News

FRAILTY AMONG THE RIGORS OF AGING

By Dr. George V. Roberson/FOR YOUR HEALTH
Monday, February 16, 2009 10:23 AM CST

Q: Dear Dr. Roberson: My mother is 75 years old and up until about 3 or 4 months ago she was living alone. She had a bad kidney infection which had to be treated in the hospital with antibiotics. Since that time she has become weaker to the point that she is unable to care for herself. We had to put her in a nursing home. She recognized the family but stays in the bed and doesn't get out much. She doesn't eat a lot. There doesn't seem to be much we can do, according to the doctor. Do you have any suggestions?

A: Sometimes a severe acute event such as an infection requiring antibiotics, a fractured hip requiring surgery and bedrest, or a malignancy which can be treated and cured in an elderly person may tip the scales to a progressively declining state of health. The relentless path to old age, frailty and death has been a hopeless enigma of medicine. Around 100 years ago the average life span was about 42 years. We have subsequently extended that to approximately 80 years for women and about 75 for men with remarkable advances in medicine and surgery. Despite that, the end result is always the same. In Ptolemy's treatise, the last years of life were described as “dispirited, easily offended, and hard to please.”

Geriatric physicians at the University of Arizona in Tucson, Ahmed, Mandel, and Fain have described an emerging geriatric syndrome of frailty. It is identified by decreased reserves in multiple organ systems, initiated by disease, lack of activity, inadequate nutritional intake and stress. It generally develops slowly, a stepwise process with increments of decline frequently precipitated by an acute event.

As we grow older, our capacity to respond to stress is limited. Frailty appears to be a product of excess demand imposed on reduced activity, according to Powell in the Journal of Social Medicine. Once individuals become frail there is often a rapid, progressive, self perpetuating downward spiral toward failure to thrive and death.

Old age, however, is not synonymous with frailty syndrome. Only about 3 to 7% of elderly people between the ages of 65 and 75 can be classified as being frail. It increases with age to about 20% after 80 years of age and 32% frailty after 90 years of age.

Why is frailty important? Currently 20% of the population is over 65 years of age. The most rapidly growing segment of the population are those over 85 years of age. As the elderly population continues to grow the impact of frailty will be felt throughout families and will pervade our economic healthcare and social systems.

Multiple causes can lead to a state of frailty, including immobility, chronic illness, and even poor dentition. Poor dentition itself cannot cause frailty but leads to chronic undernutrition, eventually muscle waisting and placing the patient in the cycle of developing frailty and progressive deterioration.

Diagnosis of frailty requires 3 of the following charateristics: