Failure to thrive syndrome

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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. How can you tell if this is just fatigue or lack of energy in a loved one? Or are these the warning signs of failure to thrive syndrome? Family caregivers, relatives, neighbors - each and every one of us may, at some point, have to help an elderly individual suffering from this syndrome.


What is failure to thrive syndrome?


Geriatrician Jean Carrié first mentioned and described the characteristics of failures to thrive syndrome as "a process of involution and age-ing 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.

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.


What causes failure to thrive syndrome?


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 failures 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.


Can failure to thrive syndrome be prevented in the elderly?


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 in 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.


The need to prepare properly for a move to a care home

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 on set of failure to thrive syndrome. Several facilities in England offer short stay or convalescence packages.


What are the symptoms and clinical signs of failure to thrive syndrome?

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 related to a refusal to eat (refusal to open their mouth or even swallow).

  • Lack of thirst leading to dehydration.

  • Generalised 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. 


How should you respond to failure to thrive syndrome?


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.


How can failures to thrive syndrome be managed?


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, treatment of certain complications such as the need for a rectal examination or physiotherapy massage. Some cases may even require hospital admission.


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.


Senior 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 0203 608 0055 for free, personalized assistance.


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