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Use of the diagnosis "failure to thrive" in older veterans
J K Hildebrand1, S K Joos, M A Lee
1VA Medical Center, Portland, OR 97207, USA.
Objectives:
To describe how physicians apply the term "failure to thrive" (FTT) to older patients. Specifically, to describe the clinical presentation, underlying etiologies, diagnostic and therapeutic interventions, and discharge outcomes of veterans having the discharge diagnosis of FTT.
Design:
Retrospective chart review.
Setting:
The Department of Veterans Affairs Medical Center (VAMC), Portland, Oregon, a 400-bed referral and teaching hospital.
Participants:
All veterans 65 years of age and older admitted to the Portland VAMC from October 1, 1990, through September 30, 1993, whose coded discharge diagnoses included FTT (n = 132).
Measurements:
Medical records were reviewed by a trained abstractor to obtain key data about clinical presentation, etiologies, interventions, and discharge outcomes.
Results:
Subjects were predominantly male (98%), with a mean age of 76 years +/- 9 years. Weight loss was a key feature: 67% of subjects had evidence of weight loss by study criteria. Anemia was present in 55%, low cholesterol in 50%, and low albumin in 44%. Lymphopenia was common, present in 66% of subjects. Most patients were admitted from home (83%); only 7% came from nursing homes. On admission, the majority (82%) were dependent in at least one ADL, and 36% were cognitively impaired. Cancer was the most common underlying diagnosis (30%), followed by infection (18%), dehydration (13%), and depression (12%). Only 46% of subjects were discharged home, while 34% went to nursing homes. Fourteen percent of subjects died during the hospitalization, an additional 11% died within 30 days after discharge, and 32% died within 1 year after discharge. The subgroup of subjects with cancer and/or infection had increased mortality rates at 30 days and 1 year after hospitalization.
Conclusion:
We conclude that FTT may constitute a discrete syndrome with diagnostic, therapeutic and prognostic implications in older people, but in the absence of consensus about diagnostic criteria, there is a large degree of subjective variation in how physicians apply the term.