Dear Doctors: You had a column about frailty that got my dad's attention. He's 76, a former high school and college athlete and has always been strong. Now he's got one of the signs you talked about: less grip strength. I read you can head off frailty if you start soon enough. If that's right, how?
Dear Reader: The word "frailty" is commonly understood to mean physical weakness and fragility. However, it is also a clinical syndrome. This is a group of signs and symptoms that often occur together. Doctors consider this a state of health. As we discussed, the major markers of frailty include slowed walking speed, impaired balance, less grip strength and loss of endurance. While not defining features of the syndrome, conditions such as high blood pressure, diabetes, bone loss and changes in cognition can often show up.
When someone is diagnosed with frailty, it means the body has steadily lost strength and the ability to recover from stress. If they get injured, ill or develop a chronic disease, they are at higher risk of a poor outcome. They also get more vulnerable to stressors in the environment such as air pollution and extreme heat or cold. Frailty raises the risk of injuries, such as falls. It also raises the chance that the person will need to be hospitalized. This can start a steep and sometimes rapid physical decline.
The good news for your father is that, if addressed early enough, it is possible to slow or even reverse frailty. But it's important to understand that the syndrome is complex and has many causes. That means prevention is not guaranteed. Several factors influence the outcome. This includes a person's age, their overall health, their medical conditions and family history. It also depends on how well they can follow a prevention program.
You said your father has already noticed a decrease in grip strength. It would be a good idea for him to begin with a medical evaluation for frailty. This typically involves tests to assess walking speed, balance, mobility, strength and endurance. Nutrition, weight, thinking and mood are also often part of the assessment. If your father has other symptoms of frailty, they will be found through these tests. At the very least, the tests will provide an important baseline for the future.
A loss of muscle mass is a big cause of frailty. For that reason, a program to decrease risk focuses on both nutrition and exercise, especially strength training. Research suggests people who eat a Mediterranean diet have lower risk of frailty. That means focusing on plant-based foods, whole grains, legumes, healthy fats, fish, poultry and dairy. Older adults should also eat enough protein every day. Physical activity should include resistance exercises, cardio, balance work and stretching. It is also important to stay mentally and socially active. If your father has a frailty exam, his healthcare provider can tailor a program to his specific needs.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
