Learning About Failure to Thrive (FTT) in Adults

Failure to thrive (FTT) is a term that's used when a person has an ongoing decline in health and daily function. FTT is not a single disease. Instead, it’s a sign that something is affecting the person’s overall well-being, often in more than one way.

It often includes several signs, such as unplanned weight loss, weakness, trouble with daily activities, reduced ability to move (mobility), and depression.

FTT is a serious sign that a person is struggling. But with attention, medical care, and support, they can get better day by day. Recovery may be gradual. Progress may come in small steps. When the causes are found and treated, people can regain strength and appetite. Their mood and social interest can improve. And they can get their independence and mobility back.

FTT is caused by a mix of medical, emotional, nutritional, and social factors.

Medical causes can include:

• Chronic illnesses such as heart failure, COPD, kidney disease, cancer, and diabetes.
• Infections, especially a urinary tract infection or pneumonia.
• Medicine side effects.
• Pain that limits eating, sleeping, or moving.
• Untreated health conditions.
• Dental problems or trouble swallowing.
• Vision or hearing loss.

Mental health and cognitive causes can include:

• Depression.
• Anxiety.
• Dementia or memory loss.
• Grief or major life changes.
• Substance use issues.

Nutrition-related causes can include:

• Not eating enough calories.
• Dehydration.
• Trouble with chewing or swallowing.
• Loss of taste or smell.
• Limited access to food.
• Nausea, constipation, or diarrhea.

Social and environmental causes can include:

• Living alone.
• Limited transportation.
• Financial strain.
• Lack of social support.
• Unsafe living conditions.
• Caregiver burnout.

FTT can lead to:

• Falls and injuries.
• Worsening weakness.
• Confusion or delirium.
• Increased risk of infections.
• Pressure injuries (bedsores).
• Time in the hospital.
• Loss of independence.

The earlier it’s noticed, the more likely it can be improved.

You may notice changes over time. These can include changes in eating, drinking, moving, mood, and more. Below are signs to keep an eye out for.

Physical signs can include:

• Clothes fitting looser.
• Face looking thinner.
• Fatigue.
• Sleeping more than usual.
• Walking more slowly or needing help standing.
• Frequent falls.
• Poor hygiene or changes in grooming.

Eating and drinking changes can include:

• Eating smaller portions.
• Skipping meals.
• Food going bad in the fridge.
• Trouble swallowing or choking.
• Drinking very little fluid.

Emotional or mental changes can include:

• Withdrawing from friends and family.
• Sadness or irritability.
• Forgetfulness.
• Confusion or trouble following conversations.

Functional changes can include:

• Trouble managing medicines.
• Missed appointments.
• Trouble cooking, cleaning, or bathing.
• Trouble paying bills or managing mail.

FTT is assessed by looking at the whole picture of a person’s health. A doctor may:

• Review weight trends.
• Ask about appetite.
• Ask about mood, memory, and daily functioning.
• Review all medicines and supplements.
• Check for pain, swallowing problems, or dental issues.
• Do a physical exam.

The doctor may order blood and urine tests to look for causes such as:

• Anemia.
• Thyroid problems.
• Vitamin deficiencies.
• Kidney or liver issues.
• Infection.
• Dehydration.

Caregivers play an important role in helping a person with FTT. Small, consistent steps can make a big difference in quality of life.

Try these steps to encourage more calories:

• Offer small meals and snacks more often, 5 or 6 times a day.
• Add high-calorie extras to food. These include butter, olive oil, nut butters, and cheese.
• Serve favorite foods, even if they aren’t perfectly healthy.
• Focus on afternoon and evening meals because appetite is often low in the morning. Some people eat better later in the day.

Offer protein-rich snacks such as:

• Yogurt.
• Eggs.
• Smoothies.
• Peanut butter.
• Cottage cheese.
• Nutrition drinks that have protein.

Dehydration can cause weakness, dizziness, and confusion. It can also lead to acute kidney injury (AKI). To help keep the person hydrated:

• Keep their favorite drink nearby.
• Offer drinks throughout the day.
• Include soups, fruit, gelatin dessert (such as Jell-O), or flavored ice pops in the daily menu.

Watch for signs of dehydration, such as:

• Dark urine.
• Dry mouth.
• Dizziness.
• New confusion.

Even light activity helps to maintain strength and prevent falls. It can boost appetite and reduce depression. Safe activity can include:

• Short walks, even inside the home.
• Chair exercises.
• Physical therapy.

Depression is common and often missed in older adults. Watch for:

• Loss of interest.
• Changes in sleep.
• Low motivation.
• Social withdrawal.

Depression is treatable. Talk to the doctor if you spot signs of depression.

Medicines can cause:

• Loss of appetite or taste.
• Drowsiness.
• Nausea.
• Dizziness.
• Confusion.

Ask the doctor or pharmacist to review all:

• Prescription medicines.
• Over-the-counter medicines.
• Vitamins and supplements.

Small changes can reduce strain and falls. You can:

• Clear clutter and loose rugs.
• Add more lighting.
• Add grab bars in the bathroom.
• Have the person use a shower chair.
• Consider a walker or cane if needed.

Many adults with FTT need more support than family can provide alone. This is not a failure of the family or caregivers. It’s often the safest plan. This extra support might include:

• Home health nursing.
• Physical therapy or occupational therapy.
• A dietitian.
• Social work support.
• Meal delivery services.
• Adult day programs.
• Assisted living or skilled nursing care.

Call 911or take the person to the emergency room if they:

• Are suddenly confused or have no energy (severe lethargy).
• Have fainting or repeated falls.
• Have an injury from a fall.
• Haven't had anything to eat or drink for more than 24 hours.
• Have signs of severe dehydration.
• Have a high fever or possible infection.