Why Frailty Isn't Inevitable and How to Prevent It
Health care experts now see it as a medical condition
You know them when you see it. Older adults who appear so fragile that a strong gust of wind might knock them over. They are often exceedingly thin, and their skin is parchment-like. They walk slowly and hesitantly, and may lack the strength to even lift a mug of coffee. In other words, they’re frail.
Although frailty is commonly associated with old age, it’s not synonymous — nor inevitable. Frailty is a medical condition all on its own, with many medical, social and economic implications.
Multiple factors (medical, environmental, educational and psychological) impact frailty, the ability to function and resilience, say experts. Frailty is linked with increased risk of falls, delirium, institutionalization, disability and death. It can lead to poorer recovery from surgery, including longer hospital stays and greater physical and mental decline. It’s also associated with higher health care use and related costs.
"Risk does increase over time, so you want to address it as soon as possible. Attending to prevention is important."
However, frailty can also be prevented or, in some cases, people can improve after being frail. You can take steps now to delay or minimize this condition for yourself. If you’re a caregiver, you can also help an older loved one regain some of his or her strength and resilience.
Frailty is not a given as we age, according to geriatrician Dr. Linda Fried, dean of Columbia University’s Mailman School of Public Health. “We’re seeing evidence that particularly physical activity and resistance exercise. and the right diet, seems to be very effective in delaying the onset of frailty or preventing it,” she says.
Fried and colleagues were the first to define the condition, and pinpoint those at risk, in seminal research published nearly two decades ago. They described frailty as a condition that meets three or more of the following criteria:
- Low physical activity
- Weak grip strength
- Low energy
- Slow walking speed
- Non-deliberate weight loss
In the United States, about 15% of adults 65 and older are considered frail, according to a 2015 study by Johns Hopkins University researchers; the rate varies depending on the exact measures used. Other researchers have subsequently published frailty measures that use slightly different criteria. There are also an estimated 28% to 44% of older adults who are considered pre-frail — defined by Fried as meeting one or two frailty markers.
As the world population ages, frailty has the potential to become a more serious health issue, regardless of which scale is used.
A new study by researchers in Australia that analyzed frailty in people over age 60 in 28 countries, found that as many as one in six adults 60 and older, not living in nursing homes or assisted living facilities, is at risk of developing frailty. Women are at greater risk than men, since they generally start out with less muscle mass. Frailty is also more common among older African Americans than whites, and among low-income people, regardless of race or ethnicity.
“Risk does increase over time,” says Fried, “so you want to address it as soon as possible. Attending to prevention is important.”
Prevention Advice for Older Adults and Caregivers
So what steps can you take to stave off this condition for yourself or someone you care for? It can be especially hard on caregivers who are often pressed to find free time, but a healthy diet with adequate lean protein and exercise and resistance training to keep or build muscle mass are key for older adults and caregivers.
“If you’re helping someone to eat well, you should also eat well,” says Fried. “There’s evidence that a healthy approach like the Mediterranean diet is also associated with the prevention of frailty.”
It also appears the need for proteins to maintain muscle is critical, she says. Yet, as people get older, they don’t always eat enough protein. This happens for a variety of reasons, including: cost; losing sense of taste or appetite; health conditions that make chewing or swallowing difficult and mobility issues, which make it harder to get to the store or cook.
When it comes to physical activities, Fried suggests creating a two-for approach: Caregivers should do resistance training along with a care recipient. If the person can walk, get out with him or her and walk a few times each day. If the caregiver can take a break, getting some more intense exercise beyond that is really critical, she says.
“Caregivers have to work on promoting their own health and preventing frailty and other health problems,” Fried says. “Ultimately it will help the person they’re caring for if they’re feeling better.”
Chronic Conditions Increase Frailty Risk
Certain chronic conditions can increase the risk for frailty. In one study, researchers found that those with diabetes, heart disease, osteoporosis, lung disease or stroke had a two-fold greater risk of frailty. People with dementia were as much as 10 times more likely to become frail.
Managing or preventing chronic disease decreases that risk. A large study by researchers from the University of Connecticut and the University of Exeter in the U.K. found that 60- to 69-year-olds with healthier hearts were less prone to frailty and other negative consequences of aging.
Additionally, certain medications might affect age-related muscle loss (sarcopenia) and bone health (osteoporosis). It’s important to check with your doctor or specialist about any medication side effects and whether you (or the person you care for) should add more calcium or vitamin D to your diet. Yogurt, milk and leafy greens, like spinach, are good sources of these nutrients.
Exercise to Prevent Frailty
When it comes to exercise, getting started is often the hardest part. The National Council on Aging has information about several fitness programs that can help you or a loved one on the path to decreased frailty.
The U.S. Centers for Disease Control and Prevention offers a free, downloadable book on exercise and strength training. Also check with a local senior center or neighborhood Y, many of which offer low-impact, older-adult-friendly exercise classes. Caregivers can join in, and increase intensity for themselves as appropriate.
Frailty is not destiny, says Fried. It comes down to commonsense basics: getting a good amount of exercise, getting adequate sleep, eating the right diet and managing your health and any chronic conditions you may have. While it may sound pedestrian because we’ve heard it so often, in the last 20 or 30 years, science has shown that they all matter a lot as we age.