I have a few over-age-50 patients who are on the “frail” side.  Though frailty is typically thought of as a condition that affects much older (over-age 70) adults, usually women, it isn’t always strictly associated with someone’s age.  If you, or someone you know, are frail, let me tell you about the unique health concerns that this condition can pose.

Frailty Poses Special Health Concerns

In medical terms, frailty generally means that you’re of slighter build without a lot of muscle mass – most often from unintentional weight loss.  This weight loss can be a result of several things, lack of adequate food, excessive smoking, alcohol drinking, chronic or acute health conditions, like COPD, intestinal disorders, cancer, illness treatments, even depression.

Being frail with less muscle mass, you likely move slower, have less endurance for physical activity and often fatigue more easily. You may even require assistance with activities of daily living in dressing, bathing, or just getting around.  The extent of health care services, or placement in a nursing home depends upon the degree of declining fitness and physical endurance a person develops, as they get older.

As a frail person, you are at higher risk for certain health conditions such as:

• Infections – the immune system of frail adults is much weaker than healthy adults.  Simple infections can become very serious in frail people.
• Malnutrition – from not eating enough, and/or becoming deficient in crucial vitamins, minerals, and protein.   Low vitamin D levels have recently been found in research out of Oregon State University to be associated with an increased risk of death in frail persons.  Many frail people do not get enough sun exposure and are deficient in vitamin D.
• Low blood pressure – lack of food and fluids intake can result in low blood pressure, which puts frail people at much higher risk of death. Recent studies out of the University of Oregon show higher than normal blood pressures in frail people may actually be more protective to their overall health and survival.

Can Frailty Be Treated?

Yes, of course! It’s never too late to try and turn around nutritional deficiencies and muscle mass loss that has lead to a weakened, frail condition. If you have a chronic health condition that has lead to your frailty, keeping good strength and nutritional status will likely be an ongoing issue for you.  Working to maintain good nutrition and physical endurance, though, will help you feel better and manage your particular health issue better.  It will also keep you feeling stronger and help you stay more independent – especially as you get older.  Here are some things I recommend to my frail patients:

• Optimize nutrition.   Make use of vitamin/mineral fortified supplement shakes to bolster any nutritional deficits you may have. Try to prepare high nutrition meals.  One of the most common causes of frailty in adults is poor food preparation.  Often, older adults living alone opt for eating a can of soup instead of taking the time to prepare a higher calorie, balanced nutritious meal.  If you need help preparing meals, perhaps a friend, family member, or even a neighbor can help you with this.  There are also community outreach programs that assist with meal preparation and/or delivery of prepared meals.
• Aerobic Exercise.  Though you may not feel strong enough to exercise, next to building your nutrition, it is one of the most important things you can do to decrease frailty.  It not only helps your muscles get stronger, it helps your breathing capacity, blood flow throughout your body, and brightens your mood. Start by walking 10 minutes a day; get a friend or family member to go with you if necessary.  Extend the length of your walk every week to build up your endurance.  If you have access to a community pool, walking in the shallow end, or paddling on a board, can also help build strength and endurance.
• Resistance Exercise.  You don’t have to go to a gym to do resistance exercise. Fill a few plastic milk jugs halfway with water at first.  Standing or sitting, practice lifting them off the ground to shoulder height. Then extend them slowly over your head.  As you get stronger, fill the jugs a little fuller.  Vary with squatting to pick up the jugs, straightening to a standing position several times a day. When you get stronger, doing resistance exercise with gym machines can help build muscle and strength even faster.
• Stop smoking, excessive alcohol drinking. Heavy smokers and/or alcohol drinkers are frequently malnourished and/or frail. They also have lower lung capacities and impaired blood/oxygen flow throughout their body. Ask your doctor about the many programs available to help you quit smoking and/or drinking.

Frailty is a condition I prefer my patients avoid at any age – especially as they get older.  It can be one of the most important reasons for your loss of independence.  If you have specific medical conditions that have lead to your frailty, work with your doctor to create a detailed plan to help your frail condition return to strength and health.

Stay well,
Mark Rosenberg, M.D.
Natural Health News

Frailty in Older Adults, http://jama.jamanetwork.com/article.aspx?articleid=204046

Frail, Older Adults With High Blood Pressure May Have Lower Risk of Mortality,

http://www.sciencedaily.com/releases/2012/07/120716162947.htm

Lower Vitamin D Could Increase Risk of Dying, Especially for Frail, Older Adults, http://www.sciencedaily.com/releases/2012/07/120726135232.htm

Photo credit: hurstville.nsw.gov.au