuals. As research in this area evolves, nursing practice will continue to adapt, ensuring that patients receive the support they need to thrive despite the challenges they face.