Identifying failure to thrive syndrome in good time or even anticipating this condition can save the life of an elderly relative. This is a phenomenon of which people are frequently unaware and obvious signs may sadly go unnoticed. So how can we detect its onset? What should we do if we are unsure? Can it be prevented and treated? We need to gain a better understanding of failure to thrive syndrome and adopt a suitable approach in order to protect our elderly relatives.
Loss of appetite or interest, withdrawal, silence, and sadness.
Or are these the warning signs of failure to thrive syndrome? Family caregivers, relatives, neighbours - each and every one of us may, at some point, have to help an elderly individual suffering from this syndrome.
Geriatrician Jean Carrié first mentioned and described the characteristics of a failure to thrive syndrome as "a process of involution and aging in its most complete state". The subsequently coined phrase, "failure to thrive", refers to deterioration in the condition of a patient who is “failing to thrive”. It is even referred to as "unconscious suicide". It affects between 1 and 4% of particularly frail, hospitalised individuals over 70 years of age although around 80 is the average age for this condition.
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Failure to thrive is characterized by a rather sudden change in the behavior of an elderly person, accompanied by loss of independence. Even an entirely independent individual can suddenly lose their zest for life and refuse to carry out essential activities of daily living such as eating, washing, or getting up, despite being perfectly capable of doing so prior to the onset of symptoms. This dependence is not initially physical but results in an inability to cope without third-party intervention. It can be accompanied by various forms of anxiety such as a fear of being alone, for instance.
Under no circumstances should these warning signs be taken lightly. In fact, they pose a real danger for the individual in question. Lack of movement poses the risk of muscle atrophy. The body becomes weaker due to an inappropriate diet and lack of care, thereby creating a breeding ground for infections and lung infections in particular. Sadly, this situation can prove fatal in over 80% of cases. It is important to note that the clinical course is very severe but not irreversible. Although failure to thrive syndrome will lead to death in the majority of cases, those who overcome this condition will be in complete remission. They can then start to eat healthily, communicate, and recover psychologically. Those who do recover are more likely to regain their independence if the syndrome is discovered and treated promptly. However, it is important to remain vigilant to avoid any risk of recurrence.
The causes can be physical or psychological. In most cases, the syndrome develops following shock such as the loss of a loved one, often a partner, an acute illness, surgery, hospitalization, a poorly prepared move to a nursing home viewed by the individual as abandonment, an accident, a fracture or fall, and, more significantly, if a certain length of time elapses before the relative is helped or supported by a loved one. Depending on the frailty of each individual, the anxiety linked to the tragic event can lead to failure-to-thrive syndrome within days or weeks. It is most common in elderly individuals over 80 years of age who are frail and present certain conditions such as diabetes, heart problems, and respiratory problems or who have a history of neuromuscular disorders.
Given the sudden clinical onset and the difficulties involved in managing this syndrome, prevention is essential. It has proved to be the most effective approach to protecting a loved one. Any difficult physical or psychological episode experienced by the individual warrants special attention and close monitoring. Convalescence is a crucial stage and failure to thrive syndrome may recur during this period. The individual must be surrounded, helped, and supported both physically and psychologically. Those who live alone are particularly vulnerable, especially in the event of a fall when a rapid response is vital. Indeed, the longer the person spends on the floor, afraid and anxious, the longer the recovery process will be, and the greater the risk of failure to thrive syndrome. Essential daily care must be provided to prompt a speedy recovery.
Regardless of the decision to move to a care home, this crucial step must be a pleasant experience for the person concerned. They should be included in the decision-making process by arranging for them to visit the facility in question or to select their new accommodation from photos and videos if they are unable to travel. They should be shown a great deal of affection and every effort should be made to ensure that they settle in well and do not feel abandoned. Following a hospital stay, a care home or nursing home is the ideal place for people to convalesce. They do not have to be at home all alone and can benefit from all the attention and care they need to recover. This is vital in order to considerably reduce the risk of the onset of failure to thrive syndrome. Several facilities in England offer short-stay or convalescence packages.
The symptoms of failure to thrive syndrome can sometimes go unnoticed or may be masked by the onset of depression or other syndromes related to age and dependency. However, a sudden loss of autonomy, unusual behaviour or the refusal to eat and get out of bed should immediately alert the caregiver and family.
As a general rule, a person becomes weaker and struggles to regain their former physical and mental form during convalescence or following an emotional shock, despite being on the road to recovery.
Both physical and psychological clinical signs may appear:
Anorexia and malnutrition are related to a refusal to eat (refusal to open their mouth or even swallow).
Lack of thirst leads to dehydration.
Generalized and very marked fatigue.
Chronic constipation and urinary retention.
Withdrawal, silence, cognitive decline.
Refusal to accept treatment/care.
Aggressiveness or, on the contrary, considerable passiveness.
Depressive tendency.
Refusal to move or to get out of bed.
It is important to remember that a person with failure to thrive syndrome will not ask for help from a third party because they refuse to take care of themselves. It is sometimes difficult for the caregiver to rapidly digest the situation and to arrange for appropriate nursing care in good time. The caregiver does not necessarily live with the parent and, regardless of how often they visit, it is often difficult to attribute behavioral changes to conditions other than the common cold, temporary fatigue or other age-related illnesses. Nevertheless, it is essential to keep a constant eye on the individual’s condition in order to detect symptoms as soon as possible and promote a swift recovery. A fast response increases the chances of recovery and can prevent the person from remaining dependent on prolonged bed rest and muscle atrophy, even if they have recovered from failure to thrive syndrome.
If failure to thrive syndrome is diagnosed, admission to a care home or even a nursing home is often necessary because a complex care package is required. Relatives are often overwhelmed by the situation and do not know how to respond to a person who refuses care and who may even spit out the food given to them. A team of professionals will be better placed to provide the essential care and psychological support required, such as prevention of bedsores, psychotherapeutic follow-up, the gradual introduction of a healthy diet and rehydration, prescription of appropriate medication, and treatment of certain complications such as the need for a rectal examination or physiotherapy massage. Some cases may even require hospital admission.
| Possible Trigger | Potential Impact |
|---|---|
| Bereavement | Grief may lead to withdrawal, appetite loss and reduced motivation. |
| Hospitalization | A hospital stay can disrupt routines and contribute to loss of independence. |
| Fall or Fracture | Reduced mobility may accelerate physical and functional decline. |
| Major Living Change | An unwanted or poorly prepared move may increase anxiety and withdrawal. |
If you are uncertain or if you notice the slightest change in the behaviour of an elderly relative, do not hesitate to contact your GP, or even call the emergency services if the GP is unavailable. In such cases, it is far better to be overzealous than to respond too late.
Failure to thrive in older adults describes a significant decline in overall well-being and independence. It may involve reduced appetite, decreased activity, withdrawal, difficulty carrying out everyday tasks, and a general deterioration in physical or psychological functioning.
Warning signs may include a sudden loss of energy or motivation, refusing to eat, remaining in bed or sitting for long periods, neglecting personal hygiene, withdrawing from others, increased dependence, anxiety, and losing interest in previously normal activities.
Temporary fatigue generally improves with rest and recovery. Failure to thrive involves a broader and more persistent decline that may affect eating, mobility, personal care, communication, mood, and independence. A sudden or unexplained change in an older person's usual behaviour should be assessed by a healthcare professional.
Failure to thrive may be associated with physical illness, psychological distress, or a combination of factors. Potential triggers described in older adults include bereavement, hospitalization, surgery, falls, fractures, accidents, illness, social isolation, or a difficult transition to a new living environment.
The loss of a spouse or another loved one can have a profound psychological and physical impact on an older adult. In particularly frail individuals, bereavement and the resulting isolation, anxiety, or loss of motivation may contribute to a significant deterioration in overall well-being.
Reduced food intake and physical activity can contribute to weight loss, muscle weakness, loss of mobility, and greater dependence. An older person who stops eating, moving, or caring for themselves may also become more vulnerable to falls, infections, dehydration, and other complications.
Improvement may be possible, particularly when the underlying causes are identified and addressed promptly. Medical assessment, nutritional support, rehabilitation, psychological support, social interaction, and assistance with everyday activities may all form part of an individualized care plan.
Families can pay particular attention after major physical or emotional events such as illness, hospitalization, surgery, bereavement, or a fall. Regular contact, assistance with meals and daily activities, emotional support, and early attention to changes in behaviour or independence can help identify problems before they become more severe.
Older adults living alone may be particularly vulnerable when illness, a fall, bereavement, or declining mobility makes everyday activities more difficult. Regular contact and access to appropriate assistance can help identify changes in their physical or emotional condition more quickly.
Medical advice should be sought promptly when an older adult develops an unexplained decline in appetite, weight, mobility, self-care, mood, or ability to complete everyday activities. A healthcare assessment can help identify medical, nutritional, psychological, medication-related, or social factors contributing to the decline.
Depending on the person's needs, a retirement or care home may provide regular meals, assistance with daily activities, social interaction, supervision, and access to appropriate care services. Families should look for a residence capable of addressing the individual's nutritional, mobility, psychological, and medical support needs.
Retirement Home Plus advisors are available to help families find a care home in keeping with the urgency of each individual situation and the needs of the person involved. Contact us on 343 309 52 89 for free, personalized assistance.
Failure to Thrive (FTT) in older adults is a serious condition characterized by a sudden decline in appetite, independence, physical activity, and psychological well-being. It can develop after an emotional shock, illness, hospitalization, surgery, fall, or poorly managed transition to a care home. Warning signs include refusal to eat or drink, severe fatigue, withdrawal, cognitive or behavioral changes, refusal of care, and staying in bed. Early recognition, close monitoring, medical assessment, nutritional and psychological support, and appropriate professional care are essential. A supportive and well-prepared transition to a care home can also help reduce the risk of FTT and support recovery.
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