Management of Adult Failure to Thrive

Initial Assessment and Intervention

The European Society of Cardiology recommends reducing polypharmacy by stopping medications without immediate effect on symptom relief or quality of life, such as statins, to address easily modifiable contributors first 2, 3
The European Society of Cardiology suggests adjusting timing and dosing of diuretics to prevent incontinence and maintain adequate hydration 2, 3
The treatment strategy must address the syndrome's defining features, including weight loss, decreased appetite, poor nutrition, and functional decline, with interventions directed at easily modifiable contributors first, followed by aggressive nutritional support and multidisciplinary coordination 1

Increase caloric density of the existing diet by fortifying foods with extra oil or fat rather than simply increasing volume, as this approach is more effective than attempting to increase meal size, which often fails in patients with poor appetite 4
Add oral nutritional supplements (ONS) to normal food intake, as nutritional counseling alone is insufficient to improve nutritional status, and multiple studies demonstrate that counseling without supplementation fails to reverse malnutrition 4
Encourage unrestricted oral intake with no futile food restriction, as increased intake promotes physiologic adaptive processes, and in patients with functioning gut, macronutrient absorption increases substantially with increased oral intake, potentially up to 3-fold the resting energy expenditure 5

Provide medication compliance aids and tailored self-care advice for patients with cognitive impairment, and involve family and caregivers in medication management and nutritional support 2, 3

Monitor growth and functional status at regular intervals, every clinic visit initially, then every 3 months for ongoing assessment, as serial measurements over time are more valuable than single evaluations for detecting treatment failure 4
Recognize failure to thrive as a key decision point requiring discussion of end-of-life care options, and consider palliative care when patients demonstrate progressive functional decline, poor quality of life, cardiac cachexia, or are clinically judged to be close to end of life 2, 3
Focus on symptom management, emotional support, and communication with patient and family, and use morphine (with antiemetic) to reduce breathlessness, pain, and anxiety when appropriate, and coordinate shared care approach between palliative care services and primary care physician 2, 3