LETTER
Failure To Thrive in Older Adults
Christopher D. Still, MS, DO;
Caroline M. Apovian, MD; and
Gordon L. Jensen, MD, PhD
15 April 1997 | Volume 126 Issue 8 | Page 668
TO THE EDITOR:
In their recent article, Sarkisian and Lachs [1] provided an insightful perspective on the limitations of "failure to thrive" as a disease construct in older persons. The definition of the failure to thrive syndrome has traditionally been an unexplained decline in function, structure, or metabolic process in excess of that expected for an age-matched cohort. Common contributor domains include impaired physical function, malnutrition, depression, and cognitive impairment [1]. Unexplained weight loss is common; a stereotypical picture of frail, undernourished persons most often comes to mind.
At the other end of the malnutrition spectrum, the overnourished morbidly obese person may have similar limitations. The current prevalence of obesity among elderly persons is 30% or greater [2]. Recent surveys have suggested a relation between body mass excess and the degree of functional impairment [3]. Objectively measured limitations in physical performance are also related to body mass excess in older women [4]. Like frail elderly persons, obese elderly persons may have limitations of activities of daily living and functional dependence. Destructive joint disease, which often limits mobility, is prevalent among obese older persons [5]. Comorbid conditions, such as depression, hypertension, restrictive lung disease, obstructive sleep apnea, coronary artery disease, lipid dyscrasias, gout, cholelithiasis, and adult-onset diabetes mellitus are also observed.
We concur with Sarkisian and Lachs that "failure to thrive" has limitations as a disease construct, and we wish to emphasize for practitioners that the malnutrition domain includes obesity (overnutrition).
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Author and Article Information
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Geisinger Medical Center, Danville, PA 17822
1. Sarkisian CA, Lachs MS. "Failure to thrive" in older adults. Ann Intern Med. 1996; 124:1072-8.
2. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. JAMA. 1994; 272:205-11.
3. Galanos AN, Pieper CF, Coroni-Huntley JC, Bales CW, Fillenbaum GG. Nutrition and function: is there a relationship between body mass index and functional capabilities of community-dwelling elderly? J Am Geriatr Soc. 1994; 42:368-73.
4. Apovian CM, Frey CM, Rogers JZ, McDermott B, Jensen GL. Body mass index and physical function in obese older women. J Am Geriatr Soc. 1996; 44:1487-8.
5. Felson DT. Weight and osteoarthritis. Am J Clin Nutr. 1996; 63(Suppl): 430S-2S.
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