Functional, Social, and Psychological Disability as Causes of Loss of Weight and Independence in Older Community-Living People

This article reviews functional, social, and psychological disabilities that relate to weight loss and independence in older community residents and suggests possible ways in which these factors may be alleviated. Although these disabilities clearly interact with one another as causes of failure to thrive, this article is organized into three major sections: functional disability, psychological and social factors, and malnutrition. In-depth geriatric assessment provides directions to reverse or halt failure to thrive. Using case materials, possible interventions are presented; these include dietary changes, a carefully planned program of physical exercise, treatment for depression, and a combination of social and environmental "prescriptions" designed to reduce social and emotional isolation. Appropriate social supports are also necessary, as is careful attention to how caregiver stress may be reduced through suitable interventions.