Adult Failure to Thrive

undefinedThis week, we celebrate Healthy Weight Week. When most people hear this, they think: “weight loss.”  Unfortunately, as a hospice professional, I see many patients that lose weight unintentionally.

Adult Failure to Thrive (AFTT) is a debilitating illness that presents a multitude of symptoms.  In the elderly, AFTT is a state of decline defined as “multifactorial”, and may be caused by chronic underlying diseases and functional decline.  The symptoms of this condition include weight loss, decrease or no appetite, impaired nutritional status and, at times, immobility and impaired activity level.  The individual may develop decubitus ulcer due to a low serum and/or protein level.  This condition should never be viewed as a normal part of aging, and, if the course of the disease cannot be altered with conventional treatments, end-of-life care may be the most appropriate type of treatment.

The Centers for Medicare and Medicaid Services (CMS) has approved Adult Failure to Thrive as a hospice diagnosis and has established criteria to determine if the individual has a prognosis of six months or less if the disease progresses as expected.  Irreversible nutritional impairment as evidenced by a body mass index (BMI) of 22 or less, declines enteral/parental nutritional support or has not responded to such support despite an adequate caloric intake and a Palliative Performance Scale (PPS) equal to or less than 40%.  Other variable supporting the terminal diagnosis, although not required to qualify for hospice, includes recurrent infections such as UTI’s, URI, or sepsis, decreasing serum albumin or cholesterol, dysphagia, nausea and/or vomiting that responds poorly to treatment, pain,  stage 3-4 decubitus ulcers, edema and changes in level of consciousness.   The more comorbid and secondary conditions the individual exhibits, the more likely a terminal prognosis would be expected.

I, as many Americans, fight the battle of the bulge. Sadly, these individuals are fighting a different battle.  Referring to hospice only ensures that they receive the most compassionate care available during their final days.

DeAnna L. Looper RN, CHPN, CHPCA 
Chief Corporate Clinical Consultant / Legal Nurse Consultant / HPNA Approved Educator/Certified ELNEC Trainer/ Certified Grief Recovery Specialist
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