John Morley, MD, on Fragility

The word "frail" is used colloquially to describe older people so often that many people do not realize that frailty is a distinct geriatric syndrome. Dr. John Morley, an authoritative figure in our emerging understanding of frailty, answered some of Infoaging's questions about frailty and aging.

What is frailty? What causes frailty and how is it different from the physical changes that characterize normal aging?

Frailty is a vulnerable state where an individual is at increased risk of adverse health states and/or dying when exposed to a stressor. Physical frailty is characterized by:

Fatigue

Resistance problems – Can’t walk up a flight of stairs

Aerobic problems – Cannot walk a block

Illnesses – Greater than 5

Loss of 5% or more of weight in 6 months

It is caused by multiple diseases, polypharmacy, lack of exercise and inadequate food intake. It differs from aging by showing multiple deficits in the individual.

What, if anything, can older adults do to prevent frailty?

Exercise (both resistance and aerobic) is key to preventing frailty. This should be between 20 to 30 minutes a day. High protein intake helps to maintain muscles. Much data supports taking 1000 IU of vitamin D daily.

What are the best things frail older adults can do to protect their health and independence? Can frailty be reversed?

Frail older persons need to be in a regular exercise program (resistance, aerobic and balance). They should maintain their weight eating a high protein diet. They should take 1000 IU vitamin D daily. They should have pneumonia and influenza vaccinations. They should have a geriatrician review their medicines to see whether they can be reduced. If depressed older persons should get treatment.

There is substantial data that physical frailty can be reversed and/or its course can be delayed.

Hospitalization can be especially risky for frail adults. What can older adults do to protect their health and functionality when hospitalization is necessary?

In hospital it is important not to stay in bed and to walk around as much as possible. Acute Care for the Elderly (ACE) units that encourage older persons to get up and move around have been shown to improve hospital outcomes. Older adults lose 1 kg of muscle within 3 days of being admitted to hospital. A leucine enriched protein supplement may prevent muscle loss. Polypharmacy (too many drugs) leads to unexpected side effects in older persons, so question why you are being given a drug and if it is necessary. Make sure you are receiving at least 1000 IU of vitamin D each day in hospital.