PubMed · 8128147
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K Moore. 1994. Stroke: the long road back.. https://pubmed.ncbi.nlm.nih.gov/8128147/
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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.
OBJECTIVE: To examine whether patients' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction. DESIGN: Patients' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later. SETTING: Two large teaching hospitals in Auckland, New Zealand. SUBJECTS: 143 consecutive patients aged under 65 with their first myocardial infarction. MAIN OUTCOME MEASURES: Attendance at rehabilitation course; time before returning to work; measures of disability with sickness impact profile questionnaire for sleep and rest, social interaction, recreational activity, and home management; and sexual dysfunction. RESULTS: Attendance at the rehabilitation course was significantly related to a stronger belief during admission that the illness could be cured or controlled (t = 2.08, P = 0.04). Return to work within six weeks was significantly predicted by the perception that the illness would last a short time (t = 2.52, P = 0.01) and have less grave consequences for the patient (t = 2.87, P = 0.005). Patients' belief that their heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities, and social interaction. A strong illness identity was significantly related to greater sexual dysfunction at both three and six months. CONCLUSIONS: Patients' initial perceptions of illness are important determinants of different aspects of recovery after myocardial infarction. Specific illness perceptions need to be identified at an early stage as a basis for optimising outcomes from rehabilitation programmes.
Arthritis and other rheumatic conditions are among the most prevalent chronic conditions in the United States, affecting an estimated 40 million persons in 1995 and a projected 60 million by 2020. Previous reports have documented marked differences in the prevalence rates of arthritis and related activity limitations by race and ethnicity, suggesting the relative importance of arthritis might vary among these groups. In addition, race and ethnicity are associated with important differences in health characteristics and must be addressed in efforts to reduce health disparities as specified by the national health objectives for the year 2000. To examine the relative importance of arthritis among these groups, data from the 1989-1991 National Health Interview Survey (NHIS) were used to estimate the prevalence of self-reported arthritis and related activity limitation by race and ethnicity, compare these estimates to those for other chronic conditions, and estimate these prevalences for 2020.