We all lose muscle and strength as we age. Frailty is something more. It can take away your health, your vitality, and your independence. But it’s not inevitable.
What It Is. While there is no single, universally accepted definition of frailty, it’s understood as a syndrome that impacts health, energy level, physical abilities, and, in some definitions, cognitive abilities. This syndrome is typically seen in older adults, although it can occur in younger people.
“Frailty is characterized by a reduced resilience,” says Roger A. Fielding, PhD, senior scientist and leader of the Nutrition, Exercise Physiology, and Sarcopenia Team at the Human Nutrition Research Center on Aging (HNRCA). “The body doesn’t respond adequately to external stressors such as an infection or other illness, surgery, or a fall. The individual may have a delayed or weak immune response to an infection, for example, or poor recovery from surgery.”
Researchers have come up with different ways to identify frailty. The most common approach, the Fried frailty phenotype, assess five criteria:
• Weakness, measured by low handgrip strength;
• Self-reported exhaustion or low energy;
• Walking speed of less than 0.8 miles per second with or without a walking aid;
• Low physical activity; and/or
• Unintentional weight loss of 10 pounds or more (or 5 percent or more of body mass) in a year.
People who have three or more of these criteria are considered frail. Those with any two are pre-frail, meaning they are at high risk of becoming frail. Poor balance and cognitive impairment can also be considered symptoms of frailty.
“All five of these criteria involve some change in muscle or muscle function,” says Fielding. “In fact, many people who are frail also have sarcopenia (and many who have sarcopenia also are frail). Sarcopenia is an age-associated decline in muscle mass and strength first identified here at HNRCA. Everyone loses muscle mass and strength with age. With sarcopenia, that loss limits the person’s ability to function.”
Since there are no recommendations for routine testing (and no standard diagnostic test), it’s hard to know how common frailty is. Sources estimate that four to 16 percent of community-dwelling women and men aged 65 and older in the U.S. are frail. A full 25 percent of those over 84 are estimated to be frail. Many more are considered pre-frail.
Why it Matters. As frailty progresses, people lose their independence. The loss of strength leads to poor mobility and increased risk of falls. People with frailty are at higher risk for infections, hospitalization and long hospital stays, surgical complications, and being unable to return to independent living after a surgical procedure. They may also experience loss of appetite, which increases risk for unintended weight loss and undernutrition. Ultimately, frailty increases risk of death.
What to Do. “Take a pre-frail or frail individual and have them begin a program of physical activity, and we can reverse some of the symptoms,” says Fielding. “Physical activity also works to avoid becoming frail in the first place.”
➧ Be active! Aerobic activity (which gets your heart rate up), strength training, and balance exercises all help to maintain muscle and strength as we age. Start now, and keep at it.
➧ Stay social. Social and mentally-stimulating activities are associated with heathy aging, including a lower risk of becoming frail.
➧ Correct hearing problems. People who don’t hear well are less likely to lead active, social lives.
➧ Watch for unintentional weight loss. If you are losing weight without trying, check with your healthcare provider. This could indicate an underlying problem and is a risk factor for frailty.
Generally, being active, maintaining a healthy body weight, consuming a healthy dietary pattern, and staying socially and cognitively active are the recommended ways to stay strong, active, healthy, and independent as you age.
Risk Factors for Frailty. The most commonly cited risk factors for developing frailty are advanced age, smoking, underweight, overweight, obesity, lower socioeconomic status, and less education. “One of the biggest factors is a sedentary lifestyle,” says Fielding. “People who are less active are at greater risk.” Other factors include social isolation, living alone, a generally unhealthy lifestyle, and traumatic life events. People diagnosed with type 2 diabetes, respiratory disease, stroke, dementia, multiple sclerosis, connective tissue disease, osteoarthritis, and chronic fatigue syndrome or who suffer from multiple disorders are more likely to develop frailty. It is more common in women than men, but men with frailty have a higher mortality rate.