Frailty: Cause, Diagnosis, Treatment
Overview
Many people believe that frailty is only an inevitable result of aging instead of a medical condition, however, the latest study result shows that the opposite is true.
A landmark study was published on August 2 in the Journal of the American Medical Association (JAMA) Network Open. Researchers found that frailty is not an adjective used to describe the stage of old age, it is rather a medical condition all on its own. This discovery has significant medical, social and economic implications.
This first global study to estimate the likelihood of community-dwelling older adults developing frailty was led by researchers at Monash University in Australia. Researchers explored the incidence of frailty in 120,000 people over the age of 60 in 28 countries and found out that 4.3 per cent will develop frailty per year.
Cause
Frailty is associated with a lower quality of life and a higher risk of death, hospitalisation, and institutionalisation. The condition tends to occur among older adults, but even young people can be frail if they have one or more disabling chronic diseases.
Diagnosis
For now, there is no standard definition of frailty, but researchers and clinicians tend to regard it as a condition that meets three out of the following five criteria:
- low physical activity
- weak grip strength
- low energy
- slow walking speed
non-deliberate weight loss
Treatment
At present, there is no specific treatment for the condition of frailty. Treatment options for those who are frail or at risk should be aimed at any specific disorders that may be contributing to their frailty.
Disorders that may lead to increasing frailty and potential treatments are listed below:
- Falls/fractures. Treatment options include vitamin D, calcium treatment and exercise
- Depression. Treatment options include exercise, social interaction, counselling, psychotherapy and antidepressants
- Lowered testosterone (males). Treatment options include replacement therapy
- Cognitive impairment. Treatment options include cholinesterase inhibitors and exercise
- Hypothyroidism. Treatment options include L‐thyroxine
- Inflammation/muscle strength. Treatment options include exercise and statins/ACE inhibitors
- Type 2 diabetes. Treatment options include thiazolidinedione and anti‐glycaemics
- Blood‐clotting activity. Treatment options include aspirin
- Poor nutrition. Treatment options include dietary regulation
- CHD. Treatment options include antihypertensives, aspirin, statins
- Arthritis. Treatment options include NSAIDs and steroids
As more than 20 per cent of the world’s population will be aged over 60 years by 2050, the number of people diagnosed with frailty is projected to increase.
However, the news is not all bad. Interventions such as muscle strength training and protein supplementation may help to prevent or delay the progression of frailty.
The researchers also advocate for “regular screening to assess older people’s vulnerability to developing frailty so that appropriate interventions can be implemented in a timely manner”.
Keywords: frailty