The physical examination should include a complete medical and mental status examination. Tachycardia or severe hypertension may indicate drug toxicity or thyrotoxicosis; fever may suggest encephalitis or porphyria. 18 Physical signs suggestive of underlying diagnoses include cushingoid appearance in certain endocrinopathies, arthritic deformities in autoimmune disorders, or movement and gait disturbances in conditions such as multiple sclerosis and Parkinson disease. 37 The neurologic examination should assess for focal signs, sensory deficits, myoclonus, or tremors. Tendon reflexes, cranial nerve testing, and ophthalmologic examination are important if a brain lesion, infection, or metabolic disease is suspected.
Treatment of failure to thrive should focus on identifiable diseases and be limited to interventions that have few risks for these frail patients. Failure to thrive commonly occurs near the end of a person’s life, so the potential benefits of treatment should be considered before evaluations and treatments are undertaken. 5 Initially, treatment involves efforts to modify possible causes. A team approach that includes a dietitian, a speech therapist, a social worker, a mental health professional, and a physical therapist may be helpful. 3 Figure 2 24 offers an algorithmic approach to the diagnosis and management of elderly patients with failure to thrive.