Page 206 - Encyclopedia of Nursing Research

FAILurE TO THrIVE (AduLT) n 173

in terms of norms for age and sex (Frank & There also is relatively little published
Zeisel, 1988). Pediatric FTT is generally clas- research on adult FTT. Methodological
sified as organic, in which there is a known approaches have varied and, without a dom- F
underlying medical condition; nonorganic, inant model of adult FTT, studies have used
in which the causes are psychosocial; or different definitions of the syndrome, as well
mixed. Advances in pediatric research have as various defining criteria. In one of the earli-
also produced a theoretical framework est reported studies, Messert, Kurlanzik, and
in which malnutrition is of fundamental Thorning (1976) identified adult FTT through
importance, either as a primary cause of documentation of a cluster of symptoms in
FTT or a secondary symptom of a chronic five adult patients diagnosed with neurolog-
illness. ical disorders (age range = 24–67 years, mean
On the basis of several years of clini- = 49 years). All of the patients had irreversible
cal and research experience with the elderly, weight loss despite high caloric intake, wide
Verdery (1996) proposed two etiological fac- variations in body temperature, decreased
tors for adult FTT. The first is that the syn- levels of consciousness, unexplained rapid
drome may occur in response to an event development of decubitus ulcers, and sud-
that triggers a more rapid than normal rate of den death. A second study examined the
decline. The idea that a trigger event may be characteristics of 62 male patients admit-
a precursor to FTT needs further investiga- ted with a medical diagnosis of FTT (Osato,
tion but it is intuitively believable from both Stone, Phillips, & Winne, 1993), using ret-
a clinical and research perspective: an event rospective chart review. The patients had a
could be physiological in nature (for example, wide age range (37–104 years), an average of
a hip fracture), environmental (for example, a seven medical diagnoses, required an aver-
change in residence), psychological (for exam- age of five medications, and 62% had low
ple, death of a spouse), or a combination of levels of serum albumin (<3.5 g/dL). A third
all three. Verdery’s second proposition is that study retrospectively examined the medical
there are two categories of adult FTT. This records of 82 elders admitted with a diagno-
first is primary adult FTT, where the reasons sis of FTT (Berkman et al., 1986) and used fac-
for the patient’s decline are ambiguous or tor analysis to group FTT factors into three
obscure. In secondary adult FTT, the reasons categories: patient care management prob-
are diagnosable and potentially treatable and lems, functional problems, and patient cop-
there is a wide range of possible underlying ing problems. A fourth study followed 252
factors: (a) medical history and treatment, subjects for 2 years after new hip fracture
for example, immune function or polyphar- (Fox, Hawkes, Magaziner, Zimmerman, &
macy; (b) psychological problems, primarily Hebel, 1996). Subjects were generally older
depression; (c) nutritional factors, including (mean = 77 years) and FTT was defined as a
eating disorders; and (d) social and/or envi- decline in walking 6 to 12 months postfrac-
ronmental factors such as isolation or alcohol ture after subjects had achieved an initial
intake. Although many of the factors in the gain in mobility. results were mixed: those
secondary category of adult FTT have been classified as FTT (n = 26) were significantly
investigated in relation to health behaviors worse off than the “no decline” group in
and outcomes, few have been examined from their cognitive decline, number of hospi-
within a theoretical framework of adult FTT; talizations at 12 months, and self-reported
in part because, unlike pediatric FTT, there health at 24 months. No statistically signifi-
is no consensus on the critical concepts and cant differences were found between the two
their relationships, nor are there objective cri- groups on social interaction or depression
teria that can be used to evaluate deviation scores, mortality, physician visits, or nursing
from the norm. home stays. A fifth study also used physical