What to know about frailty and aging
By Liz Seegert
While it’s true that frailty may be a part of old age, it’s not always inevitable. It’s important to understand frailty, especially when reviewing studies or reports since some research or programs include only frail elders, while others may encompass “healthy” (read: not frail) older adults.
What’s the difference?
Aging is a series of interconnected processes of growing older, a biological phenomenon often referred to as "senescence.”
Frailty is a chronic, progressive condition categorized by at least three of five criteria:
- Muscle weakness
- Unintentional weight loss
- Low physical activity levels
- Slow walking speed
Another model, the frailty index, defines frailty as cumulative deficits identified in a comprehensive geriatric assessment — the gold standard for identifying frail hospital patients.
When someone becomes frail, their body loses its ability to cope with every day or acute stress, making them more vulnerable to disease, disability and death. Something as simple as the flu or a fall could send them into a downward spiral that may be impossible to recover from.
- One recent study estimated that 15% of the older non-nursing home population is frail and 45% are prefrail.
- These adults have significantly increased risk of falls, disability, long-term care and mortality.
- Frailty status can often mean the difference between living independently or being dependent on others for care.
- Most frail older adults are women (partly because women live longer than men), are more than 80 years old, are racial or ethnic minorities, have lower incomes, and/or are in supportive settings.
- Because of the rapid growth of those 65 and older, the number of frail elders is on the rise.
- Everyone older than 70 should be checked for frailty, according to an article by geriatricians representing six major international and U.S. medical organizations.
- When interviewing a person who may be frail, reporters should bear in mind that cognitive reserve may be limited; the person may not fully understand the interview’s purpose or how their information will be used. Be sensitive to their situation.
Preventing or delaying frailty
Conversely, don’t assume that because someone looks frail it means they actually are. People inevitably lose muscle mass as they age, but regular physical activity can help stave off weakness. Recent research suggests that frailty may be reversible, which could result in significant improvement in public health. Certain activities can delay onset and reduce severity of frailty, say experts at the Cleveland Clinic.
- Walking can improve heart fitness, balance and muscle mass. Resistance and weight training can build muscle and help to reduce joint stiffness and pain. Even small increases in fitness can improve symptoms of frailty.
- Maintaining mental sharpness is also important for older adults. Crossword or number puzzles, reading, playing games and socializing are all good ways to keep the mind active.
- Depression, other psychiatric illnesses and medical problems should be monitored to prevent progression of frailty.
- Good nutrition with a balanced diet should encompass protein (to maintain muscle mass), fruits and vegetables, fiber and fluids (especially in warmer climates).
- Diagnosing people in the pre-frail stage — even those in their 40s — can significantly delay or prevent progression to frailty, can help maintain independence, reduce health care costs and improve quality of life. So why are more physicians not screening for this condition?
More resources for reporting on frailty and aging:
- When communicating issues of risk to patients, reporters need to distinguish between relative and absolute risk. AHCJ’s Brief Primer on Medical Reporting can help you understand the difference – and ensure that the numbers add up.
- Johns Hopkins Older Americans Independence Center
- National Health and Aging Trends Study
- This article on the link between nutrition and frailty from BMJ and another article on whether the Mediterranean diet may impact frailty
- National Pace Association: Program of All Inclusive Care for the Elderly, (PACE) programs coordinate and provide all needed preventive, primary, acute and long-term care services so older people, including frail elders, can continue living in the community.
- National Council on Aging Center for Healthy Aging promotes evidence-based health promotion in the community to keep older adults living independently
- Institute on Aging — works to enhance quality of life for aging adults and adults living with disabilities in the Bay Area, including community supports and the PACE program.
- Aging and Disability Resource Centers — help older adults, people with disabilities, and family members in every state learn about and access long-term services and supports.
- Linda Fried, M.D,, Dean, Columbia University Mailman School of Public Health.
- Paula Carter, Ph.D. Director, Institute on Aging, Portland State University
- George Kuchel, M.D., Professor of Medicine, Chair in Geriatrics and Gerontology, University of Connecticut
- Laura Mosqueda Chair, Department of Family Medicine, Keck School of Medicine, USC