"Failure to thrive" in elderly depressed patients: A new concept or a different name for an old problem?

With increasing frequency one may encounter the term "failure to thrive (FIT)" as applied to elderly patients. FIT in elderly patients is characterized by an insidious deterioration in their self-care abilities, loss of weight, loss of interest in social activities, a gradual decline in physical and/or cognitive function, and increased dependency on family members. The deterioration is beyond the expected, age-associated, "normal" decline. Depression is considered to be only one of the possible causes of FIT in the elderly. However, we suggest that the term, "FIT," as applied to elderly, depressed patients, does not appear to have intrinsic clinical value in that it describes a situation which represents an extreme form of the depressed syndrome rather than a separate clinical entity. It seems that early recognition of FIT would lead to appropriate supportive treatment being instituted before an advanced level of deterioration is reached. However, early diagnosis of the depression should have the same result and should lead to appropriate antidepressant treatment combined with vigorous nutritional intervention as well. The clinical problem which may lead to a delay in treatment of "FIT" affected elderly depressed patients is not a failure to diagnose "FIT" but a failure to diagnose depression.