Understanding frailty

“Frailty” used to be a rather vague description, like “old age.” Currently, however, it is recognized as a cluster of conditions that deserves medical attention.

The following are signs of frailty:

• Complaints of fatigue
• Physical inactivity
• Slow gait (walking speed)
• Poor balance (frequent falls)
• Decreased strength (for instance, weak hand grip)
• Unintentional loss of 10 pounds, or 5% or more of body weight in the past six months

Between 5% – 17% of older adults can be considered “frail.” There is a continuum of frailty from “prefrail” to late stage. Frail individuals are more likely to become seriously ill from simple infections. They are more likely to be hospitalized and to become disabled. Not surprisingly, they are more likely to die sooner than their nonfrail peers. 

Frailty seems to involve a combination of physical processes in the body that reduces our normal reserves and resilience to bounce back from illness or a fall. Chronic inflammation—the immune system on hyperdrive—is a factor. Also the common reduction of muscle mass as we age. People with multiple chronic conditions also seem to be at higher risk.

No one organ system is to blame. And there are no blood tests, x-rays, or other imaging tests to confirm frailty.

To determine the level of frailty (and how best to approach it), you will want to get a full geriatric assessment. This will involve identifying medical conditions and creating a list of medications. But it also requires a functional assessment (how well your loved one can complete daily living tasks). Fall risk, hearing, vision, mental health, and cognitive impairment testing are also included. A care manager can assist you with these assessments.

Some aspects of frailty can be remedied. If your relative is in the “prefrail” or early-frail stage, they could benefit from strength training and balance exercises. Understanding frailty for those further down the continuum can help with decisions about how well a surgery or aggressive treatment is likely to be tolerated, or whether hospice is the most supportive option.

Are you concerned your loved one may be frail?
As the Roanoke and Lynchburg experts in family caregiving, we at Gentle Shepherd Hospice see frailty come up time and again in medical decision making. Want to learn what you can do to improve your relative’s resilience? Give us a call at 1-800-789-0586 (toll-free).