In the realm of geriatric care, one condition that’s often seen but not fully understood is Geriatric Failure to Thrive (GFTT).
GFTT refers to a state of decline observed in older adults that can’t be entirely attributed to a specific disease or medical condition. It presents a complex and multifaceted challenge for healthcare providers, including dietitians, in long-term care facilities.
This guide aims to provide comprehensive insight into GFTT, its impact on the elderly patients, and strategies for its identification and management of the nutrition complications.
What is Geriatric Failure to Thrive?
GFTT is a multidimensional problem often characterized by:
Weight loss
Decreased appetite
Poor nutrition
Inactivity
Dehydration
There are more symptoms that are non-nutrition related such as:
Often combined with dehydration, depressive symptoms, cognitive impairment, and functional impairments.
The causes of GFTT can be categorized into medical, social, and psychological factors.
Medical causes include:
Chronic disease such as congestive heart failure, chronic obstructive pulmonary disease, renal failure, and chronic infections.
Drug interactions and side effects of medications can also contribute to a patient’s state of decline, as can the presence of decubitus ulcers, sarcopenia (loss of muscle mass), and frailty.
Social factors include:
Isolation, financial constraints, and lack of support from family members, all of which can contribute to GFTT. The role of the social worker in long-term care facilities can be crucial in identifying and addressing these issues.
Psychological issues such as depression and anxiety, often exacerbated by chronic medical conditions and the fear of death, can lead to a lack of interest in eating and, subsequently, weight loss.
The Impact of GFTT on Long-Term Care Residents
GFTT has significant impacts on the physical, nutrition, psychological, and social health of older patients. Physical function deteriorates, leading to immobility and an increased susceptibility to illness due to compromised immune function. Cognitive function can also decline, leading to confusion and decreased quality of life.
Socially, the elderly might face increased isolation due to their declining physical and cognitive health. In some severe cases, the discussion of end-of-life options and advanced directives might be an important consideration.
The Role of Dietitians in Managing GFTT
Dietitians play a crucial role in managing GFTT.
Regular screening for malnutrition, developing individualized nutritional strategies, working in collaboration with other healthcare professionals, and advocating for patient wellbeing are key responsibilities.
As a practical application or Dietitians, this means at quarterly assessments ensuring that you have an MNA or SGA built into your assessment.
The MNA or SGA can help to identify the areas where a patient’s nutrition is lacking. GFFT is essentially when you don’t know how to characterize or give a nutrition diagnosis because you don’t know what the root cause is.
GFFT and its negative health consequences will result in Malnutrition. This is the area where the Dietitian can try to put in nutrition interventions to address it.
I’ll give you some practical strategies to deal with GFFT here.
Practical Strategies for Dietitians: Identifying and Addressing GFTT
A. Nutritional Interventions
One of the primary goals in managing GFTT is ensuring that patients meet their caloric intake needs. High-calorie, high-protein diets and nutritional supplements can help meet these needs. Ensuring adequate fluid intake is also crucial.
B. Identifying and Addressing Eating Difficulties
Dysphagia, poor appetite, and difficulty feeding can contribute to malnutrition in older patients. Management includes appropriate food texture modifications, stimulating appetite, and providing feeding assistance when needed.
C. Monitoring and Adjusting Dietary Plans
Regular reassessments of weight, food intake, and overall health are necessary for ensuring the effectiveness of the treatment plan. Adjustments may be needed based on resident feedback and progress.
The Nutrition Care Process for GFTT
The Nutrition Care Process (NCP) is a systematic approach to providing high-quality nutrition care. Here’s how it can be applied to a patient with GFTT:
- Nutrition Assessment:
This initial assessment or quarterly should include a review of the patient’s medical history (focusing on chronic concurrent diseases such as congestive heart failure, kidney disease, and chronic obstructive pulmonary disease).
Include a physical examination to check for warning signs of malnutrition (like weight loss and sarcopenia), and a review of the patient’s medication list to identify any potential medication interactions that may affect food intake.
If you want a free medication-food interaction list with nutrition side effects, you can download one here for free.
Tools like the Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) can be used to assess nutritional status. If you need a nutrition assessment for your facility, look at this one with a built in SGA.
- Nutrition Diagnosis:
Based on the nutrition assessment, the dietitian would then identify and describe specific nutrition problems or diagnoses.
In the case of GFTT, common diagnoses could include malnutrition, inadequate caloric intake, or nutrition impact symptoms due to drug interactions or side effects. - Nutrition Intervention:
The dietitian, working in collaboration with the patient, family members, and other healthcare providers, would then develop and initiate a personalized nutrition intervention plan.
This could involve increasing caloric intake through high-calorie, high-protein meals, addressing any identified nutrition impact symptoms, and providing education to the patient and family members on the importance of nutrition in managing GFTT.
You can read this article that has some great tips on nutrition interventions for weight loss. - Nutrition Monitoring and Evaluation:
The dietitian would regularly monitor the patient’s progress towards their nutrition goals, adjusting the intervention plan as necessary.
This could involve regular monitoring of body weight, food intake, and functional status, as well as reassessing the effectiveness of interventions for any nutrition impact symptoms.
Wrapping Up Geriatric Failure to Thrive
Geriatric Failure to Thrive is a complex issue that significantly impacts the overall health, functional ability, and quality of life of older patients in long-term care facilities.
As dietitians, understanding the multitude of contributing factors, recognizing the warning signs, and knowing how to assess and manage these patients effectively are critical for improving their health outcomes.
Make sure to look for weight loss, inadequate intake, loss of interest in food, decreased functional ability at meals, and dehydration.
By employing the Nutrition Care Process, dietitians can systematically and effectively address the nutritional needs of these patients.
Ultimately, the goal is to improve their nutritional status, enhance their quality of life, and support their optimal nutrition status for as long as possible.
While the task can be challenging, remember that as a dietitian, you are an integral part of the healthcare team.
Your expertise can make a significant difference in the lives of these frail patients, especially those who are in a state of decline.
Continue to keep yourself informed and updated with current clinical practices and research to provide the best care possible. After all, optimizing the health and wellbeing of older adults in our care is a rewarding endeavor that makes our roles as healthcare professionals truly meaningful.
If you want to read a great research article on Geriatric Failure to Thrive, I recommend reading this one.
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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.
