Updated: Apr 25, 2021
There are five indicators for frailty are (1.) muscle weakness, (2) fatigue,, (3) reduced physical activity, (4) slow walking (gait) speed, and (5) weight loss.
The American College of Sports Medicine (ACSM) states that exercise and physical activity for frail people is more beneficial than any other intervention and that muscle strengthening and balance training to be most important and recommends this to be performed three day per week for at least 3 to 5 months for increasing functional ability in frail older adults.
Exercise is key to maintaining muscle mass that enables performance of the activities of daily living. Even at advanced age of 90+ older adults can improve strength, balance and mobility. Frailty prevention is cheaper than treatment. Physical frailty Is a manageable condition. When an older adult has been diagnosed with frailty immediate intervention is necessary.
Effects of frailty are falls, hip replacements and a gradual downward spiral where a vulnerable older adult dies from complications.
Frailty is a clinical state in which the ability of older people to cope with acute or everyday stressors is compromised by increasing vulnerability brought by age-associated declines in physical function and reserve across multiple organ systems.
Which means there is an increase in an individual’s vulnerability for developing dependency and/or mortality with any kind of change in health status such as infection or physical injury such as a fall.
Falls and frailty
Frailty as a risk factor for falls, and frail older adults are likely to experience recurrent falls, hip fracture, and death. Frail older adults are at high risk of complications during medical treatment or illness, have prolonged recovery times, and often hospital re-admissions.
Muscle loss and loss of function
Sarcopenia or loss of muscle plays a major role in what many believe advances functional loss and contributes to becoming frail. Studies have shown that without the intervention of progressive resistance training, lean muscle tissue loss can begin as early as the age of 30. These small changes go unnoticed or are even accepted as part of normal aging until a person finds difficulty in completing simple tasks. While the outward circumference of a limb may remain the same, the interior integrity of the muscle mass is decreasing.
Exercise to prevent and reverse frailty
Exercise in frail individuals increases functional performance, walking speed, chair stand, stair climbing, and balance, and decreased depression and decreased fear of falling. Matching the exercise routine to a person's personality and physical ability if an art as well as a science. Exercise programs need to aim to improve functional activities of daily living.
Regaining and maintaining muscle can be done with resistance training using hand weights, resistive tubing and bands, a ball, and ankle weights.
Helping frail older adult improve function
Qualified health and fitness professionals need to have the patience and skills suggesting participation in activities clients/patients don't want to do and have the ability to adapt fitness methods to a client/patient’s abilities and conditions and focus goals on improving functional wellness.
Frail obese: increased risk for joint injuries due to high stress (bodyweight),joint pain> inactivity > reduction in muscle strength and bone density etc. Fracture risk/spontaneous fracture due to heavy weight on a compromised skeletal system
Symptoms of frailty
A person is considered frail if they demonstrate at least 3 of these symptoms, and pre-frail with one or two symptoms.
Unintentional weight loss (10 lbs. in a year)
Slow walking speed
Low physical activity
Signs of frailty
Changes in muscle loss, functional impairment, cognitive impairment, depression are changes marking increased risk
Balance and gait/walking abnormalities
Medication and frailty
Polypharmacy or taking multiple medications is recognized as a possible major contributor to the pathogenesis of frailty. Reduction in inappropriate medicines can clearly decrease costs and medication side effects in frail populations. Some drugs and the side effects of long term use of medication affect muscle function. Overmedication may cause sleepiness and lack of motivation to exercise.
For the purposes of optimally managing individuals with physical frailty, it is recommended all persons older than 70 years and all individuals with significant weight loss ( ≥ 5%) due to chronic disease should be screened for frailty. (NIH Frailty Consensus: A Call to Action PMC4084863)
Several screening tools are available to recognize and diagnose pre-frailty and frailty.
Most tools focus on 1 or more of the 5 core domains that define the frailty phenotype: slowness, weakness, low physical activity, exhaustion, and weight loss-sarcopenia or muscle loss.
Early recognition and diagnoses
Early recognition and diagnoses of pre-frailty and frailty can greatly reduce the risk and prevent accelerate loss of function due to the effects of frailty and related increasing healthcare costs. Early intervention with frail persons can improve quality of life and reduce costs of care. If you recognize the symptoms of frailty in yourself or a loved one, immediate intervention is needed. The Corona virus and the risk for Covid-19 resulted in many older adults to be physical inactivity-too much sitting or lying down which reduces muscle strength, leads to weight loss and muscle wasting.
In-home and virtual exercise training
Fitness & Function continues to provide wellness services during this challenging time. Our health/fitness professional use personal protection equipment, wear a face mask, practice frequent hand washing, use hand sanitizer or wear gloves and ask our clients to do the same. You have the option to switch services can from in-home visits to virtual visits.