Catherine A. Sarkisian, MD; Mark S. Lachs, MD, MPH
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Sarkisian CA, Lachs MS. Failure To Thrive in Older Adults. Ann Intern Med. 1997;126:669. doi: 10.7326/0003-4819-126-8-199704150-00039
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Published: Ann Intern Med. 1997;126(8):669.
We appreciate the comments of Dr. Still and concur that the morbidly obese older patient may be declining functionally just as an undernourished older patient might be; this is yet another compelling argument for abandoning failure to thrive as a diagnosis because it reinforces the stereotype of the wasting patient as the only one who qualifies for the label. Although it was not the purpose of our paper to provide a comprehensive differential diagnosis for patients who are declining, we agree with Dr. Stead that tuberculosis is a diagnosis that is often overlooked.
Dr. Portnoi is mistaken in claiming that we see no difference between the concepts of failure to thrive and naturalness of death. Certainly there is nothing more gratifying for an internist than to diagnose occult reversible illness in a declining patient and facilitate his or her recovery. No data exist, however, to indicate how often and in which clinical settings this reversal occurs. In our paper, we emphasize that it is just this type of data that we badly need in order to distinguish between patients undergoing a natural death and those likely to benefit from our interventions.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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