Frailty: What you need to know
The term “frailty” seems to be practically synonymous with aging. And while it’s true that adults naturally have a gradual physical decline as they age, not every older adult is frail and not every frail person is old.
The difference between aging and frailty
Aging, also called senescence, refers to the biological process of growing older. As people age, it becomes more difficult for the body to repair itself and maintain optimal health, according to Neal S. Fedarko, Ph.D., professor of medicine, division of geriatric medicine and gerontology, Johns Hopkins University. People age differently based on both genetics and lifestyle factors.
Frailty is considered a chronic and progressive condition, categorized by at least three of five criteria: muscle weakness, unintentional weight loss, low physical activity levels, fatigue and slow walking speed. The body loses its ability to cope with everyday or acute stress, becoming more vulnerable to disease and death, as Samuel Durso, M.D., director of geriatric medicine and gerontology at Johns Hopkins School of Medicine explained in a recent AHCJ webcast.
Individuals with three or more frailty criteria also have higher rates of depression, do not recover from surgery as easily, and have greater cognitive impairment and other medical conditions, said Durso. However, frailty is not an inevitable part of aging, writes Los Angeles Times reporter Marlene Cimons in an op-ed at Livescience (based on her 2010 Washington Post story on the same topic).
Just because someone looks frail doesn’t necessarily mean they are. For example, people inevitably lose muscle mass as they age, but regular physical activity can help stave off weakness. Numerous studies show that regular exercise such as walking and strength training, can delay onset of and reduce severity of frailty
An estimated 7 percent to 12 percent of Americans age 65 and older are considered frail. Risk rises with age — from one in 25 people between ages 65 and 74 to one in four of those older than age 84.
Frail older adults are at risk for falls, increased dependency, hospitalization, institutionalization, and death. Frail individuals also tend to use the most health resources in both acute and community settings.
Frail older adults have an increased burden of symptoms, are medically complex, and often have increased social needs. However research shows that early identification of frailty and prompt intervention can delay or prevent the clinical consequences.
The medical community recognizes two types of frailty: primary frailty, which is associated with aging; and secondary frailty, which is associated with end-stage diseases such as heart failure, chronic lung disease or renal disease.
Frailty may be slowed in its early stages, but as it progresses, it becomes less amenable to treatment.
Explaining frailty to your audience
- When communicating issues of risk to patients, reporters need to distinguish between relative and absolute risk. Be sure to check AHCJ’s Brief Primer on Medical Reporting to make sure you understand the difference – and to ensure that the numbers add up
- Dr. Durso cited this article from Annals of Internal Medicine as a source to help reporters explain these differences.
- This recent WSJ article by Laura Landro on muscle strength and aging is another example of good health reporting – by including visuals and simple explanations, she makes the topic easy for a lay person to grasp.
- Avoid "hype," including dietary or medical interventions. There are no “wonder pills” yet.
- Johns Hopkins Older Americans Independence Center
- This article by Judith Graham on frailty screening
- SNAP, a new New York State initiative that investigates the connection between frailty and dementia
- This article on the effects of Vitamin D on frailty
- The National Health and Aging Trends Study
- This article on frailty and end-of-life care from the Cleveland Clinic Journal of Medicine
- A bipartisan call for Medicaid to widen the PACE program for the frailest seniors