August 2024: Frailty in Older Adults

The issue
Frailty is a state of reduced physiologic reserve that becomes steadily more common with age: worldwide surveys show its prevalence climbs from ≈11 % in people aged 50–59 to over 50 % in those ≥ 90, especially among hospital or nursing‑home residents and the socially vulnerable.

What do I need to know?
Frailty can be viewed as (1) the Fried frailty phenotype — exhaustion, weakness, slowness, inactivity, weight loss — or (2) an accumulation‑of‑deficits index that counts chronic conditions, impairments, and lab abnormalities. Even “prefrail” adults (one‑to‑two Fried features) face higher risks of falls, disability, and death. Brief clinic screens flag those who need a full comprehensive geriatric assessment (CGA), which uncovers reversible problems and guides an individualized care plan. Evidence‑based countermeasures include multicomponent exercise, protein‑rich nutritional support, and CGA‑led medication reviews; all build muscle, cut hospitalizations, and slow functional decline, even though effectiveness in routine care varies.

Potential risk of frailty
An older adult is robust or prefrail (0–2 Fried features) but noting slower gait or new fatigue.
Recommended Actions

• Encourage aerobic + strength exercise 3–4 times/week, balanced diet, and social engagement to boost physiologic reserve.
  
  

• Review chronic‑disease control and ensure vaccinations and preventive screening are up to date.
  
  

Imminent risk of frailty
Three Fried features or rising deficit index but still independent in most activities.
Recommended Actions

• Request a CGA to identify treatable contributors (depression, hypothyroidism, drug side‑effects, poor nutrition).
  
  

• Begin supervised resistance training, add protein (1.2 g/kg/day) and vitamin D if low, and address polypharmacy.
  
  

• Arrange community supports (meals, transport, exercise classes) to maintain activity.
  
  

Confirmed frailty
Four‑to‑five Fried features, frailty index > 0.55, or dependence in daily self‑care.
Recommended Actions

• Continue tailored exercise and nutrition if tolerated; add physical/occupational therapy for mobility aids.
  
  

• Use CGA findings to deprescribe non‑beneficial medications and focus on quality‑of‑life goals.
  
  

• Strengthen social support, adapt the home for safety, and integrate palliative or hospice services when needed.
  
  

What can I do?
Ask the clinician, “Am I (or my loved one) at potential, imminent, or confirmed frailty risk, and what specific steps fit that stage?” Keep a log of weight, walking speed (e.g., time to walk 4 meters), and energy levels each month; share any decline promptly. Participate in community exercise programs or chair‑based strength routines if mobility is limited, and aim for protein with every meal. Family caregivers should help track medications, arrange CGA appointments, and ensure regular social interaction so small setbacks don’t spiral into lasting disability.