Frailty Syndrome

For today’s guest arti­cle I’d like to thank Lau­rie G. Jacobs, M.D., direc­tor of the Jack and Pearl Resnick Geron­tol­ogy Cen­ter, Albert Ein­stein Col­lege of Med­i­cine and Vice Chair, Clin­i­cal and Edu­ca­tion­al Pro­grams, Mon­te­fiore Med­ical Cen­ter.

This blog post first appeared in The Doctor’s Tablet, the offi­cial blog of Albert Ein­stein Col­lege of Med­i­cine.

 

Frailty: How a Constellation of Symptoms Leads To Risk

by Lau­rie G. Jacobs, M.D. on March 12, 2013

Elderly Man Walking with Son

Frailty Syn­drome

Frag­ile: This Side Up. Few of us find much ambi­gu­i­ty when faced with a mail par­cel marked with those four words. Yet the relat­ed word “frailty” often caus­es con­fu­sion among doc­tors and patients alike. The word “frail” applies to peo­ple, not things—and that’s where the top­ic becomes tricky.

Mer­ri­am Web­ster defines frailty as “being phys­i­cal­ly weak; eas­i­ly bro­ken or destroyed,” with syn­onyms list­ed as “break­able, del­i­cate, and frag­ile.” Most peo­ple asso­ciate this qual­i­ty with aging, although frailty is not unique to aging, and is not nec­es­sar­i­ly part of aging.

Frailty usu­al­ly appears as a state of decreased phys­i­cal func­tion and dis­abil­i­ty, but that is not always the case. Frail old­er adults, how­ev­er, do have a high­er risk of falling, of being insti­tu­tion­al­ized and even of dying soon­er than non­frail indi­vid­u­als of the same age.

Physi­cians, par­tic­u­lar­ly geri­a­tri­cians who spe­cial­ize in the care of old­er adults, have increas­ing­ly focused on try­ing to char­ac­ter­ize frailty in the hope of pre­vent­ing or treat­ing it—and help­ing pre­pare patients and fam­i­lies for its poten­tial­ly dis­abling effects.

Frailty is often viewed as a con­tin­u­um of changes in an indi­vid­ual, not as a sin­gle qual­i­ty that is present or absent. That makes its def­i­n­i­tion even more chal­leng­ing. Although con­sen­sus sur­round­ing the phys­i­o­log­ic def­i­n­i­tion of frailty has not yet been achieved, a work­ing def­i­n­i­tion has been estab­lished. It includes the pres­ence of three or more of the fol­low­ing qual­i­ties:

  • Weight loss
  • Weak­ness
  • Exhaus­tion
  • Low activ­i­ty lev­el
  • Slow gait (walk­ing) speed

Let’s take a clos­er look at each qual­i­ty:

Weight loss

Frailty can be indi­cat­ed by a loss of more than 10 pounds or 5 per­cent of total weight in the past year. This change rep­re­sents sar­cope­nia, the tech­ni­cal term describ­ing a decline in mus­cle mass, although it may also rep­re­sent inad­e­quate nutri­tion­al intake even when phys­i­cal activ­i­ty is low.

Weakness

Weak­ness is deter­mined by grip strength as mea­sured by a dynamome­ter. Nor­mal results vary by body-mass index—a mea­sure of one’s size—which is impor­tant in strength mea­sure­ments.

Exhaustion

Wors­en­ing exer­cise tol­er­ance may be mea­sured using a self-report­ed scale. Doc­tors often use a slid­ing scale to record patient respons­es to the fol­low­ing two state­ments: “I felt that every­thing I did was an effort in the last week” and “I could not get going in the last week.”

Low Activity Level

Activ­i­ty lev­el is mea­sured by calo­ries burned for activ­i­ties in a giv­en peri­od of time. Var­i­ous inves­ti­ga­tors have estab­lished a cut­off point—for exam­ple, activ­i­ties requir­ing few­er than 270 or 383 kilo­calo­ries per week.

Gait

A slow­er walk­ing speed is an indi­ca­tion of a gen­er­al slow­ing in motor per­for­mance. It has been mea­sured using sev­er­al stan­dard­ized tests that ask indi­vid­u­als to start walk­ing at their usu­al pace from a stand­ing start. They are timed for a stan­dard dis­tance and their speed is cal­cu­lat­ed as meters per sec­ond, mod­i­fied for height. For a 15-foot walk, six to sev­en sec­onds is a stan­dard pace.

There are oth­er ele­ments of frailty that may or may not be asso­ci­at­ed with the term, such as changes in cog­ni­tion, which have not been includ­ed in this list but should be mon­i­tored.

The def­i­n­i­tion of frailty still con­tains ambi­gu­i­ties; some indi­vid­u­als who appear frail do not meet these cri­te­ria, and still oth­ers who do not appear frail will be char­ac­ter­ized as such by this work­ing def­i­n­i­tion.

Indeed, unlike the fragili­ty of glass, frailty remains in the eye of the beholder—but we are slow­ly get­ting clos­er to the mir­ror.

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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods.

His website, askdrlavine.com, provides more information about his approach.

Please contact him at drlavine@yourbodyofknowledge.com or at 212-400-9663.

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