Aging can take many paths throughout one’s lifetime. Some older adults will age well, with few major health problems and others will experience poor health with numerous comorbidities and medically complex conditions. A newer concept in the study of aging is one that many medical professionals are encountering and trying to prevent, delay or hopefully reverse. The condition is called “frailty” and it is becoming more common.
What is Frailty?
Researchers are still trying to more accurately describe and define frailty, as it is a newer concept. Some define it loosely as a range of physical and mental health conditions in older people including debility and cognitive impairment. Others say it is a clinically recognizable state of increased vulnerability associated with increased aging, a decrease in reserve and function, and a diminished ability to effectively handle daily stressors.
Increased Frailty, Higher Risk of Adverse Outcomes
Frailty in and of itself is not the only problem. Everything that it’s associated with and leads to can become very problematic in the lives of frail seniors. With increased frailty comes more risk of adverse outcomes including disability, multiple hospitalizations, poor quality of life, being admitted to a skilled nursing home and earlier death.
Frailty can also lead to:
- Decreased physical activity
- Falls with injury
- Cognitive decline
- Decreased nutritional status
- Depression
Risk Factors for Frailty
The concept of frailty can be confusing, because some of its causes are also its adverse outcomes. In a sense, it’s a rather circular concept. Some risk factors for what some researchers call “frailty syndrome” are:
- Aging
- Unhealthy lifestyle habits
- Low physical activity
- Poor nutrition
- Poor living environment
- Comorbidities
- Polypharmacy
- Genetics
- Being female
Many of these factors are interrelated and form a cycle. Ultimately, they lead to conditions including chronic malnutrition, rapid decline in health and premature mortality.
Interventions to Prevent, Delay or Reverse Frailty
Early detection of frailty and appropriate medical intervention can make a difference in prevention, delaying or reversing the effects of this syndrome. Frailty screening and multidisciplinary interventions should begin as soon as possible to prevent poor outcomes and reduce mortality rates among frail seniors.
Adherence to Medications
Because seniors take more prescription drugs than any other age group, making sure they take the right medications at the right time is vital. In order to ensure this, healthcare professionals and caregivers can educate the person on the importance of medication schedules, simplify dosage regimens, stay connected to their doctor and other medical providers, and watch for potential medication side effects.
Assessment and Prevention of Falls
One out of every four adults 65 years of age and older falls annually, some with serious injuries and death. Falls can lead to disability and admission into skilled nursing facilities. Frail seniors are at an increased risk for falls with serious consequences and should be assessed for the following risk factors:
- Living alone
- Polypharmacy
- Sedentary lifestyle
- Impaired cognitive functioning
- Impaired vision
- Malnutrition
- Alcohol or substance use
The fall risk assessment can include:
- A physical examination including functional and cognitive status
- History of past falls and outcomes
- Balance capabilities and muscle strength
- Cardiovascular function
- Orthostatic hypotension
- Medications and adverse effects
- Vision impairment
- Feet and footwear examination
- Environmental hazards
Preventing falls is crucial and starts with educating the senior about safety in the home or living environment. Sometimes decluttering the living space can help. Removing floor mats or area rugs can reduce falls as well as eliminating extension cords where possible.
Encouraging taking extra vitamin D, getting some exercise or moving around more, and reducing prescription medication that is deemed unnecessary may help frail seniors reduce risk of falling. Treating heart conditions, preventing orthostatic hypotension and wearing prescription glasses can all help reduce fall risk.
Exercise Interventions
A major risk factor and adverse outcome of frailty is decreased physical activity. Getting the senior to move around more often can help. Depending upon the individual’s health status, exercise interventions can be key factors in preventing, delaying and in some cases, reversing risks associated with frailty. Some important considerations concerning exercise interventions include:
- Frequency of exercises
- Duration of activity
- Intensity of exertion and resistance
- Types of exercise including balance, aerobic, endurance and flexibility
- Compliance with exercise sessions
- Assessment and risk involved with exercises
Interventions for Mood and Cognitive Function
Mood and cognition are both risk factors as well as adverse outcomes of frailty and should be assessed with appropriate interventions prescribed afterwards. Cognitive functions to be assessed include short- and long-term memory, language processing like writing, reading and speech, visual and special processes, and abstract thinking. Mood should be assessed for depression, lack of motivation, helplessness and low energy.
Final Thoughts on Age-Related Frailty
Frailty is the accumulation of risk factors as an individual ages. It is common among some older adults living independently in their own homes and is more common among those residing in skilled nursing facilities. Early detection is key to prevent further decline, delay associated adverse outcomes, and in some cases, reverse the condition through appropriate clinical interventions. Interventions can help reduce risk of falls, hospitalization, disability and premature death.