What’s in a Name? Understanding Failure to Thrive and Frailty in the Emergency Department

Abstract

in nature. However, one study showed that of older adults admitted to the hospital with the admitting diagnosis of “failure to thrive,” 88% of these patients ultimately had an acute medical problem, the most common of which were infectious, followed by cardiac and neurologic 3 . Patients with failure to thrive had longer and more complex hospital stays than patients who were admitted for long-term care placement only. 4 Additionally, over half of the patients presenting with “nonspecific complaints” developed a serious condition within 30 days . 5 These studies suggest that nonspecific symptoms grouped as failure to thrive may instead indicate a high probability of serious underlying, acute, medical etiology. Acute medical causes that may present as weakness, confusion, poor appetite and can be masked if categorized as failure to thrive include, but are not limited to, cardiac ischemia, valvular disease, stroke, electrolyte imbalance, infections, neurologic disease, and anemia. Medication reactions and interactions should also be considered, particularly if temporally related to the onset of symptoms. Higher-risk medications include steroids, statins, antihypertensives, and any centrally-acting medications. Furthermore, clinicians should determine if the clinical presentation generalized as failure to thrive more accurately represents hypoactive delirium when assessing a patient. Hypoactive delirium is the most common form of delirium and is characterized by increased somnolence, Failure to thrive is a progressively outdated way to describe older adults with vague symptoms without an immediately apparent etiology. The associated bias that there is no acute medical condition or that it is a surrogate for inability to cope at home may result in missing a serious underlying condition and further highlights the need to move away from this phrase and instead to depict patients more precisely in terms of their symptoms. Conversely, frailty is a geriatric syndrome that the ED should strive to recognize more frequently in order to accurately risk-stratify older adults, assist in medical decision-making, and pro-actively connect patients and families to the most appropriate resources.