Frailty Debilitates and Kills

Frailty predicts increased risk of death and other bad events

You can reduce your risk of frailty

While frailty seems obvious enough, science lacks a universally agreed upon method of evaluating frailty. The Frailty Index (FI) is commonly used to evaluating frailty in a clinical setting. Researchers calculate FI as the number of deficits a patient exhibits divided by the total number of deficits considered. For example, if a doctor finds that a patient exhibits five of 20 deficits that older people often commonly have, the FI for that patient would be 5/20 = 0.25. Deficits include symptoms or signs of chronic diseases or disabilities or social problems based on a patient examination or laboratory data. A recent systematic review and meta-analysis of 19 studies showed that the Frailty Index significantly predicted risk of premature death. Using pooled data for adults age 20 or older, each 1 percent and 10 percent increase in the Frailty Index predicted 3.9 and 28.2 percent increases in premature death risk, respectively.

A new study from the UK showed that a version of the Frailty Scale significantly predicted risk of death for patients admitted for emergency surgery. Specifically, each one unit increase in the seven-unit Clinical Frailty Scale (moving toward greater frailty) predicted an 80 percent increased risk of death over the 90 days following admission to the hospital. In addition, each one-unit increase on the scale predicted longer hospital stays and increased risk of re-admission after discharge. Frailty wasn’t restricted to the oldest old. Frailty (Clinical Frailty score of 5 or greater) appeared in 25 percent of patients aged 70-79. For older baby boomers who end up in the hospital for emergency surgery, their prospects decline greatly as their degree of frailty increases.

One of the most feared situations for elderly people is being confined to a nursing home due to inability to physically perform activities of daily life. Physical frailty is commonly regarded as an inevitable part of old age. But research suggests this isn’t true. Volunteers living in a long-term care home for the aged participated in a study to determine if lower-body resistance exercise training and nutrient supplementation would improve the their strength and functional capabilities. The 94 subjects (out of 100) who completed the 12-week training had an average age of 87 and nearly all required a care, walker or wheelchair to move about when the study began.

Resistance training mirrored that recommended for much younger people in that subjects used weights corresponding to 80 percent of the maximum amount of weight they could lift properly  one time. Weights used in the exercises increased as the subjects’ strength increased. Training sessions lasted 45 minutes with three sets of exercises of eight repetitions each. The researchers found that subjects in the exercise group increased lower body muscle strength by 113 percent, while those who did not exercise increased muscle strength by 3 percent. Gait velocity, stair climbing ability, and spontaneous physical all increased dramatically in the subjects who exercised compared to those who did not. Thigh cross-sectional muscle area increased by 2.7 percent and decreased by 1.8 percent in the exercise and non-exercise groups, respectively. Why did the size of the thigh muscle increased modestly, while lower-body strength increased greatly? Perhaps improved neural recruitment of existing but underused muscles created most of the observed increase in strength. It appears that older people can use progressive strength training to delay or eliminate the onset of frailty.

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