What Is Adult Failure to Thrive (AFTT)?

Adult failure to thrive (AFTT) is the presence of one or more medical conditions, usually in elderly, frail patients, that put them at risk of further decline. AFTT, however, is not a specific diagnosis that can serve as the reason for a referral to hospice care.

To define failure to thrive, health experts look at key factors, including poor appetite, weight loss, fatigue, and overall progressive decline in a person’s ability to carry out everyday activities.

These activities of daily living (ADLs) assess a patient’s ability to dress, eat and drink, bathe, move from one location to another safely, groom, and toilet on their own, without help from others.1

As they gradually lose the ability to care for themselves, these adults are classified as failing to thrive. Typically, patients with AFTT might have underlying medical conditions, but no specific organ system decline for which a prognosis for an advanced illness would make them eligible for the Medicare hospice benefit.

Why Is AFTT Not a Diagnosis?

AFTT is considered a collection of symptoms or signs of decline rather than a specific diagnosis. It usually appears in elderly people who are already ill, face the challenges of other nonspecific medical conditions, or face increasing loss of ability to perform everyday activities.

The most common factors involved in AFTT include:

  • Unexplained weight loss, even with adequate nutrition or nutritional support
  • A 40% or lower score on the Palliative Care Performance Scale, a modification of the Karnofsky Performance Status2, which classifies patients based on their functional capabilities, ranging from fully functional (100%-80%) to unable to work but able to handle most basic personal needs (70%-50%) to seriously ill/disabled/hospitalized and requiring full assistance (40%-10%)2

For Medicare coding, AFTT and “debility” are logged as ICD-9-CM/ICD-10-CM codes.

Hospice Admission for Failure to Thrive

Because AFTT is not a specific diagnosis, it is not accepted as a legitimate reason for a patient to be admitted to hospice care.

Generally, hospice experts ask other questions to determine hospice eligibility, such as: “Does a patient with an existing advanced illness spend more than 50% of their waking hours resting (e.g., sitting or lying down).

If so, the presence of an advanced illness could serve as the basis for an admission to hospice care in patients who also exhibit the characteristics of AFTT. 

Who Is Eligible for Hospice Care?

Generally, patients are eligible for hospice care if:

  • A physician has determined that they have an advanced illness and a prognosis of 6 months or less if the disease runs its normal course
  • The patient and/or family has chosen to pursue comfort-focused care over curative care

Patients typically are referred to hospice care if they have advanced cancer, heart disease, lung disease, Alzheimer’s disease/dementia, end-stage liver or kidney disease, sepsis, or other advanced illnesses.

1Stanford University School of Medicine, Palliative Care. Adult Failure to Thrive. Retrieved from: https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/common-terminal-diagnoses/adult-failure-to-thrive/

2National Palliative Care Research Center. Karnofsky Performance Scale Status Scale Ratings Definition. Retrieved from http://www.npcrc.org/files/news/karnofsky_performance_scale.pdf

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