Admission Diagnosis of “FTT” vs. Discharge Diagnosis in Older Adults on a Clinical Teaching Medicine Service in a Tertiary Care Teaching Hospital Kristine Kim Preceptor: Dr. Martha Spencer PGY 5 Geriatric Medicine Fellow UBC Geriatric Medicine Email: [email protected]
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“FTT” in Older Adults on a Teaching Medicine Service in a ... · • To determine the disparities between the initial diagnosis of FTT and final discharge diagnosis in a clinical
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Admission Diagnosis of “FTT” vs. Discharge Diagnosis in Older Adults on a Clinical Teaching Medicine Service in
a Tertiary Care Teaching Hospital
Kristine KimPreceptor: Dr. Martha SpencerPGY 5 Geriatric Medicine Fellow
Presenter Disclosure• Faculty: Kristine Kim• Relationships with financial sponsors: None
Disclosure of Financial Support• I have no financial disclosures• I have no conflicts of interest
Failure To Thrive
• FTT associated w/ weight loss, PO intake, poor nutrition and inactivity (NIA)
• NOT normal aging
• Associated with • Morbidity• Mortality Rates• Medical Care/Readmission• Institutionalization Kumeliauskas L et al, 2013, Berkman et al, 1989,
Egbert A.M, 1996, Sarkisian 1996
Current Thoughts – A quick feeler
“Better than...Circling...The..Drain”
"The Dwindles“ “Dwindling”
“I prefer Wasting Syndrome. The patient will
need a medical and neurocognitive evaluation in hope to find a reversible
condition. Palliative referral is a common outcome.”
“or ‘piss poor protoplasm’ ”
“It is to avoid the sort of workup someone our age would deserve and would get. I would not give that DX to the average 70 year old. In a 90 year old with chronic problems who took a sudden turn, I would rule out the obvious easy to fix things and then use FTT. Often would suspect occult malignancy, but without some mass somewhere, need a hospice diagnosis.”
Goals of Study
• To determine the disparities between the initial diagnosis of FTT and final discharge diagnosis in a clinical teaching medical service.
• We propose the term FTT is being utilized when an alternative diagnosis for an underlying medical condition is determined as a
diagnosis prior to discharge.
MethodsSubjects Recruited
(n= 94)
Subjects included (n=76)
Subjects Eligible(n=74)
Excluded:‐ Not admitted to CTU/FM
(n= 1) ‐ Admitted prior Jan 1 2016
(n=1)
Excluded:‐ Concurrent Acute
Admission Diagnosis (n= 18)Retrospective cohort study Tertiary university hospital (St. Paul’s Hospital)
‐Misuse of FTT on admission in older adults• High rate of acute medical illnesses• High degree of multimorbidity• ?Delay diagnosis/medical care
‐ Further study needed• Reasons for using FTT (ie focus groups ‐ residents/ED staff)• Outcomes: morbidity/mortality• Intervention: education (residents/ED staff)
Strengths and Limitations
‐ Strengths:• Builds on current literature• Tertiary Hospital in Canada• Practical goal of leading to practice change
‐ Limitations:• Systemic bias – limited algorithmic accessibility• Small sample size• Limited to internal medicine and family medicine
Special Thanks
• CGS (host)• Dr. Martha Spencer (PI)• Elena Szefer (Statistician)• Darby Thompson (Statistician)