Frailty prevention: The key to well-being

Well-being has a different meaning to all of us and what we constitute as well-being and quality of life will shift during our life-course. Ultimately, we want to stay functional, fit and healthy enough to do all the things we want to, need to and love to do.

Frailty can be seen as a syndrome that signals a change in multiple physiological systems with age and is not necessarily linked to a disease.1, 2 However, comorbidities, inflammation, sarcopenia (muscle wasting), polypharmacy, endocrine disorders, decreased protein levels, energy malnutrition, social isolation and poverty can increase our risk of frailty.1, 2, 3

The International Association of Gerontology and Geriatrics Frailty Consensus defines frailty as a loss in strength and physiological malfunction that increases an individual’s risk of falls, institutionalisation, dependency, vulnerability and mortality.1

The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty include the following:1

(1) Identify frailty with validated measurements

(2) Implement a resistance training exercise program

(3) Monitor polypharmacy by reducing or deprescribing any inappropriate/excess medications

Conditional recommendations:

(1) Identify and resolve causes of fatigue e.g., lack of sleep, medication, underlying health conditions

(2) Resolve unintentional weight loss e.g., screen for reversible causes, protein and caloric supplementation

(3) Prescribe vitamin D for individuals deficient in vitamin D

The frailty index uses slow gait speed, weak grip strength, exhaustion, low energy expenditure and weight loss to quantify vulnerability. Other domains such as chronic disease, mood, social resources and cognition can also be used to measure frailty.4

Mobility and balance are especially vulnerable to changes in our overall health. However, these therapeutic multi-factorial interventions can delay or even prevent frailty.4, 5 Once again, this evidence-based research confirms the important role exercise, nutrition and active lifestyle plays in not only preventing frailty, but also maintaining our functionality, quality of life and well-being as we age.5

Resources

1.Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc. 2017 Jul 1;18(7):564-575. doi: 10.1016/j.jamda.2017.04.018. Erratum in: J Am Med Dir Assoc. 2018 Jan;19(1):94. PMID: 28648901.

2.Kenneth Rockwood, Arnold Mitnitski, Frailty in Relation to the Accumulation of Deficits, The Journals of Gerontology: Series A, Volume 62, Issue 7, July 2007, Pages 722–727, https://doi.org/10.1093/gerona/62.7.722

3.Linda P. Fried, Catherine M. Tangen, Jeremy Walston, Anne B. Newman, Calvin Hirsch, John Gottdiener, Teresa Seeman, Russell Tracy, Willem J. Kop, Gregory Burke, Mary Ann McBurnie, Frailty in Older Adults: Evidence for a Phenotype, The Journals of Gerontology: Series A, Volume 56, Issue 3, 1 March 2001, Pages M146–M157, https://doi.org/10.1093/gerona/56.3.M146

4.Cameron, I.D., Fairhall, N., Langron, C. et al. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med 11, 65 (2013). https://doi.org/10.1186/1741-7015-11-65

5.Fairhall N, Kurrle SE, Sherrington C, Lord SR, Lockwood K, John B, Monaghan N, Howard K, Cameron ID. Effectiveness of a multifactorial intervention on preventing development of frailty in pre-frail older people: study protocol for a randomised controlled trial. BMJ Open. 2015 Feb 9;5(2):e007091. doi: 10.1136/bmjopen-2014-007091. PMID: 25667151; PMCID: PMC4322196.