Frailty Prevention & Management

Senior Couple Walking

Frailty is a biologic and physiologic process and even though the likelihood of becoming frail grows with age, frailty is not a normal part of the aging.

Being frail introduces many risks to the aging process. Frailty is often synonymous with the overall weakness and often leads to disability and frequent hospitalizations. But, frailty is a dynamic process influenced also by lifestyle choices.

Frailty and Disability

Researchers who studied disability found that it is a dynamic process. In a 53-month long study, community-dwelling individuals have transitioned between states of disability. In the study, the disability was defined as a need for assistance in one of the key Activities of Daily Living (ADL) – bathing, dressing, walking, and transferring. Overall, the recovery rates reported in the study were as high as 28 %.

Even though recovery from disability was often short-lasting, just the possibility to regain independence, even temporarily, gives patients hope. Moreover, the findings suggest additional efforts and resources can help an at-risk group of elderly to maintain or regain their independence.

Since the disability is one of the frailty-related outcomes, researchers also asked whether frailty is a dynamic process as well. It was found that indeed, individuals move between states of frailty (non-frail, pre-frail, frail). Importantly, the transitions go both ways. Thus it is possible to transition from frailty back to pre-frailty.

Prevention

There’s still a lot to be learned about frailty, its prevention, and remedies. So far, research has linked frailty to hormonal changes, and chronic inflammatory state. Researchers are currently looking at the links between frailty and changes in gene expression, oxidative DNA damage, and telomere shortening.

What is not clear yet, is cause-and-effect relationships between frailty and different pathophysiologic factors.

Lifestyle

Two big aspects of a lifestyle – diet, and physical activity – influence the aging process and can increase the risk of developing frailty or disability. But diet and exercise have also the potential to help with the management of frailty.

Poor nutritional status of one’s diet and higher levels of inflammatory markers are associated with a higher risk of becoming frail. Chronic inflammation is actually thought to be one of the key underlying mechanisms.

There are many reasons for the malnourishment of the elderly, e.g. access to food, medication, physiological age-related changes, etc. Some diseases, such as depression, diabetes, atherosclerosis, and Parkinson disease, are likely to increase inactivity and malnourishment which might lead to frailty.

Luckily, the Mediterranean diet was proved to reduce the inflammatory makers and thus is potentially beneficial, for the prevention and management of frailty.

Physical Activity

Overweight and obesity are associated with disability, prefrailty, and frailty. In a study of more than 1000 women in their 70s, researchers found that being overweight was significantly associated with prefrailty, and obesity was associated with prefrailty and frailty.

One of the easiest to administer treatments for frailty is physical exercise, strength training, and balance training especially. Home-based physical therapy programs have the potential to affect physical functions among physically frail elderly as well as to reduce disability in ADLs, improve mobility and walking, and decrease the functional decline in frail individuals.

Muscle strength and physical functioning can be improved by exercise. The higher the volume and intensity of the resistance training the more muscle mass, muscle strength, and physical performance improve.

Active Ageing

Overall, it is recommended to focus on 4 key pillars of active aging – physical activity, healthy diet, maintaining mental health, and engaging in social activities.

These recommendations are true for every individual, no matter the age or health status. But it’s even more important to keep an eye on the elderly population, who often lacks access as well as motivation to care about healthy food, physical movement, mental engagement, and social interaction.


Sources:

Am J Lifestyle Med. 2017 Nov 28;12(2):107-112. doi: 10.1177/1559827617742847. eCollection 2018 Mar-Apr.

Beckwée, D., Delaere, A., Aelbrecht, S. et al. J Nutr Health Aging (2019). https://doi.org/10.1007/s12603-019-1196-8

Blaum CS, Xue QL, Michelon E et al. The association between obesity and the frailty syndrome in older women: The Women’s Health and Aging Studies. J Am Geriatr Soc 2005;53:927–934.

Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Archives of Internal Medicine. 2006;166(4):418–23. 

Hardy  SEGill  TM Recovery from disability among community-dwelling older persons.  JAMA2004;2911596- 1602

Laclaustra M et al., The inflammatory potential of diet is related to incident frailty and slow walking in older adults, Clinical Nutrition, https://doi.org/10.1016/j.clnu.2019.01.013

Wilson  JF Frailty—and its dangerous effects—might be preventable. Ann Intern Med2004;141489- 492

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