Forget what you think you know about frailty and aging. Once a generalized description, evoked by Shakespeare as a “shrunk shank” of an old man, frailty is now recognized as a chronic condition that can be identified as early as mid-life, prevented and managed like other health conditions, but is twice as likely to occur in women than men.
When the pandemic forced a prolonged isolation over the last 2.5 years, we saw a substantial increase in loneliness and depression, especially among older women. For some, that brought on an acceleration of mental and physical deterioration, including the onset of frailty.
So, what is frailty? It is a syndrome, with its own symptoms, often associated with aging and characterized by loss of energy, muscle strength, and other reserves. Even small changes in health, such as a minor infection or change in medication, can put a frail person at significant risk of adverse outcomes. People who become frail are at high risk of falls and disability. When ill, they may be slow to recover, at risk of becoming dependent, and sadly, because of fear and limited mobility, they may become even more isolated.
Don’t be fooled by common misconceptions.
Frailty is a major concern in the field of geriatric medicine, but when I first began working with frail patients years ago, I was shocked that there was no standard definition or criteria. When working with older women, I noticed they often complained of a loss of energy as they aged, which wasn’t necessarily due to other conditions.
I remembered my mother, who remained active throughout her life, earning her Ph.D. in her 50s and teaching for many years after that. Her example showed me that staying vibrant at all ages is possible; frailty is not inevitable as we age. As I studied the problem more deeply with colleagues, I was able to debunk many of the misunderstandings around frailty and established a standard approach to assess it.
Here are few of the most common misconceptions around frailty:
- While many frail people are thin, frailty doesn’t necessarily mean you or a loved one have to be underweight. Those who are overweight or even an ideal weight may be frail.
- Frailty isn’t always a part of aging. Although its risk increases with age, it is not inevitable.
- Frailty isn’t necessarily permanent. Although symptoms can be debilitating, research shows that in some cases, early frailty can also be reversed.
- Although women have a higher incidence of frailty than men, with up to 10 percent diagnosed in their lifetimes, they appear to be more resilient than men, and their mortality rates are lower.
Often, but not always, people who are frail feel vulnerable or experience a loss of independence, and can become tentative or anxious about engaging in activities they previously valued, which can also lead to social isolation or loneliness.
Who is really at risk?
In the U.S., about 15 percent of adults 65 and older living at home or in assisted living settings are considered frail, according to Johns Hopkins University. That estimate jumps to 1 in 4 among people over 80 and almost 40 percent for those over 90.
Women carry a greater risk for frailty. This is likely because they tend to have less muscle mass than men, and age-related biological processes that diminish their muscle mass can cause their frailty to appear more quickly than men of the same age.
But don’t assume this is a condition that only affects seniors. Younger people have been found to exhibit pre-frailty symptoms too, starting in their 50s or even in their 40s. Early awareness is critical to intervention and preventing progression.
Those who have chronic diseases with high inflammation, like congestive heart failure, HIV, or kidney disease, are also at high risk of becoming frail. Diseases like these can worsen a frail person’s prognosis and impact the success of treatments. A doctor can diagnose the condition with the approach I developed, which assesses a person who has three or more of the of these factors: After a positive diagnosis, a doctor can provide treatment and guidance to prevent, affect and sometimes reverse frailty’s severity. For family and friends of someone with the condition, carefully observe their symptoms, including how vibrantly they live their lives: Two of the most critical ways to prevent frailty are through exercise and diet. Frailty can be caused in part by loss of muscle mass, which is related to aging. The effects of exercise, especially walking each day and resistance training with weights are similar to the benefits of getting a car tuned up: every part of one’s physiology runs better. Walking and easy strength training can improve strength and resilience. In addition to physical activity, diet matters, particularly eating protein and taking in enough energy each day through nutritious foods such as fish, chicken, vegetables, low-dairy products, and whole grains, rather than carbohydrates. Finally, stay engaged with others and continue to take part in activities you enjoy. Staying positive has numerous health benefits, including developing resilience against frailty. There is also a virtuous cycle to staying connected with others; for example, opportunities to eat with others improves eating and activity levels. Having a reason to get up in the morning helps you stay active.
Linda P. Fried, MD, MPH
Linda P. Fried, MD, MPH, is the Dean of Columbia University’s Mailman School for Public Health. With specialties in epidemiology and geriatric medicine, Dr. Fried has built programs to strengthen the public health focus on pandemic preparedness, the health effects of climate change, mental health at the community level, and increasing the health spans for longer lives. A member of the U.S. National Academy of Medicine, she received the 2022 Kober Medal of the Association of American Physicians and was named to City and State’s Health Power List of individuals leading New York through the coronavirus crisis. Recommended
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