Frailty in the Elderly
The Japanese Centenarian Study has identified nine factors important in living to be 100-years and independent.-that is preserved activities for daily living, and good cognitive and social status)
These are good visual acuity; regular exercise; spontaneous awakening in the morning; preserved mastication; no history of drinking alcohol; no severe falls after age 95 years; frequent protein intake; living at home; and being male.
Factors militating against such longevity are a low level of exercise, a tendency to fall, and low protein intake.
Frailty is not an unavoidable consequence of accumulating years but an independent geriatric syndrome/ The clinical characteristics are anorexia, sarcopenia, osteoporosis, fatigue, risk of falls, and poor physical health. Frailty makes elderly people highly vulnerable to disability, dependency, need for long-term care, and death.’ On the basis of US studies, frailty affects about 7% of people aged 65 years or older and about 25-40% of octogenarians or those who are older.
Frail elderly people have reduced stress tolerance because of decreased physiological reserves in the muscles, bones, circulation, and hormone and immune systems.
The presence of three or more of the five Fried criteria is increasingly used for clinical diagnosis: unintentional weight loss, exhaustion, low energy expenditure, slowness, and weakness. The natural course of frailty is progressive, increasing the risk of comorbidity and disability over time. The term primary frailty can be used when the state is not associated directly with a specific disease, or when there is no substantial disability; secondary frailty when the syndrome is associated with known comorbidity such as dementia or overt cardiovascular disease .
The increasing frequency of obesity in elderly people further complicates the clinical picture. For so-called fat-frail individuals,-frailty is actually inside and not readily apparent. The replacement of muscle for fatfurther complicates the problem of frailty.
Frailty commonly coexists with coronary heart disease, and is associated with an inflammatory state” For effective prevention and treatment of frailty in elderly people, the syndrome (particularly the primary form) must be recognised and interventions need to start early. Screening for frailty is important.
Exercise to preserve and increase muscle mass and strength, and appropriate nutrition (especially adequate protein intake) are first-line treatments for primary frailty. Patients with secondary frailty also benefit from these along with good care of the underlying disease and palliative care in late stages of frailty and disease. Furthermore, patients with frailty should be given appropriate treatment for pain and depression. Falls and their consequences should be prevented with balance control, vitamin D, hip protectors, and adequate treatment of osteoporosis. Immunisation against influenza, pneumococcal pneumonia, and herpes zoster can protect the frail body from acute and subacute strain.
From Frailty in elderly people. Lancet 2007, 369, April 21 1328-9 by Strandberg and Pikala
- Martin Eastwood