Dear Doctors: I was interested in your column about frailty. My husband and I turned 80 this year, and we show some of the symptoms you mentioned, but neither of us considers ourselves frail. Isn't it normal to slow down as one gets older? What is the point of this diagnosis?
Dear Reader: Thank you for an excellent -- and important -- question. Frailty has the misfortune of including a word that conjures a specific image, which can make the diagnosis challenging to explain. The word "frail" suggests someone is fragile, weak and vulnerable. However, that doesn't accurately reflect the medical concept. A diagnosis of frailty indicates how well someone can withstand a stressor such as injury or illness, and how successfully they can rebound from it.
Frailty is often assessed using a clinical tool known as the Fried frailty index, which focuses on five criteria. They include physical weakness, poor endurance, unintentional weight loss, slow walking speed and low physical activity. As you point out, some of these are common effects of older age. But a clinical diagnosis of frailty looks for clusters of symptoms. When the criteria of the Fried index occur together, they telegraph a loss of physical resilience. This, in turn, signals a distinct risk to health and well-being.
Meeting one or two criteria of the Fried index indicates prefrailty. This is an intermediate state, a warning sign that clinical frailty may be on the horizon. It is also a point at which, with proper nutrition and exercise, it can be possible to reverse the symptoms. Meeting three or more of the criteria indicates clinical frailty. At this point, even a relatively minor illness or injury can set off a cascade of complications.
One example is a chest cold. For a stronger adult, it's unpleasant. But thanks to their physiological reserves, they can fight it off and fully recover. In someone diagnosed with frailty, it can more easily lead to complications such as pneumonia, and to a hospital stay. Simply being hospitalized adds to the risk of illness or infection. The loss of endurance associated with frailty often slows recovery and can lead to a loss of autonomy. Rather than remaining a manageable setback, that chest cold can escalate to a prolonged struggle.
And that brings us to your question about the point of this diagnosis. With prefrailty, it is a chance for the person to make beneficial lifestyle changes. These typically include adopting a nutrient-dense diet rich in vegetables, fruit, soluble fiber and adequate protein. On the physical side, strength training, balance and mobility work, and cardio work, each tailored to the person's abilities, build resilience. When someone is diagnosed with frailty, it helps family members and clinicians respond appropriately to illness and injury. And there is evidence that when identified in an early stage, frailty itself can be improved. The goal of the diagnosis is to give the person the information they need to keep minor medical setbacks from cascading into life-changing medical events and to preserve independence.
(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.)
