What Is Frailty, Really?

By Elizabeth Millard |

What it’s not: a synonym for an older person with weakness. Learn what frailty truly means and how you can prevent it.

Two older friends sharing a laugh

The word “frail” is often used to describe an older adult who is usually thin and has muscle weakness. But that usage isn’t entirely correct.  

Frailty is a true medical condition that can lead to serious complications, especially if you’re not familiar with the symptoms. That’s why we asked two geriatric specialists for insight on how frailty is diagnosed, why it’s a problem, and what you can do to prevent or treat it. Here’s what you need to know.  

What Exactly Is Frailty? 

“Frailty is a state of increased vulnerability to stressful events,” says Liron Sinvani, M.D., a geriatric hospitalist at the Feinstein Institutes for Medical Research at Northwell Health in Manhasset, New York. It’s not just about weak muscles or low bone density. Your entire system is affected, potentially lowering your immune response and increasing your risk of infections or chronic diseases, she says.  

“Frailty affects about 1 in 10 individuals over the age of 65 and leads to reduced function and health,” Dr. Sinvani adds. “It is a syndrome that means your body is less able to cope with everyday or acute stressors like illness, which can cause a ripple effect.”  

A more standardized definition for frailty is still being discussed within the medical community, adds Scott Kaiser, M.D., a geriatrician and director of geriatric cognitive health for Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California. But he says there’s agreement that it involves physiological decline characterized by vulnerability and a higher risk of negative health outcomes, including infections, illnesses that must be treated in the hospital, falls, and disability.  

What Causes Frailty and How Is It Diagnosed? 

Getting older — especially older than 75 — is a major risk factor for this condition, but it’s not the only one, Dr. Sinvani says. Other things that contribute to frailty include:   

  • Low physical activity levels or immobility 
  • Poor nutrition 
  • Social isolation or loneliness 
  • Chronic disease such as diabetes or heart failure 
  • Advanced illness such as cancer 

To diagnose frailty, your doctor will look for symptoms that include unintentional weight loss, exhaustion, and overwhelming weakness — meaning everything you do feels like it requires a big effort, Dr. Sinvani says. During a screening, you may also talk about:  

  • Whether you’ve unintentionally lost 10 or more pounds in the past year 
  • If you have trouble standing without assistance 
  • Whether you’ve noticed any problems with your grip strength, which can indicate overall muscle weakness 
  • If your activity level has declined in the past year, including formal exercise plus household chores and hobbies 
  • Whether you feel exhausted three or more days most weeks 
  • Your walking pace, since going slowly may be a sign of frailty 

“In diagnosis, we look at how all of these might be connecting together,” Dr. Kaiser says. “Usually, there can be a cascade of problems. For example, if you’ve lost a lot of weight, that may make you feel weak, and so you’ll spend more time in bed. In turn, that causes loss of mobility and balance and increases your fall risk and cognitive function,” he says. “Put simply, frailty involves some type of decline in terms of your health.” 

Can Frailty Be Prevented, Even If You’re Over 65? 

Frailty is not an inevitable part of aging, Dr. Kaiser says. Even if you have some early signs of frailty (such as any of the screening criteria mentioned above), it may be reversible with targeted interventions.  

“Research suggests that regular physical activity, including walking and strength training, can improve mobility and strength overall, which reduces the risk of weakness,” Dr. Kaiser says. In addition to exercise, other lifestyle habits can also be a boon, including:  

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  1. Eat healthfully. Aim for a diet that’s rich in vegetables, fruits, nuts, seeds, whole grains, seafood, and extra virgin olive oil and low in red meat, added sugars, and refined and processed foods. A meta-analysis published in the Journal of the American Geriatrics Society found that this way of eating, known as the Mediterranean Diet, is associated with a reduced risk of frailty in older adults. 
  2. Stay socially connected. Recent research in The Lancet tracked more than 9,000 adults over 14 years and found that both loneliness and social isolation increased the risk of developing frailty. The good news is that just as you can take steps to improve your fitness or diet, you can build social connections in several ways. Check them out here.  
  3. Keep your mind active and engaged. Cognitive difficulties and frailty have been linked in studies, and they seem to be bidirectional — meaning if you become more frail, then you’re more likely to struggle with cognitive impairment and vice versa, according to a research review in Frontiers in Medicine. Exercise is a great way to keep your body and mind strong, but other ways to keep your brain sharp include reading, learning a new skill, or creative activities such as painting, knitting, or drawing. 

All of these together are not only essential to decrease the risk of frailty, but they’re also key to its management. There’s no single treatment — such as medication — for frailty. What helps most is to get to the root causes and address those, Dr. Kaiser says.  

For instance, if you’re at higher risk of frailty due to poor diet or being sedentary, it can help to focus on changing those aspects of your daily life.  

“This is an important issue to see in its early stages because that’s when you can make the biggest difference,” Dr. Kaiser says. “Healthy habits related to exercise, nutrition, and social time can go a long way toward preventing frailty and helping to treat it if it’s already in progress.”  

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