When you think of a person being frail, you have the picture of someone who is very elderly, thin, bent over typically with at least a walking stick or possibly even in a wheelchair. Unfortunately, frailty is more common and more pervasive than this typical stereotype.

A recent study of 3000 people over the age of 65, followed for two & a half years, revealed that frailty is much more common than once thought. It appears that 6% of people over the age of 65 who were surveyed were considered frail, whereas 38% were considered pre-frail, leaving only 56% considered robust. The news is even worse for women where this is 8% being frail and 41% pre-frail whereas with men frailty occurs in 5%, pre-frailty in 34%.

So, what is the definition of frailty? Frailty is defined as a heightened risk of illness or injury from even relatively minor stresses. Pre-frailty is where the symptoms of frailty may be present but physical capability is not diminished compared with those who are frail. The physical and physiologic consequences associated with frailty are increasing weakness, falls and tendency to fracture.

There is a very useful frail scale which goes by the acronym, strangely, FRAIL. For every one yes answer, you score one point and if you answer yes to three or more questions you are considered frail, whereas one to two questions are considered pre-frail.

Frail scale

  1. Fatigue - are you tired most of the time?
  2. Resistance – do you need help walking up stairs and do you have difficulty getting out of a chair?
  3. Ambulation-can you walk one block without any problems?
  4. Illness-Do you have five or more illnesses? When you think about this answer it may be as simple as High blood pressure, obesity, diabetes, osteoporosis and arthritis. These are five illnesses and this gives you one point.
  5. Loss of weight - Have you lost more than 5% of your body weight unintentionally over the past six months?

It is fact that from age 30 we lose muscle mass and bone mass. This is especially so for people who are inactive where you can lose 3 to 5% of bone and muscle mass per decade which accelerates over age 65. At age 30 we have maximum bone strength and especially after menopause, women for five years the rate of bone loss can be as much as 2-3% per year and then 1 % per year, thereafter. Typically, a female loses 53% of their peak bone mass by age 80.

Some recent interesting studies around frailty looked at 3200 adults 65 and older in the Health and Retirement study commencing in 2008. This study showed that those who consumed a moderate amount of alcohol, (two standard drinks per day) were less frail and had lower inflammatory markers compared with people who were heavy drinkers or non-drinkers. This has also been shown to reduce the risk for cardiovascular disease.

The second study revealed in just over 3100 adults 50 and older found that people who were considered frail and also had prolonged sitting had a much higher death rate whereas people who were not frail and sat for prolonged periods of time did not have any health effects.

The final study showed that those people who consumed basically a Mediterranean diet were much less likely to be frail.

My five tips for preventing and treating frailty are as follows:

  1.  Exercise is definitely the most important aspect here. The Walker suggested dose is three to five hours per week with two thirds cardio and a third resistance training
  2. Dietary intake along the lines of the Mediterranean diet with good regular doses of high-quality protein
  3. Medication review-many people are on multiple therapies for different conditions which can lead to significant side-effects. The most commonly prescribed drugs in the world are statin drugs to lower cholesterol which can cause fatigue and muscle pain. Many other drugs can lead to fatigue, dizziness and excessive drops in BP. It is vital to check with your doctor and pharmacist as to whether these drugs are all vitally necessary and what potential interactions can occur.
  4. Vitamin D-Through sunlight or supplements is vitally important and low levels of vitamin D are associated with the number of illnesses along with fatigue. These include osteoporosis, cardiovascular disease, cancer, multiple sclerosis, depression, asthma and Type II diabetes.’
  5. Ubiquinol - the active version of coenzyme Q 10 and one of the major drivers of the little fuel packs in every cell, called the mitochondria. This is an excellent supplement to take for people who are tired, people with muscle pain or people taking statin drugs.

Thus, frailty is not a condition reserved for the very elderly but is something that can seriously affect health in middle age. As with all conditions, the best management is prevention.