Adult Failure to Thrive

NOTE: Adult Failure to Thrive is not a primary diagnosis that can be used for hospice admission, but is often an indicator or underlying condition related to a primary diagnosis that would benefit from hospice care. Our expert staff can assist you in determining the primary diagnosis accompanied by other co-morbidities that indicate decline like Adult Failure to Thrive.

The adult failure to thrive syndrome is characterized by unexplained weight loss, malnutrition and disability. The syndrome has been associated with multiple primary conditions (e.g., infections and malignancies), but always includes two defining clinical elements, namely nutritional impairment and disability. The nutritional impairment and disability associated with the adult failure to thrive syndrome may be severe enough to impact on patient’s short-term survival.

The adult failure to thrive syndrome may manifest as an irreversible progression in the patient’s nutritional impairment/disability despite a trial of therapy (i.e., treatment intended to affect the primary condition responsible for the patient’s clinical presentation.) The presence of comorbid conditions may hasten the patient’s clinical progression and as such should be identified and addressed. The medical criteria below support the terminal prognosis for patients with adult failure to thrive syndrome.

Criteria 1 and 2 MUST be met; factor 3 will lend support to terminal status. The patient would meet criteria if ALL of the following are met:

1. Irreversible nutritional impairment, as evidenced by both of the following:

  • Body Mass Index (BMI) will be less than 22kg/m^(BMI (kg/m^2) =703x (weight in pounds) / (height in inches) ^2).
  • Declines enteral/parenteral nutritional support OR has not responded to such support, despite an adequate caloric intake


2. Significant Disability as evidenced by the Palliative Performance Scale (PPS) equal to or less than 40%.

3. Other variables lending support to terminal diagnosis include the following:

  • Recurrent or intractable infections, such as pneumonia or other URI, sepsis, or UTI
  • Decreasing serum albumin or cholesterol
  • Dysphagia leading to recurrent aspiration and inadequate oral intake documented by the decreasing food portion consumption
  • Nausea/vomiting poorly responsive to treatment
  • Diarrhea, intractable
  • Generalized pain
  • Decline in systolic blood pressure to below 90 or progressive postural hypotension
  • Edema
  • Change in level of consciousness
  • Abnormal electrolyte levels
  • Progressive 3-4 stage pressure ulcers

If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline. Contact your local Compassus program for further information.