Adult Failure to Thrive
The adult failure to thrive syndrome is characterized by unexplained weight
loss, malnutrition and disability. The syndrome has been associated with
multiple primary conditions (e.g., infections and malignancies), but always
includes two defining clinical elements, namely nutritional impairment and
disability. The nutritional impairment and disability associated with the adult
failure to thrive syndrome may be severe enough to impact on patient’s
short-term survival.
The adult failure to thrive syndrome may manifest as an irreversible progression
in the patient’s nutritional impairment/disability despite a trial of therapy
(i.e., treatment intended to affect the primary condition responsible for the
patient’s clinical presentation.) The presence of comorbid conditions may hasten
the patient’s clinical progression and as such should be identified and
addressed. The medical criteria below supports the terminal prognosis for
patients with adult failure to thrive syndrome.
The patient would meet criteria if ALL of the following are met:
1. Nutritional Impairment is severe enough to impact weight. The BMI will be
less than 22kg/m^2. BMI (kg/m^2) =703x (weight in pounds) / (height in inches)
^2.AND
2. Significant Disability as evidenced by the Palliative Performance Scale equal
to or less Scale equal to or less than 40%.
AND
3. Enteral/Parenteral Nutritional Support is either being declined or the
patient has not responded to such, despite adequate caloric support.
Both the BMI and level of disability should be routinely monitored, or if
nutritional support is instituted, observations should be made at initial
certification and each subsequent recertification.
At the time of recertification, recumbent mid-arm muscle area in cm^2 may be
substituted for weight or BMI with documentation as to why a BMI or weight could
not be obtained. In the event a beneficiary presents with nutritional impairment
and disability does not meet criteria, an alternate diagnosis such as "abnormal
loss of weight" or "cachexia" can be used.
If a patient meets the medical criteria above, they are by definition eligible
to receive hospice services. Some patients may not meet the criteria, but may
still be eligible for hospice care due to comorbidities or rapid functional
decline. Contact your Samaritan Care Hospice Consultant for further information.
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