As people age, they can experience many losses – declining health, loss of loved ones, loss of independence. These losses can lead some elderly individuals to feel a sense of hopelessness and give up on life. Giving up on life, or failure to thrive, in the elderly is a complex phenomenon with psychological, social, and physical components.
What is failure to thrive in the elderly?
Failure to thrive in the elderly is characterized by extreme weight loss, decreased appetite, poor nutrition, inactivity, fatigue, and despondency. An elderly person who has given up on life essentially stops eating and drinking adequately and withdraws from social engagement. It can be triggered by medical illnesses like dementia, depression, infections, chronic pain or by stressful life events like loss of a spouse or losing independence. If left untreated, failure to thrive can lead to death.
What causes elderly people to give up on life?
There are many possible causes for failure to thrive in the elderly:
– Depression – Depression is common in the elderly, especially after the death of a spouse or loved one. Depression saps motivation and can cause social withdrawal.
– Dementia – Dementia damages brain cells and can make the elderly forget to eat or drink. It also impairs judgement and reasoning.
– Physical illness – Chronic or debilitating physical illnesses like cancer, heart failure, COPD make self-care difficult. Medications can also cause loss of appetite.
– Pain – Chronic untreated pain can lead to depression and loss of interest in life.
– Loss of independence – Having to move into a nursing home after living independently can demoralize some elderly.
– Grief – Grief after the death of friends or family can be overwhelming.
– Social isolation – Living alone with loss of social connections can cause people to feel life has no meaning.
Signs and symptoms
Here are some common signs and symptoms of failure to thrive in the elderly:
– Weight loss of more than 5% in one month or 10% in six months
– Minimal food and fluid intake, eating less than 50% of daily needs
– Lack of interest in food or eating
– Dirty, unkempt appearance with ragged clothes due to decreased hygiene
– Fatigue and lack of energy
– Irritability, apathy, social withdrawal
– Loss of muscle mass
– Brittle hair and nails
– Increased frailty
– Frequent falls or instability
– Depression
– Confusion or dementia
– Complaints of constipation or incontinence
Physical effects
Failure to thrive can have deleterious effects on the body:
– Malnutrition – Inadequate calories, protein and nutrients lead to vitamin deficiencies.
– Dehydration – Not drinking enough water can cause kidney problems.
– Loss of muscle mass – Muscle atrophy due to protein deficiency and inactivity.
– Decubitus ulcers (bedsores) – Unmoving elderly are prone to bedsores.
– Frequent infections – Weakened immunity due to malnutrition.
– Anemia – Lack of iron and folate.
– Electrolyte imbalances – Deficiencies in sodium, potassium, calcium.
– Impaired wound healing
– Osteoporosis – Lack of calcium and vitamin D weakens bones.
– Organ failure – Dehydration and malnutrition stresses vital organs.
Mental and emotional effects
Failure to thrive can also deeply impact mental health and emotions:
– Depression – Most common effect, leads to loss of interest and hope.
– Anxiety – Can be related to medical illnesses.
– Cognitive decline – Malnutrition accelerates dementia and memory loss.
– Mood swings – Lability, agitation and aggression may occur.
– Social isolation – Withdrawal from friends and family.
– Loneliness – Due to loss of spouse or peers.
– Boredom – From lack of activity and interest in hobbies.
– Insomnia – Disruptions in sleep cycle.
– Suicidal thoughts – Depression can lead to suicidal ideation.
– Hopelessness – Feeling that life has no meaning.
– Helplessness – Loss of autonomy and independence.
When to seek medical help
Call your doctor if an elderly person exhibits:
– Rapid weight loss
– Loss of appetite lasting over 2 weeks
– Signs of dementia like forgetfulness or confusion
– Difficulty walking, moving or performing self-care
– Little to no fluid intake for over 2 days
– Symptoms of depression like sadness, lack of interest in activities, or suicidal thoughts
– Bedsores or skin breakdown
– Multiple falls
– Irritability, anxiety or agitation
Risk factors
Certain factors place the elderly at higher risk of giving up on life:
– Age over 85 years
– Social isolation or living alone
– Loss of spouse
– Limited mobility
– History of depression
– Dementia
– Loss of vision or hearing
– Chronic illnesses
– Functional impairment in activities of daily living
– Cognitive decline
– Grief after death of relative or friend
– Poor nutrition
– Recent hospitalization
– Nursing home admission
– Female gender
– Low income status
Complications
When left unchecked, failure to thrive can lead to serious complications:
– Severe malnutrition and muscle wasting – cachexia
– Cardiovascular collapse
– Multiple organ failure
– Coma
– Severe infections like pneumonia or sepsis
– Bedsores can get infected and turn into gangrene
– Falls leading to fractures
– Permanent disability
– Worsening of pre-existing health conditions
– Eventual death
Diagnosis
Doctors diagnose failure to thrive through:
– History taking – medical, social, family history
– Physical exam checking weight, frailty, hydration status
– Mental state assessment for depression, dementia and mood
– Blood tests for anemia, electrolytes, albumin, and vitamins
– Imaging tests like X-rays or CT scans to check for internal issues
– Nutritional assessment involving a dietician
– Review of medications
– Depression screening tools like PHQ-9
– Dementia evaluation using tests like the Mini-Mental State Exam
Treatment
Treatment of failure to thrive involves:
– Treating underlying medical issues like infections, pain, heart failure
– Managing chronic illnesses and medications
– Starting antidepressants or therapy for depression
– Implementing dementia therapies and behavioral plans
– Providing social support, visitors, activities
– Correction of nutritional deficiencies with high-calorie diet or supplements
– Starting physical therapy to improve mobility and strength
– Assisting with self-care activities like eating, dressing and bathing
– Home care services or adult day care attendance
– Modifying the home environment to improve safety and access
– Addressing grief, anxiety or social isolation
– Hip protectors and fall precautions
– In severe cases, tube feeding or intravenous fluids may be necessary
Prevention
Some ways to prevent failure to thrive include:
– Staying socially engaged through community groups or volunteer work
– Maintaining relationships with family and friends
– Treating chronic medical conditions optimally
– Eating a balanced diet high in nutrients and protein
– Doing physical activity or exercise within limits
– Practicing good sleep hygiene
– Avoiding excess alcohol and certain medications
– Getting vision and hearing impairments corrected
– Working on physical therapy and home safety after hospitalization
– Addressing memory loss through games and acetylcholine-boosting foods
– Managing grief and adapting to loss in a healthy way
– Asking for help from family or community services when needed
– Maintaining a sense of purpose and hobbies
– Staying mentally stimulated by reading, socializing and learning new skills
– Working closely with your healthcare providers
Prognosis
With prompt and intensive treatment, the elderly with failure to thrive have a good chance of recovering nutritional and functional status. However, the prognosis depends on:
– How early it is diagnosed
– Reversibility of underlying triggers like infections
– Motivation level of the elderly individual
– Adherence to diet and treatment
– Social support system
– Degree of physical and cognitive disability
– Availability of caregiver assistance
– Progress of chronic diseases like dementia
Complete recovery is possible in mild cases, while moderate-severe cases have a mortality rate up to 33% within a year. Prevention is always better than cure when dealing with failure to thrive.
Conclusion
Failure to thrive is common but treatable in the elderly if caught early. It arises due to a complex interplay of physical, mental, social and environmental factors. Close monitoring of nutritional intake, weight, physical ability and mental health in the elderly can help identify failure to thrive symptoms promptly. With medical care, nutrition support, therapy and social assistance, the condition can be reversed before complications occur. Prevention through healthy habits and social engagement is equally important. A holistic approach with the involvement of the individual, family, friends and healthcare providers gives the best chance of recovery.