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Failure to Thrive in the Elderly

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1. Failure to Thrive in the Elderly

Failure to Thrive in the Elderly Failure to Thrive in the Elderly Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Failure to Thrive (...) in the Elderly Failure to Thrive in the Elderly Aka: Failure to Thrive in the Elderly II. Epidemiology: Incidence Community adults: >5% : >25% Hosptalized: >50% III. Pathophysiology: Contributing Factors Physical function decline: Weakness, falls, ADL decline : Weight loss, , decreased immunity Depression Cognitive ( , ) IV. Causes Medications See See Most common medication culprits Psychotropic medications s Recently added medications Consider non-prescription drug use, Missed dose and non-compliance

2018 FP Notebook

2. Failure to Thrive in the Elderly

Failure to Thrive in the Elderly Failure to Thrive in the Elderly Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Failure to Thrive (...) in the Elderly Failure to Thrive in the Elderly Aka: Failure to Thrive in the Elderly From Related Chapters II. Epidemiology: Incidence Community adults: >5% : >25% Hosptalized: >50% III. Pathophysiology: Contributing Factors Physical function decline: Weakness, falls, ADL decline : Weight loss, , decreased immunity Depression Cognitive ( , ) IV. Causes Medications See See Most common medication culprits Psychotropic medications s Recently added medications Consider non-prescription drug use, Missed dose

2018 FP Notebook

3. Failure to Thrive in the Elderly

Failure to Thrive in the Elderly Failure to Thrive in the Elderly Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Failure to Thrive (...) in the Elderly Failure to Thrive in the Elderly Aka: Failure to Thrive in the Elderly From Related Chapters II. Epidemiology: Incidence Community adults: >5% : >25% Hosptalized: >50% III. Pathophysiology: Contributing Factors Physical function decline: Weakness, falls, ADL decline : Weight loss, , decreased immunity Depression Cognitive ( , ) IV. Causes Medications See See Most common medication culprits Psychotropic medications s Recently added medications Consider non-prescription drug use, Missed dose

2015 FP Notebook

4. Managing undernutrition in the elderly. Prevention is better than a cure

. Malnutrition in the elderly: a multifactorial failure to thrive. The Permanente Journal 2005;9:38–41. 30. Milne AC, Potter J, Avenell A. Protein and energy sup- plementation in elderly people at risk from malnutrition. Cochrane Database syst Rev 2005(2):CD003288. 31. silver hJ. oral strategies to supplement older adults’ dietary intakes: comparing the evidence. nutr Rev 2009;67:21–31. 32. Australian Government Department of health and Ageing and national health and Medical Research Council. nutrient (...) , such as cancer or cardiac, hepatic or renal failure. Manage chronic or reversible medical conditions once ‘red flags’ have been eliminated, many other medical conditions or their treatments that may contribute to undernutrition can be addressed within general practice (Table 3). It is also important to review patient attitudes toward weight; elderly patients may be confused by Figure 1. Contributing factors and health outcomes associated with undernutrition 1,3,5,7,22 Contributing factors • Medical – eg

2012 Clinical Practice Guidelines Portal

5. Five-Weekend Care of the Elderly Certificate Course: Continuing professional development activity for family physicians (PubMed)

approximately 6 months.Each weekend focuses on a different theme including cognitive impairment, gait disorders, mental health and pain management, geriatric medical problems, and failure to thrive. Participants complete written assignments between weekend sessions, which involve self-reflection on how the new knowledge and skills gained through the course will be incorporated in the management of elderly patients in their practices.The 5-Weekend Care of the Elderly Certificate Course is an accredited (...) Five-Weekend Care of the Elderly Certificate Course: Continuing professional development activity for family physicians Primary care practitioners have unique clinical challenges in caring for elderly patients and require educational courses that are specifically designed for their needs in caring for this patient population.To improve family physicians' knowledge of and confidence in managing common geriatric problems.The accredited course curriculum is delivered on 5 weekends over

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2015 Canadian Family Physician

6. Chronic Renal Failure (Diagnosis)

, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost (see ). CKD is more prevalent in the elderly population. However, while younger patients with CKD typically experience progressive loss of kidney function, 30% of patients over 65 years of age with CKD have stable disease. [ ] CKD is associated with an increased risk of cardiovascular disease and chronic renal failure. Kidney disease is the ninth leading cause of death in the United States. The Kidney Disease Outcomes (...) neuropathy, usually asymptomatic Restless leg syndrome Gastrointestinal symptoms: Anorexia, nausea, vomiting, diarrhea Skin manifestations: Dry skin, pruritus, ecchymosis Fatigue, increased somnolence, failure to thrive Malnutrition Erectile dysfunction, decreased libido, amenorrhea Platelet dysfunction with tendency to bleed Screen adult patients with CKD for depressive symptoms; self-report scales at initiation of dialysis therapy reveal that 45% of these patients have such symptoms, albeit

2014 eMedicine.com

7. Chronic Renal Failure (Treatment)

Hyperkalemia Pericarditis Encephalopathy Intractable volume overload Failure to thrive and malnutrition Peripheral neuropathy Intractable gastrointestinal symptoms In asymptomatic adult patients, a glomerular filtration rate (GFR) of 5-9 mL/min/1.73 m², [ ] irrespective of the cause of the CKD or the presence of absence of other comorbidities Timely planning for long-term renal replacement therapy Consider the following: Early patient education regarding natural disease progression, different dialytic (...) Chronic Renal Failure (Treatment) Chronic Kidney Disease Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile

2014 eMedicine.com

8. Chronic Renal Failure (Overview)

, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost (see ). CKD is more prevalent in the elderly population. However, while younger patients with CKD typically experience progressive loss of kidney function, 30% of patients over 65 years of age with CKD have stable disease. [ ] CKD is associated with an increased risk of cardiovascular disease and chronic renal failure. Kidney disease is the ninth leading cause of death in the United States. The Kidney Disease Outcomes (...) neuropathy, usually asymptomatic Restless leg syndrome Gastrointestinal symptoms: Anorexia, nausea, vomiting, diarrhea Skin manifestations: Dry skin, pruritus, ecchymosis Fatigue, increased somnolence, failure to thrive Malnutrition Erectile dysfunction, decreased libido, amenorrhea Platelet dysfunction with tendency to bleed Screen adult patients with CKD for depressive symptoms; self-report scales at initiation of dialysis therapy reveal that 45% of these patients have such symptoms, albeit

2014 eMedicine.com

9. Chronic Renal Failure (Follow-up)

Hyperkalemia Pericarditis Encephalopathy Intractable volume overload Failure to thrive and malnutrition Peripheral neuropathy Intractable gastrointestinal symptoms In asymptomatic adult patients, a glomerular filtration rate (GFR) of 5-9 mL/min/1.73 m², [ ] irrespective of the cause of the CKD or the presence of absence of other comorbidities Timely planning for long-term renal replacement therapy Consider the following: Early patient education regarding natural disease progression, different dialytic (...) Chronic Renal Failure (Follow-up) Chronic Kidney Disease Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile

2014 eMedicine.com

10. Iron Deficiency – Diagnosis and Management

ages: tiredness, restless legs, inattention, poor school performance, irritability/depression, growth retardation, unexplained cognitive and intellectual impairment, breath-holding spells, developmental delay, pica/pagophagia Infants: poor feeding, lethargy, failure to thrive, cardiomegaly, tachypnea Adolescents: presyncope, syncope, headache, irritability, fatigue, exercise intolerance, restless legs Diagnosis Serum ferritin is the diagnostic test of choice for iron deficiency. The ferritin cut (...) Gastrectomy or duodenal bypass Bariatric surgery Chronic renal failure Signs and Symptoms in Adults Even in the absence of anemia, isolated iron deficiency causes symptoms and warrants investigation and treatment. Early stage iron deficiency can exist without overt anemia, but with other non-hematological symptoms due to deficiency of iron-containing cellular enzymes and unsaturated myoglobin. Some patients may be asymptomatic. Signs and symptoms of iron deficiency and IDA in adults: Fatigue Cold

2019 Clinical Practice Guidelines and Protocols in British Columbia

11. Heart Disease and Stroke Statistics

Cardiac Arrest, Ventricular Arrhythmias, and Inherited Channelopathies e377 18. Subclinical Atherosclerosis e401 19. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris e415 20. Cardiomyopathy and Heart Failure e438 21. Valvular Diseases e455 22. Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism), Chronic Venous Insufficiency, Pulmonary Hypertension e472 23. Peripheral Artery Disease and Aortic Diseases e481 Outcomes 24. Quality of Care e497 25. Medical Procedures (...) States and globally. The Statistical Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease [CHD], heart failure [HF], valvular disease, venous disease, and peripheral arterial disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2007, the annual versions of the Statistical Update have

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2019 American Heart Association

12. Appropriate Use Criteria: Imaging of the Abdomen and Pelvis

Cystic liver disease 33 Failure to thrive 33 Gastroenteritis 33 Hirschsprung’s disease (congenital aganglionosis) 34 Hypospadias 34 Irritable bowel syndrome 34 Jejunal or ileal stenosis 34 Meckel’s diverticulum or diverticulitis 34 Midgut volvulus 34 Neonatal jaundice: biliary atresia and neonatal hepatitis 34 Piriformis syndrome 34 Posterior urethral valve 34 Pyloric stenosis 34 Small left colon syndrome 34 Urinary tract infection 35 Vesicoureteral reflux 35 References 35 Codes 39 History 40 Imaging (...) for evaluation of symptoms persisting 2 or more weeks when ANY of the following are present: ? Failure of medical management ? Failure to thrive ? Fever ? Vomiting ? Following barium enema or anal manometry when there is suspicion for ANY of the following: o Anal stenosis o Impaction in patients younger than 1 year of age o Tight empty rectum IMAGING STUDY - Radiographs required for initial evaluation - CT or MRI abdomen and/or pelvis Rationale Constipation is a common problem in children and largely

2019 AIM Specialty Health

13. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association

for most patients. Primarily using data from randomized controlled trials, supplemented with observational data where necessary, this scientific statement provides a comprehensive review of statin safety and tolerability. The review covers the general patient population, as well as demographic subgroups, including the elderly, children, pregnant women, East Asians, and patients with specific conditions such as chronic disease of the kidney and liver, human immunodeficiency viral infection, and organ (...) or weakness accompanied by a creatine kinase (CK) concentration >10 times the upper limit of normal (ULN); that is the terminology used here and in many previous reviews. Statin-induced rhabdomyolysis is a severe form of myopathy without a consistent definition, but with CK typically >40 times the ULN, which usually requires hospitalization, because muscle fiber necrosis results in myoglobinuria that can cause acute renal failure. Table 1. Muscle Adverse Event Terminology Adverse Event Term Definition

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2019 American Gastroenterological Association Institute

14. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

to lifestyle efforts. The need for medical therapy should not be interpreted as a failure of lifestyle management but as an adjunct to it. Minimizing the risk of both severe and nonsevere hypoglycemia is a priority. It is a matter of safety, adherence, and cost. Minimizing risk of weight gain is also a priority. This is important for long-term health, in addition to safety, adherence, and cost. Weight loss should be considered in all patients with prediabetes and T2D who also have overweight or obesity (...) , the elderly, and persons with obesity ( , ). Individuals with suspected OSA should be referred for a home study in lower risk settings or to a sleep specialist for formal evaluation and treatment in higher-risk settings ( ). Behavioral support for lifestyle therapy includes the structured weight loss and physical activity programs mentioned above as well as support from family and friends. Patients should be encouraged to join community groups dedicated to a healthy lifestyle for emotional support

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2019 American Association of Clinical Endocrinologists

15. Chronic Asthma

respirations and cough; constitutional symptoms; fever unresponsive to normal antibiotics; enlarged lymph nodes; infectious contact; radiographic findings Congenital heart disease Failure to thrive; cyanosis when eating; tachypnea or hepatomegaly; tachycardia; cardiac murmur Cystic fibrosis Nasal polyps, productive cough starting shortly after birth; recurrent chest infections; failure to thrive (malabsorption); loose greasy bulky stools Primary ciliary dyskinesia Recurrent, mild chest infections (...) with cough; recurrent, severe otitis media, purulent nasal discharge; 50% have situs inversus Vascular ring, hilar adenopathy, foreign body Continually noisy respirations or wheeze Bronchopulmonary dysplasia Premature birth; very low birth weight; needed prolonged mechanical ventilation or supplemental oxygen; difficulty with breathing from birth Immune deficiency Recurrent fever and infections (including non-respiratory); failure to thrive Chronic Asthma | April 2018 Clinical Practice Guideline Page 13

2018 Toward Optimized Practice

16. Risk estimation and the prevention of cardiovascular disease

(PAD) and aortic disease. In 2015, 15% of adults aged 16 and over had any CVD condition, which represents an estimated 670,000 people living with cardiovascular disease in Scotland. Both incidence and prevalence of CVD are higher amongst men, the elderly and in deprived areas of Scotland. 1 Cardiovascular disease caused more than a quarter of all deaths in Scotland in 2015. 2 Of particular relevance to Scotland are the effects of socioeconomic status on the risk of developing CVD. The incidence (...) recommendations for the management of people with chronic heart failure, acute coronary syndrome, stable angina or cardiac arrhythmias as these are contained within other SIGN guidelines. 13-16 Cardiac rehabilitation is the subject of a further SIGN guideline. 17 1.2.2 TARGET USERS OF THE GUIDELINE This guideline will be of interest to healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists

2017 SIGN

17. Improving the health of the public by 2040

equity will require stakeholders from all sectors of society to work together. The final chapter therefore considers how to improve researchers’ engagement with practitioners, policymakers, the commercial sector and the public. 1.2 Successes and failures, opportunities and challenges Public health measures have made major contributions to remarkable improvements in our health. Life expectancy at birth for England and Wales increased by around 20 years in the first half of the 20th century (...) of the planet on which we depend is vital to protecting future human health. It calls for suitable policies to apply interdisciplinary knowledge to strengthen planetary health, by ‘promoting sustainable and equitable patterns of consumption, reducing population growth and harnessing the power of technology for change.’ 26 Specifically, it highlights failures such as not addressing the social and environmental drivers of ill health and the historical scarcity of transdisciplinary research and funding.17 1

2017 Academy of Medical Sciences

18. Asthma

: Prominent systemic features (such as myalgia, fever, and weight loss). Unexpected clinical findings (such as crackles, finger clubbing, cyanosis, evidence of cardiac disease, monophonic wheeze, or stridor). Persistent, non-variable breathlessness. Chronic sputum production. Unexplained restrictive spirometry. Chest X-ray shadowing. Marked blood eosinophilia. In children: Failure to thrive. Unexplained clinical findings (such as focal signs, abnormal voice or cry, dysphagia, and/or inspiratory stridor (...) the Prodigy topic on . Ciliary dyskinesia — clinical features include persistent moist cough present from birth. Cystic fibrosis — clinical features include persistent moist cough and gastrointestinal symptoms that are often present from birth, and failure to thrive in children. Dysfunctional breathing — clinical features include breathlessness, dizziness, light-headedness, and peripheral tingling. Foreign body aspiration — suggested by sudden-onset cough, stridor (upper airway) or reduced chest wall

2017 Prodigy

19. Life science

are more likely to provide value gain in healthcare in the future. They will be crucial for early diagnostics and maintaining quality of life after drugs start to fail, and reaching the elderly who often live away from hospitals (e.g. in the countryside). o Networks across the UK (rather than focussing only in the South East) to better match patient needs. ? Those developing the Life Sciences Industrial Strategy are looking for examples of countries that have delivered a successful life sciences (...) . ? Access and uptake of medicines by the healthcare systems are important factors for investment decisions by companies. There was a debate on the extent of this problem and the difficulty of quantifying the issue with the current NHS payment system. ? Industry has highlighted the failure to provide a contemporary standard of care that meets FDA and other regulatory standards for market authorisation across the UK as a reason for not investing in late stage clinical R&D. It was suggested, however

2017 Academy of Medical Sciences

20. Depression: Adult and Adolescent

. Emotional regulation groups are also being offered in several BHS specialty clinics. Online cognitive behavioral therapy (CBT) may be an attractive option as access to psychotherapy may be a significant barrier to care. Kaiser Permanente offers a free online CBT based program—Thrive— which offers modules on behavioral activation, cognitive restructuring and social skills training and uses interactive tools and branching logic to create a personalized curriculum for each patient. Combination therapy (...) elderly or very elderly patients compared to younger patients. Individuals vary widely in their response and tolerance to specific therapies and drugs, and it is difficult to predict which medication will be both effective and tolerable for an individual patient. Overall, SSRIs and SNRIs (such as venlafaxine) all have similar efficacy. The decision of which SSRI to start with may be based on patient or provider preference or on previous trials with a medication. If the first SSRI isn’t successful

2017 Kaiser Permanente Clinical Guidelines

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