You’ve likely known someone in your life, perhaps a loved one or friend, who seems “diminished” by age: perhaps they are slowing down, appear more fatigued, spend more and more time sitting, or are walking more slowly than they previously did. They may even need a helping hand to get out of a chair. The question is, are these signs of normal aging, or is something else going on? These symptoms are likely part of the geriatric syndrome known as “frailty,” which is not an inevitable part of aging but does become more prevalent the older you get. Worldwide, it’s estimated that 11% of people aged 50-59 are frail and for those over 90, estimates are that 51% can be considered frail. Frailty is a syndrome characterized by some or most of the physical limitations mentioned above, but it’s also a condition that means you’re less resilient and more vulnerable when you are confronted by such stressors as hospitalization, infection, surgery, cancer, or some other health challenge. If you’re undergoing surgery or chemotherapy and you’re frail, you are much more vulnerable to the associated risks of these interventions. One study from Johns Hopkins found that frailty doubles the risk of surgical complications and increases the odds of the loss of independence after a surgical procedure twentyfold. Many medical commentators wondered if President Joe Biden’s appearance during the later months of his presidential run were reflective of his affliction with frailty.

Given the vulnerability of patients with frailty, it’s important to understand what’s happening and to take account of what can be done in response, to help build strength and resilience as well as to consider the impact that health challenges may pose. While genetics and age do play a role in the appearance of frailty, it’s also clear that previous lifestyle behaviors will have had an impact, and that adjustments can help build strength and energy. There are various tests and instruments to measure the level of frailty in someone, and a geriatrician or primary care physician might want to assess a patient for frailty before proposing or clearing a patient for an intervention such as surgery or chemotherapy.

An exercise routine is one recommended way to help build up the resilience and energy for a person suffering from frailty. While clinical trials are underway to develop medications to combat frailty, most experts currently recommend both physical movement such as walking, and a strength training program to halt or even reverse some of the symptoms. A recent review article in the New England Journal of Medicine recommends that community-dwelling older adults who are combating frailty undertake both exercise and oral nutritional supplementation to help halt the frailty and minimize associated risks, including falls. Exercises such as yoga and Tai Chi are also said to help protect against frailty and reduce its effects. A post from Johns Hopkins suggests combatting frailty with physical activity most days of the week (again, walking combined with strength training is recommended) in addition to eating a healthy diet (protein intake is important) and keeping your mind active and engaged. 

A recent study reports another additional concern regarding frailty. Published in JAMA Neurology, this new study reports that frailty is tied to a greater risk of future dementia in older adults. According to this study of 30,000 US and UK participants, frailty may be an early indicator (as many as 4-9 years early) of the future onset of dementia. In this study, frailty scores among the participants were much higher in those who went on to be diagnosed with dementia. Thus, frailty may not only be a consequence of dementia but may also be a contributing factor to a dementia diagnosis. This result then suggests that frailty screening should happen more regularly so that efforts can be made to proactively combat or halt a frailty diagnosis and perhaps forestall or lessen the risk for subsequent dementia. To learn more about this study, click here or here.

Finally, one other recent study examined the connection between frailty and social isolation and loneliness. According to this study of over 2300 Dutch older adults (aged 55 and over) who were followed for over 20 years, frailty may lead to social isolation, and loneliness may both preceed and accelerate frailty. In essence, these conditions can form a vicious cycle, reinforcing each other and leading to further decline. But frailty, along with social isolation and loneliness, is not inevitable and can be addressed with interventions to both halt frailty, as mentioned above, and enhance the social engagement of frail adults. For more on this study, take a look here and here.