We’ve all seen older people that looked like a puff of wind could blow them over.  While not yet technically disabled, the frail have less endurance and strength than their sturdier contemporaries.  Frailty is a medical syndrome that affects 5 percent to 10 percent of people over the age of 70.  It was first identified as a condition by the medical community in the 1990s.  Since then doctors have focused on creating a more precise definition of what frailty is and understanding its causes.  One thing we know is that hospitalization, stress and injury are difficult for most people, but frail older adults are less able to successfully manage those situations.  A simple infection may cause barely a hiccup in a healthy older adult, but one that is frail may incur serious harm or even death.  Doctors found that frailty was a reliable predictor of a general decline in health and was highly associated with falls, deteriorating mobility, disability, hospitalization and death.  One study found that mortality rate was six fold higher for the frail group than it was for the non-frail group.[1]

So who is a frail older adult?  Gerontologists define an older adult as frail if they answer yes to three of the five following questions.[2]

• Are you fatigued?
• Do you have difficulty walking up one flight of steps?
• Are you unable to walk more than one block?
• Do you have more than five illnesses?
• Have you lost more than 5 percent of your weight in the last six months?

While frailty is associated with age, some older people never get frail while some middle aged people do.  A standardized definition of frailty has not been established although several have been proposed.[3]  Experts believe that rather than a single condition, it is a group of symptoms found together that are linked together in a never ending cycle.[4]  A study headed up by Linda Fried defined frailty as an intermediary state between functional and nonfunctional, and between being healthy and being sick.[5]

What causes frailty?  Smokers, people with depression or long-term medical problems and those who are underweight or malnourished are more likely to become frail.  Frailty can be caused by poor nutrition, lack of exercise and multiple medical problems such as heart disease, diabetes, arthritis and chronic obstructive pulmonary disease.[6]

Some medications may cause the elderly to become frail.  Many older adults take a laundry list of medications each day (a cocktail of five or more medications known as hyperpolypharmacy)[7].  People taking five or more medications are nearly 2 and a half times more likely to become frail than other older people according to research published in Clinical Pharmacology and Therapeutics.[8]  The potential exists for these individuals to be prescribed harmful medications, to over medicate or to have medications cancel each other out because their doctors treat each symptom individually rather than the person as a whole.

Certain diseases play a large role in a person becoming frail.  Those diseases include:[9]

• Anorexia: Chronic under-nutrition exasperated by loss of appetite due to age eventually results in fatigue, weakness, vitamin and mineral deficiencies and general wasting away.
• Sarcopenia: An age related excessive loss of muscle.  Can be genetically predetermined.
• Immobility: Lack of movement caused by illnesses such as arthritis and osteoporosis.
• Atherosclerosis:  Clogging of the arteries which can limit the amount of oxygen reaching tissues and organs.
• Balance impairment:  Decreased balance occurs naturally as a person ages but it can initiate a cycle of decreased mobility.
• Depression:  Depression can cause a feeling of fatigue, a reduction in mobility, a slowing of thought processes, an increase in number of major illnesses and a slower recovery cycle.
• Cognitive impairment: Slower mental processes and reaction speed may increase the number of falls.

Statistically, a large percentage of those who meet the definition for frailty die within five years.  Several factors that can contribute to frailty are easily treated and in some cases reversible and should be treated early.

Treatments include:

• Scheduling physical activity into every day.  Even the most vulnerable and physically challenged adults can benefit from exercise.  One of the most useful exercises is walking as it will work on heart fitness, balance and muscle mass.  But other options include: building muscle to reduce joint stiffness and pain by using resistance weights or bands (all frail persons should undergo resistance exercise training at least three times a week), and learning Tai Chi or other balance exercises.
• Keeping your mind active by socializing, reading, learning new things, playing games and doing puzzles.  Make sure you are eating enough protein to maintain muscle mass, and eat a balanced diet with plenty of fruits and vegetables, fiber and fluids.
• Men especially should be tested yearly for testosterone deficiency.  Frail people of both sexes should also be tested for hypothyroidism, vitamin and mineral deficiencies.
• Increasing food intake.
• Reducing medications.

Very few physicians outside of geriatricians screen for frailty.[10]  A study by the Cleveland Clinic suggests that a model for care would be an interdisciplinary team (that includes someone knowledgeable in geriatric medicine) in a day clinic that would have as their goal improving function, overcoming environmental challenges and keeping older adults living in their communities by preventing institutionalization.[11]