No, that’s not a description of what’s ailing the economy.
“Failure to thrive” is my father’s latest official diagnosis, sort of a catch-all when no single medical issue–and he has a bunch–immediately jumps out as the cause of his current decline. He’s dealing with recurring pneumonia, has lost weight, and has started declining meals, eating only sporadically, although still drinking.
I heard the term for the first time yesterday during a meeting with Sandra, a hospice nurse from St. Francis Hospice. We met in a conference room at the nursing home, along with my mother and sister.
Sandra had just come from introducing herself to my father and checking his medical records. She had already conclude he is eligible for hospice care because his weight loss crossed a specific threshold and his condition was no longer “stable”.
She their brief interaction up in his room on the third floor, she asked if he had heard of hospice and what hospice care tries to do during this end of life stage.
Sandra said he surprised her by calmly saying: “I think the Big Guy will be calling me soon.” She reported that he didn’t seem anxious as he said this.
Perhaps that’s the trip “over the mountain” that he mentioned during my visit over the weekend. I don’t know.
My sister points out that my dad’s mother died in 1982, one day before her 97th birthday. My dad’s 97th birthday will be on December 7, if he makes it.
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Aloha Ian and family. Thank you for sharing this journey with us. It will help me deal with things when time comes in our Ohana to have shared your father’s experiences. Mahalo, it is a generous gift you share.
What I don’t understand is why do we have to go through this? I hope that someone will be around to help me cross over the mountain quickly & painlessly.
Ian: My mother died on May 20. For the certificate, the doctor put down as the cause “Failure to Thrive”. My father, who is still quite heartbroken over the passing of his wife and my mother, is still wondering what the phrase “Failure to Thrive” means. He is under the impression that she was still able to consume and be self sustaining all the way to the end. I tried to tell him that there are times when things just start shutting down and there is no medicine or thereapy that can reverse that. I know that for your father, to have this diagnosis declared, it brings up those questions for me again. I hope that all will go well for you, as it did in my mothers final days (Hospice, 24-hour care in a home, etc).
Sounds like your dad is at peace with himself. No regrets, looks like he has lived a full life. That should be everyone’s goal.
I am truly sorry and admit I can’t know exactly how you feel. Whether they leave suddenly or after a long decline, it isn’t any easier for us to lose our loved ones.
December 7th birthday, huh? I have a friend who was born on Lanai on 12/7/41 but he obviously had no appreciation of what was happening that morning on Oahu. Your Dad turned 28 that day. Have you shared his recollection of that day (that I may have missed or forgotten)? One more episode in the chronicle of an interesting life.
Ian, your writing is so poignant, thank you. My thoughts are with you and your family and I love your sister’s sentiment about wishing him peace. I do too.
I didn’t understand until going through with my father that hospice workers are as close to angels as we can meet walking on the earth. And they understand that the challenges are not always greatest for people who can find peace in their end of fulfilling lives, but those of us who stay behind.
But ditto with OldDiver. In my experience, I found much solace in knowing that the circumstances were far better than countless alternatives.
Thank you for allowing us all the privilege sharing of your family’s experiences. May you all have peace, serenity & comfort with what comes.
Re: “failure to thrive.” I have only heard of this phrase used describe young infants that do not grow as they should, often due to inadequate nourishment. There is something at once ironic & poetic in seeing this phrase used for those at the end of life as well.
My mother died at age 91 about 2 years ago, while in an assisted living facility. For several months she had been not eating very much, losing weight, showing little interest in daily activities, and having a hard time using her walker or getting out of bed without assistance. Her weight was down to 64 pounds (5’3″). I was very surprised when her doctor gave her a diagnosis I had never heard of — “Failure to thrive.” That diagnosis seemed both obvious and bogus at the same time; because it didn’t identify any cause or cure. It merely described what was obvious. But it was a welcome diagnosis because it provided what Medicare needed to hear in order to authorize her for hospice. A week after beginning service from hospice, she died.
Here is a professional explanation of this diagnosis, which I was surprised to see was written in 1996 (so it’s been around for a long time!)
http://www.annals.org/content/124/12/1072.abstract
Annals of Internal Medicine, June 15, 1996
vol. 124 no. 12 1072-1078
“Failure To Thrive” in Older Adults
Catherine A. Sarkisian, MD; and Mark S. Lachs, MD, MPH
Abstract
The term “failure to thrive” is frequently used to describe older adults whose independence is declining.The term was exported from pediatrics in the 1970s and is used to describe older adults with various concurrent chronic diseases, functional impairments, or both. Despite this heterogeneity, failure to thrive has had its own International Classification of Diseases, Ninth Revision (ICD-9) code since 1979 and has been approached as a clinically meaningful diagnosis in many review articles. This conceptual framework, however, can create barriers to proper evaluation and management. The most worrisome of these barriers is the reinforcement of both fatalism and intellectual laziness, which need to be balanced with a deconstructionist approach, wherein the major areas of impairment are identified and quantified and have their interactions considered. Four syndromes known to be individually predictive of adverse outcomes in older adults are repeatedly cited as prevalent in patients with failure to thrive: impaired physical functioning, malnutrition, depression, and cognitive impairment. The differential diagnosis of contributors to each of these syndromes includes the other three syndromes, and multiple contributors often exist concurrently. Some of these contributors are unmodifiable, some are easily modifiable, and some are potentially modifiable but only with the use of resource-intensive strategies. Initial interventions should be directed at easily remediable contributors in the hope of improving overall functional status, because a single contributor may simultaneously influence several other syndromes that conspire to create the phenotype of failure to thrive. How aggressively should more resource-intensive strategies for less easily modifiable contributors be pursued? This is a central clinical, ethical, and policy issue in geriatric medicine that cannot be settled without better process and outcome data. This paper examines the medical etymology of failure to thrive and proposes a rational approach to evaluation and management that is based on the limited medical literature.
Thank you for this information.
Ian,
I have been following your site for a couple years now. Your writing on your Father has been wonderful. I have gone through the hospice route with several friends and relatives the past few years. These people are real angels. I really appreciate you sharing your journey. My thoughts are with you and your family as you walk with your Father through this next transition.