Elderly Cope With ‘The Dwindles’

Is grumpiness a normal condition of the elderly? Are aches and pains and waning appetites inevitable signs of aging? Do older people become so rundown they can’t be expected to keep up an active social life?

Wrong on all counts, says Dr. Anne Egbert, a geriatrician at the University of Kansas School of Medicine in Wichita.

Elderly people and their loved ones should not accept crotchetiness and other commonly observed “symptoms” of old age as normal, she says.

Reclusiveness, a lack of appetite, declining energy and some other ailments commonly associated with aging may be signs of a condition known as “the dwindles,” or, as doctors call it, “failure to thrive.”

“There’s lots of controversy about what’s considered normal in aging. Just because it’s common in aging doesn’t mean it’s normal,” Egbert said. “Failure to thrive is always abnormal.”

As people become elderly, some appear to dwindle away, becoming caught in a downward emotional and physical spiral that often leads to death. With early treatment, the dwindles can be partially or fully reversed, she said.

Doctors don’t always recognize the condition, which can develop because of poor nutrition--a problem affecting one in four elderly people, experts say. The dwindles can be touched off by other ailments as well, Egbert said.

“Say you had someone with severe emphysema. Often those people are not able to eat well, because they’re so short of breath,” Egbert said. “It’s hard to eat when you can’t get your breath, and you can lose a lot of weight and become isolated.

“You can’t go anywhere because you’re on oxygen, and that can lead into a failure-to-thrive-type syndrome,” she said.

Egbert said she’s seen improvement in about half of the people she’s treated.

“I haven’t always been successful because the underlying causes cannot always be reversed,” she said. “Often they will refuse to eat. Or if they have a medical illness you can’t correct. . . . But the key thing is to try.”

One patient, an 80-year-old Connecticut woman who had been fiercely independent all her life, was placed in a nursing home after she stopped eating regularly and became unable to care for herself.

She had fallen several times and had severe rheumatoid arthritis.

“She had refused to see a doctor for years and ended up weighing 100 pounds. She was average height and basically was shriveled up, kind of skinny,” Egbert said.

“We found a couple of things that really caused her problem,” she said. “One, she was very socially withdrawn. The reason was she couldn’t hear and she couldn’t see. She had bad cataracts and she was almost completely deaf.”

Family members lived out of state and were unable to keep in close touch. Her arthritis pain was overwhelming, and the usual medicines weren’t giving her any relief, Egbert said.

Since the woman refused to take medicine, doctors treated her pain by putting a narcotic patch--similar to a nicotine patch--on her arm.

The next step was to deal with the woman’s growing reclusiveness by increasing human contact.

The family was able to afford to hire a private nurse, who talked to the woman, held her hand and fed her a little bit at a time. The woman’s cat was allowed to visit, Egbert said.

“She just turned around incredibly,” Egbert said. “What she needed was human contact and somebody to spend time with her and relieve her pain, and when that was done she came out of her shell.”

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Recognizing ‘The Dwindles’

Dr. Anne Egbert’s conditions that characterize or lead to “the dwindles.”

* Disease. Some physical diseases that cause failure to thrive are chronic obstructive lung disease, heart failure, cancer, infections, hyperthyroidism or hypothyroidism and uncontrolled diabetes.

* Dementia. Contributes to social withdrawal, poor eating and depression.

* Delirium. Also contributes to social withdrawal, poor eating and depression.

* Drinking. Alcohol abuse and the abuse of other substances can lead to a variety of organic mental disorders and subsequent failure to thrive.

* Drugs. Drug-induced failure to thrive is commonly caused by a reduction in eating resulting from nausea or anorexia.

* Dysphagia, or swallowing difficulties. Can contribute to the failure to thrive by hindering eating and producing social embarrassment.

* Deafness. Conditions such as deafness and blindness can induce failure to thrive by hampering communication and contributing to social isolation.

* Depression. When depression is present, patients often complain that they are irritable or that they have trouble remembering.

* Desertion. Lack of contact with friends and family members, whether by death, indifference or moving.

* Destitution. Poverty can restrict access to food and medications.

* Despair. Some elderly make a conscious decision to give up after assessing their life as not worth living.

Source: Associated Press