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Failure to Thrive in the Elderly

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101. Protein-Energy Malnutrition (Treatment)

. Hepatogastroenterology . 2003 Nov-Dec. 50(54):1943-7. . Harris CL, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage . 2004 Oct. 50 (10):54-63. . Hendricks KM, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med . 1995 Oct. 149(10):1118-22. . Jilcott SB, Masso KL, Ickes SB, Myhre SD, Myhre JA. Surviving but not quite thriving: anthropometric survey of children aged 6 to 59 months (...) , and anti-inflammatory pharmacologic agents combined with more traditional forms of nutritional support to abate the protein-energy malnutrition. [ ] An intervention that brought "buddies" to the homes of the elderly who were at risk for protein-energy malnutrition was successful at decreasing such malnutrition. [ ] Long-term care Patients should receive follow-up care with nutrition professionals and social services, and their growth and development should be monitored. Previous Next: Diet and Activity

2014 eMedicine.com

102. Hutchinson-Gilford Progeria (Treatment)

and occupational therapists can develop individualized physical therapy programs to help to maintain physical activity, coordination, and flexibility. Dermatologists and/or geneticists may be the first specialists to evaluate an infant with suspected HGPS and can perform diagnostic testing, including genetic mutation analysis and skin biopsies, as needed. Pediatric gastroenterologists, feeding therapists, and nutritionists can aid in diagnosing and treating feeding disorders and failure to thrive. Pediatric (...) dentists with experience in treating children with dental anomalies can be helpful. Routine fluoride supplementation should be provided to minimize the risks of dental caries. Regular, gentle dental care minimizes the development of periodontal disease. Previous Next: Diet Infants and children with HGPS may experience feeding difficulties and failure to thrive. The use of age-appropriate nutritional supplements is recommended. Previous Next: Activity Children with HGPS do not require activity

2014 eMedicine.com

103. Pyelonephritis, Acute (Overview)

but may not occur at the same time. If the patient is male, elderly, or a child or has had symptoms for more than 7 days, the infection should be considered complicated until proven otherwise. The classic manifestations of acute pyelonephritis observed in adults are often absent in children, particularly neonates and infants. In children aged 2 years or younger, the most common signs and symptoms of urinary tract infection (UTI) are as follows: Failure to thrive Feeding difficulty Fever Vomiting (...) -to-male ratio 1:1.5 10:1 10:1 30:1 Route of infection Blood Ascending Ascending Ascending Signs and symptoms Failure to thrive, fever, hypothermia, irritability, jaundice, poor feeding, sepsis, vomiting Diarrhea, failure to thrive, fever, irritability, poor feeding, strong-smelling urine, vomiting Abdominal pain, dysuria, enuresis, fever, gross hematuria, meningismus, strong-smelling urine, urinary urgency, urinary frequency, vomiting Dysuria, enuresis, fever, flank pain or tenderness, urinary urgency

2014 eMedicine.com

104. Rhinocerebral Mucormycosis (Overview)

, and this allows the organism to invade the patient's blood vessels. Mucormycosis is described almost exclusively in patients with compromised immune systems or metabolic abnormalities. Rhizopus species have an active ketone reductase system that enables them to thrive in an acidic pH and glucose-rich medium. Hyperglycemia enhances fungal growth and impairs neutrophil chemotaxis; therefore, individuals with are commonly affected. Rhizopus species also favor an iron-rich environment and are frequently isolated (...) with mucormycosis presented with complete ophthalmoplegia and proptosis. Note the complete ptosis and periorbital edema on the right side. Iron overload Iron overload states, as observed with and deferoxamine treatment in patients receiving dialysis, may be risk factors. Iron enhances fungal growth and increases susceptibility. Researchers have reported infection in patients with liver and renal failure. [ ] Burns In individuals with burns, mucormycosis generally involves only the skin and rarely results

2014 eMedicine.com

105. Protein-Energy Malnutrition (Overview)

, and 30-40% for those in long-term care facilities. A 2019 systematic review, meta-analysis, and meta-regression of the prevalence of protein-energy malnutrition among the elderly found that rural communities were affected twice as much as urban communities and women were affected more than males. [ ] Other recent studies of geriatric patients hospitalized for orthopedic conditions [ ] or heart failure [ ] also note protein-energy malnutrition is prevalent in this population. Previous Next: Prognosis (...) to be a primary factor of poor prognosis in elderly persons. In a study designed to assess the quality of care in nursing home residents, there was a direct association between mortality and anorexia in elderly residents of both genders with an almost two-fold higher risk of death for all causes in patients with anorexia. [ ] In a separate propensity-matched study of 32,771 elderly patients hospitalized for heart failure, protein-match malnutrition was associated with higher mortality, cardiogenic shock

2014 eMedicine.com

106. Geriatric Rehabilitation (Overview)

Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation of geriatric patients (...) is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program. Depression is common

2014 eMedicine.com

107. Celiac Sprue (Overview)

, an immunologically mediated inflammatory response occurs that damages the mucosa of their intestines, resulting in maldigestion and malabsorption of food nutrients. Signs and symptoms Gastrointestinal symptoms Gastrointestinal symptoms may include the following: Diarrhea - 45-85% of patients Flatulence - 28% of patients Borborygmus - 35-72% of patients Weight loss - 45% of patients; in infants and young children with untreated celiac disease, failure to thrive and growth retardation are common Weakness (...) is a protein commonly found in wheat, rye, and barley. Most patients with celiac disease tolerate oats, but they should be monitored closely. When people with celiac disease ingest gliadin, the mucosa of their intestines is damaged by an immunologically mediated inflammatory response, resulting in maldigestion and malabsorption. Patients with celiac disease can present with failure to thrive and diarrhea (the classical form). However, some patients have only subtle symptoms (atypical celiac disease

2014 eMedicine.com

108. Seizures and Epilepsy: Overview and Classification (Overview)

frequently (70%) caused by a deletion in the paternal inherited portion of chromosome 15q11.2-q13. The remainder of cases are caused by maternal uniparental disomy of chromosome 15, complex chromosomal rearrangements, or defects in specific imprinting centers. Patients with Prader-Willi syndrome have neonatal hypotonia and failure to thrive during infancy. Patients have hyperphagia, and onset of weight gain occurs between age 1 and 6 years. Affected individuals also have mild-moderate intellectual (...) remains unknown. Identified causes tend to vary with patient age. Inherited syndromes, congenital brain malformations, infection, and head trauma are leading causes in children. Head trauma is the most common known cause in young adults. Strokes, tumors, and head trauma become more frequent in middle age, with stroke becoming the most common cause in the elderly, along with Alzheimer disease and other degenerative conditions. The genetic contribution to seizure disorders is not completely understood

2014 eMedicine.com

109. Coronary Artery Atherosclerosis (Overview)

. United States statistics In the United States, approximately 14 million persons experience CAD and its various complications. Congestive heart failure (CHF) that develops because of ischemic cardiomyopathy in hypertensive MI survivors has become the most common discharge diagnosis for patients in American hospitals. Approximately 80 million people, or 36.3% of the population, have cardiovascular disease. Annually, approximately 1.5 million Americans have an AMI, a third of whom die. In 2009, 785,000 (...) comorbidities than test subjects. The guideline is now “effectiveness-based” rather than “evidence-based.” Effectiveness-based considerations have reduced the strength of previous recommendations for use of aspirin, statins (in women with elevated C-reactive protein but normal cholesterol), and aggressive glycemic control in diabetes. The elderly and coronary artery disease Age is the strongest risk factor for the development of CAD. Most cases of CAD become clinically apparent in patients aged 40 years

2014 eMedicine.com

110. Ureteropelvic Junction Obstruction (Overview)

assistance, is the treatment of choice in older children and in most adults. [ ] Next: History of the Procedure UPJ obstruction is the most common cause of neonatal and , occurring in one per 1500 live births. Prior to the use of prenatal ultrasonography, most patients with UPJ obstruction presented with pain, hematuria, urosepsis, failure to thrive, or a palpable mass. With the enhanced ability and availability of prenatal ultrasonography, urologic abnormalities are being diagnosed earlier and more (...) may lead to progressive renal damage and deterioration. UPJ obstruction presents most frequently in childhood, but adult and elderly individuals can also present with a primary obstructive lesion. In adults, other etiologies for ureteral obstruction must be considered, including , ureteral compression due to extrinsic processes, , and other inflammatory processes. Previous Next: Epidemiology Frequency Epidemiologic features of UPJ obstruction are as follows: Ultrasonography reveals fetal upper

2014 eMedicine.com

111. Ureterocalicostomy (Overview)

can result in impairment of renal function, pain, infection, and/or stones. Previous Next: Presentation Clinical symptoms of obstruction include urosepsis, failure to thrive, flank pain or mass, and hematuria. As first described by Dietl, the episodes of flank pain, nausea, and vomiting may present during periods of rapid diuresis with large volumes of liquid intake (so-called Dietl crisis). This may manifest only after consumption of liquids that promote brisk diuresis, such as beer or coffee (...) ; renal capsule, peritoneal, or pericardial flap; [ ] Davis intubated ureterotomy, [ ] buccal mucosa graft, [ , ] and nephrectomy. The decision to perform a nephrectomy must be based on the level of function in the obstructed kidney and the function of the contralateral kidney. If the renal function of the affected kidney is less than 25%, surgical correction has a high risk for failure, and nephrectomy may ultimately be required. If the patient's renal function is less than 10%, recovery is unlikely

2014 eMedicine.com

112. Upper Respiratory Tract Infection (Overview)

to the necessary equipment are required if respiratory failure is a possibility Administer humidified oxygen to all hypoxemic patients. In patients who do not require oxygen therapy, a cool-mist humidifier may be used IV or oral glucocorticoids are commonly used to reduce symptoms and shorten hospitalization in patients with moderate to severe croup Inhaled racemic epinephrine may temporarily dilate the airways Rhinosinusitis Most cases of acute rhinosinusitis, including mild and moderate bacterial sinusitis (...) affect the prevalence of colds, because most viral URI agents thrive in the low humidity that is characteristic of winter months. Low indoor air moisture may increase friability of the nasal mucosa, increasing a person's susceptibility to infection. Laryngotracheobronchitis, or croup, occurs in fall and winter. Seasonality does not affect rates of epiglottitis. The figure below illustrates the peak incidences of various agents by season. Rhinoviruses, which account for a substantial percentage

2014 eMedicine.com

113. Strongyloidiasis (Overview)

local cutaneous involvement, or both. During chronic uncomplicated infections, the larvae may migrate to the skin, where they can cause cutaneous strongyloidiasis, known as larva currens because of the quick migratory rate of the larva. Infection is clinically characterized by watery diarrhea, abdominal cramping, and urticarial rash. In malnourished children, strongyloidiasis remains an important cause of chronic diarrhea, cachexia, and failure to thrive. This condition can also be a health (...) the preleukemic phase of HTLV-1 infection [ ] ; the Strongyloides antigen accelerates leukemogenesis, and treatment of the infection may actually decrease HTLV-1 viral load [ ] Hypogammaglobulinemia Malignancy/neoplasms, particularly hematologic malignancies (lymphoma, leukemia): Studies have suggested that Strongyloides infection may be associated with increased incidence of gastrointestinal lymphoma [ ] Organ transplantation [ , , , ] and malnutrition Chronic renal failure and end-stage renal disease

2014 eMedicine.com

114. Strongyloidiasis (Overview)

local cutaneous involvement, or both. During chronic uncomplicated infections, the larvae may migrate to the skin, where they can cause cutaneous strongyloidiasis, known as larva currens because of the quick migratory rate of the larva. Infection is clinically characterized by watery diarrhea, abdominal cramping, and urticarial rash. In malnourished children, strongyloidiasis remains an important cause of chronic diarrhea, cachexia, and failure to thrive. This condition can also be a health (...) the preleukemic phase of HTLV-1 infection [ ] ; the Strongyloides antigen accelerates leukemogenesis, and treatment of the infection may actually decrease HTLV-1 viral load [ ] Hypogammaglobulinemia Malignancy/neoplasms, particularly hematologic malignancies (lymphoma, leukemia): Studies have suggested that Strongyloides infection may be associated with increased incidence of gastrointestinal lymphoma [ ] Organ transplantation [ , , , ] and malnutrition Chronic renal failure and end-stage renal disease

2014 eMedicine.com

115. Albright Syndrome (Overview)

, hyperthermia, tremor, sleeplessness, weight loss, or (in infants) failure to thrive Other possible manifestations include the following: Cushing syndrome Growth hormone (GH) excess (gigantism and acromegaly) Acromegaly Ovarian cysts Pituitary tumors Thyroid tumors Hypophosphatemia (hypophosphatemic rickets) Hypogonadotropic hypogonadism, particularly in the setting of hyperprolactinemia See for more detail. Diagnosis Full endocrine studies should be performed. Testicular or ovarian hyperfunction (...) , facial disfigurement, and vision and hearing problems. It is difficult to treat effectively. Current therapies focus on treating complications of FD, rather than on preventing it from developing. Current studies using bisphosphonates are promising, though it is unclear whether bisphosphonates significantly reduce the morbidity associated with these lesions. Hyperthyroidism can cause severe failure to thrive in infants and young children, decreased attention span, and . Tachycardia resulting from

2014 eMedicine.com

116. Hutchinson-Gilford Progeria (Overview)

with the cutaneous and musculoskeletal manifestations may not occur until age 6-12 months or older, when the development of failure to thrive engenders a more thorough evaluation. Previous Next: Prognosis The average life expectancy for a patient with HGPS is 13 years, with an age range of 7-27 years. Data from the largest cohort of HGPS patients indicated a mean survival of 14.6 years, with an increased mean survival of 1.6 years in patients treated with a protein farnesylation inhibitor after a median follow (...) -up of 5.3 years from treatment initiation. [ ] Morbidity and mortality in persons with HGPS occur primarily as a result of atherosclerosis of the coronary and cerebrovascular arteries, with at least 90% of patient deaths directly related to complications of progressive atherosclerosis. Cardiovascular complications include myocardial infarction and congestive heart failure. Interstitial fibrosis, diffuse myocardial fibrosis, and calcification of the mitral and aortic valves may occur

2014 eMedicine.com

117. Hirsutism (Overview)

, but the same mechanisms do not appear to be involved in all patients. Drug-induced hirsutism can be distinguished from drug-induced hypertrichosis, in which a uniform growth of fine hair appears over extensive areas of the trunk, hands, and face and is unrelated to androgen-dependent hair growth. Adrenal causes of hirsutism CAH in children (ie, the classic form of adrenal hyperplasia) may cause hirsutism. These children may be born with ambiguous genitalia, symptoms of salt wasting, and failure to thrive (...) . Idiopathic hirsutism in an elderly woman. Although the terms hirsutism and hypertrichosis often are used interchangeably, hypertrichosis actually refers to excess hair (terminal or vellus) in areas that are not predominantly androgen dependent. Whether a patient is hirsute often is difficult to judge because hair growth varies among individual women and across ethnic groups. What is considered hirsutism in one culture may be considered typical in another. For example, women from the Mediterranean

2014 eMedicine.com

118. Dermatologic Manifestations of Gastrointestinal Disease (Overview)

, and respiratory tracts, leading to fragility and resulting in extracutaneous complication. [ ] A retrospective analysis of 223 patients with EB found 58% of patients had GI complications. [ ] In EB simplex, constipation and gastroesophageal reflux (GOR) were frequently observed. In junctional EB, failure to thrive and protein-losing enteropathy (PLE) were the prominent findings. Constipation was common in patients with dystrophic EB. GOR and dysphagia affected most of the patients with recessive dystrophic EB (...) . [ ] Therefore, it is particularly difficult to identify the sign of Leser-Trélat in the setting of an elderly patient. As such, this finding may be more useful in younger patients, when there is a rapid increase in the size and number of lesions or when other suspicious findings such as acanthosis nigricans, florid cutaneous papillomatosis, weight loss, dysphagia, or changes in bowel movements are present. Similar to acanthosis nigricans, patients presenting with the sign of Leser–Trélat have a poor

2014 eMedicine.com

119. McCune-Albright Syndrome (Overview)

, hyperthermia, tremor, sleeplessness, weight loss, or (in infants) failure to thrive Other possible manifestations include the following: Cushing syndrome Growth hormone (GH) excess (gigantism and acromegaly) Acromegaly Ovarian cysts Pituitary tumors Thyroid tumors Hypophosphatemia (hypophosphatemic rickets) Hypogonadotropic hypogonadism, particularly in the setting of hyperprolactinemia See for more detail. Diagnosis Full endocrine studies should be performed. Testicular or ovarian hyperfunction (...) , facial disfigurement, and vision and hearing problems. It is difficult to treat effectively. Current therapies focus on treating complications of FD, rather than on preventing it from developing. Current studies using bisphosphonates are promising, though it is unclear whether bisphosphonates significantly reduce the morbidity associated with these lesions. Hyperthyroidism can cause severe failure to thrive in infants and young children, decreased attention span, and . Tachycardia resulting from

2014 eMedicine.com

120. Geriatric Rehabilitation (Treatment)

Rehabilitation Updated: Mar 19, 2019 Author: Julie A Muché, MD; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Geriatric Rehabilitation Overview Overview As we age, we face many physical and emotional changes that can affect our level of function and well-being. Our baby-boomer population is aging, and people are living longer. We must maintain functional independence in the elderly and address the needs of our older generation. Rehabilitation of geriatric patients (...) is imperative for the patients' well-being and for society, so that we can thrive socially and economically. [ ] Essential to geriatric rehabilitation is communication, specifically improving any sensory impairment, including those related to vision and hearing. The prevention of falls and osteoporosis can protect the patient's health and improve longevity. Addressing malnutrition can promote healing and vitalize the patient to participate in a formal rehabilitation program. Depression is common

2014 eMedicine.com

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