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A 67-year-old male with a history of alcohol dependence and opioid addiction was admitted to the inpatient medicine unit from the emergency department with a diagnosis of failure to thrive. He was hemodynamically stable with an oxygen saturation of 98% on 2 litres of oxygen by nasal cannula. The patient appeared thin, dishevelled and intoxicated, but was alert and conversant. He had numerous scrapes and bruises in various stages of healing across his body. His neurological exam was described as “non-focal, moving all 4 extremities.”

Failure to Thrive or Failure to Think? The Importance of a Systematic Approach in the Evaluation of the Failing Elderly Patient