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Frailty in the Elderly: Can It Be Prevented?

Aging Article   (5,720 Views 6 Comments)
VickyRN VickyRN (New Member) New Member

VickyRN is a Nurse Educator with over 23 years in experience.

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This article discusses frailty, a common geriatric syndrome that is a predictor of falls, impaired mobility, functional decline, disability, hospitalization, institutionalization, and death. Can this devastating syndrome be prevented?

Frailty in the Elderly: Can It Be Prevented?

Frailty in the elderly is a difficult concept to define, yet we all know it when we see it. It is not a medical diagnosis per se, but a word commonly used to describe a state of fragility, vulnerability, and weakness. Frailty, once termed 'failure to thrive' in older adults, is now considered a distinct geriatric syndrome and component of the terminal aging process, a condition that is predictive of injurious falls, impaired mobility, functional decline, worsening disability, hospitalization, institutionalization, and death. Affecting 25 to 40 percent of persons aged 80 and above, frailty is a serious concern in the elderly.

It impedes function, adversely affects quality of life, speeds up the aging process, and shortens life expectancy. Frailty can be seen as a forewarning of serious medical issues and death within a few years. Indeed, frail elderly individuals have a sixfold higher mortality rate than their normal aging counterparts.

Frailty has been loosely defined as a syndrome that is marked by deteriorating health, loss of vital reserve, poor tolerance to stressors, and increased vulnerability to sickness and death. Frail older adults are less able to tolerate the stress of medical illness, hospitalization, and immobility. They are more likely to die, be hospitalized, or become disabled. Not surprisingly, frailty dramatically increases healthcare costs, greatly adding to the burden of individuals, families, and society.

The healthcare expenses of frail elderly people are five times those of non-frail elders.

The cardiovascular health study research group categorized frailty as a condition in which at least three of the following five symptoms are present: weak grip strength, a slow walking speed, low physical activity, unintentional weight loss of 10 pounds or greater in 1 year, and self-reported exhaustion. Frailty is associated with malnutrition, long-term illness, osteoporosis, cognitive impairment, and muscle weakness.

An increasing challenge that individuals face as they age is the reduction of muscle mass and/or function. This loss of skeletal muscle mass is known as sarcopenia. By age 75, most people lose one half of the skeletal muscle mass they had at their prime. The loss of muscle mass is even more pronounced in the frailty syndrome.

With the loss of muscle, there is also loss of strength, stamina, endurance, and flexibility. Since sarcopenia markedly contributes to weakness and fatigue, it is a key component of frailty.

The aging process is being studied intensely concerning interventions to decrease or prevent frailty. Research has shown that sarcopenia is not inevitable with aging. Resistance training can significantly improve muscle strength and performance, even into advanced old age.

Physical activity is important for older adults to maintain health, preserve the ability for self-care, and improve the general quality of life. Exercise increases mobility, improves gait and walking speed, and strengthens bone density. Inactivity, on the other hand, causes the cells to age faster. There is a growing body of evidence that the aging process can be reversed and frailty delayed by adoption of healthy lifestyle changes, such as exercise or physical training, a heart-healthy diet with plenty of fresh fruits and vegetables, and adequate daily protein and vitamin d intake.

References:

Sarcopenia prevention

 

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VickyRN is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is faculty in a large baccalaureate nursing program in North Carolina.

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the aging process is being studied intensely concerning interventions to decrease or prevent frailty. research suggests that sarcopenia is not inevitable with aging. resistance training can significantly improve muscle strength and performance, even into advanced old age. physical activity is important for older adults to maintain health, preserve the ability for self-care, and improve the general quality of life. exercise increases mobility, improves gait and walking speed, and strengthens bone density. inactivity, on the other hand, causes the cells to age faster. there is a growing body of evidence that the aging process can be reversed and frailty delayed by adoption of healthy lifestyle changes, such as exercise or physical training, a heart-healthy diet with plenty of fresh fruits and vegetables, and adequate daily protein and vitamin d intake.

there's also a lot of anecdotal evidence out there of people enjoying robust health into "old age". i'm of the mindset of, if you don't use it, you lose in regards to muscle and skeletal. but diet i think is part of that equation and good point about vitamin d.

some anecdotal stories below.

awesome 86-year-old gymnast on msn video

http://www.youtube.com/watch?v=dflpcczthwu&feature=related

100-year-old runner finishes toronto marathon | other sports | detroit free press | freep.com

mimi kirk (world's sexiest vegan) 71-year old talking about her raw food diet - youtube

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There's also a lot of anecdotal evidence out there of people enjoying robust health into "old age". I'm of the mindset of, if you don't use it, you lose in regards to muscle and skeletal. But diet I think is part of that equation and good point about Vitamin D.

Some anecdotal stories below.

Awesome 86-Year-Old Gymnast on MSN Video

If An 83 Year Old Can, Why Can't You? old man practicing yoga, going to gym, treks - YouTube

100-year-old runner finishes Toronto marathon | Other Sports | Detroit Free Press | freep.com

Awesome links, Tweety! Thank you :)

I thoroughly and enthusiastically agree with you. Particularly with the musculoskeletal system, if we don't use it (as we age), we will lose it! Having adequately toned and built up skeletal muscle is critically important to health and well-being, because the more skeletal muscle we have, the higher our metabolic rate, the more calories we burn, and less proportionate body fat (particularly the dangerous visceral body fat that contributes to metabolic syndrome and cardiovascular decline). We also will feel more energetic, with more stamina and endurance. I make it a point to put the pedal to the metal - I bicycle approximately 5 miles daily (whenever weather or my job permits). And it's really toning me up with improved flexibility.

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Very interesting article. I've taken a personal interest in this subject as I'm at the age where I'm rapidly becoming the "elder generation" in my family, meaning that in the last 5 years I've had an up close and personal look at deaths of my parent's generation, at what age they pass away, and what was their general state of health in the 5 to 10 years prior.

You just can't help but come away with the impression, anecdotal as these observations are, that lifestyle is a precursor to the severity of the frailty that makes our elders vulnerable to the issues you described, and it's quite striking. Regular exercise, proper nutrition, following your rehab plan if you do suffer an injury, and even things like social interaction and brain-games like crosswords or card games like Bridge (I personally think my father-in-law stays sharp as a tack due to bridge and pool, lol) really do matter, and improvements can be seen even if the good habits are started later in life.

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You just can't help but come away with the impression, anecdotal as these observations are, that lifestyle is a precursor to the severity of the frailty that makes our elders vulnerable to the issues you described, and it's quite striking. Regular exercise, proper nutrition, following your rehab plan if you do suffer an injury, and even things like social interaction and brain-games like crosswords or card games like Bridge (I personally think my father-in-law stays sharp as a tack due to bridge and pool, lol) really do matter, and improvements can be seen even if the good habits are started later in life.

I heartily agree, nursel56. Recent research has concentrated on learning about keeping people healthy and active for a longer period of time, rather than on extending their lives in a state of long-term disability.

In fact, Healthy People 2020 breaks with earlier agendas for aging (i.e., emphasis on increasing life expectancy) and actually calls for a healthy old age, in which the elderly are successfully maintaining function into advanced old age. It is no longer good enough to merely have abundance of years, but the focus now is on having quality of life along with the longevity. Among the goals for older adults listed in the Healthy People 2020 agenda:

Reduce the proportion of older adults who have moderate to severe functional limitations.

(Developmental) Increase the proportion of older adults with one or more chronic health conditions who report confidence in managing their conditions.

Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities.

Source: Healthy People 2020: The Road Ahead

Although the concept needs further research and refinement (just like frailty), one definition of 'successful aging' is 1) avoiding disease and disability, 2) maintaining mental and physical function, and 3) continuing engagement with life. # 2 and # 3 especially go along with the Activity Theory of Aging, which I have discussed here.

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Thanks for the links VickyRN.

I did some papers on Healthy People 2010 when I was getting my BSN and then forgot about it. Good to see their new focus is on quality not just quantity.

I hope it's a message we boomers get, because we are going to be a huge burden on our children and grandchildren if 75 million of us became frail. Like I said, we have no guarantees but for some of us, in fact probably most of us, frailty is an option not an inevitability.

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