Doctors give frailty issues a closer look

6/3/2001

“Susan, I'm really concerned about your Dad. He looks so frail.”

“We visited grandma today and almost overnight, she's become frail.”

Frailty is one of today's most neglected medical problems. Although it affects millions of people, there isn't even a standard medical definition of frailty. Doctors disagree on how to identify a frail person. Medicine is at the starting line in treating frailty and in advising younger people on how to delay the start of frailty.

Why be concerned about frailty?

Frailty is an enormous medical problem that will increase in severity as the population continues to age. Estimates suggest that frailty affects 5 to 20 percent of the 35 million Americans who are over age 65. That toll will grow as the over-65 population doubles during the next 30 years.

Younger people with certain diseases, including advanced cancer and AIDS, also may become frail.

Frail people use the most medical care, often lose that treasured ability to live independently, and, as family and friends fear, are at a high risk of dying.

Dr. Linda P. Fried and a group of associates at medical centers around the country completed the first in-depth study of frailty in March. She is with Johns Hopkins University in Baltimore.

The study of 5,317 older adults found that frail people were six times more likely to die over a three-year period than more-robust elderly people.

Researchers also proposed a standard medical definition of frailty, based on symptoms observed among study participants. Dr. Fried described the definition as a landmark that should give scientists the first uniform definition to use in new studies on the cause, prevention, and treatment of frailty.

By their definition, frailty involves at least three of the following symptoms:

Shrinking, which is an unintentional weight loss of at least 10 pounds (or 5 percent of a person's body weight) over the previous year.

Weakness, measured by the individual's ability to grip and squeeze objects.

Poor endurance, including a lack of energy and exhaustion that occurs after low levels of physical activity.

Slowness, as measured by the time needed to walk a measured distance.

Frailty makes people so vulnerable - and pushes some over the brink - because it creates a dangerous situation in the body that doctors term “loss of reserve.”

Organs such as the heart, liver, lungs, and kidneys have a reserve capacity set aside for emergencies that put extra demands on the body. An illness or accident, for instance, may put extra stress on the heart or kidneys. Reserve capacity dwindles in frail people, and their organs may be unable to work over time.

Dr. Muriel R. Gillick, an authority on aging at Harvard University, points out in a new book (Lifelines: Living Longer, Growing Frail, Taking Heart) that “fixing the fixable” can delay or treat frailty. It involves preventing or treating medical problems that often cause frailty.

If four problems contribute to grandma's frailty, for instance, fixing even one can help. Angioplasty or bypass surgery, for instance, can boost the heart's reserve capacity. Treatment for high blood pressure can preserve the kidneys' reserve capacity.

Cataract surgery, a hearing aid, or strength-building exercises can reduce the risk of accidents and bone fractures. Antidepressant drugs can help many older people with clinical depression stay active and involved in life.

Dr. Gillick also emphasized that frail people and their families should be realistic about what medical interventions like surgery can accomplish.

All too often, with the current state of medical knowledge, people must accept the dependency that accompanies frailty and find new ways of living a meaningful life.

Michael Woods is the Blade's science editor. Email him at mwoods@theblade.com.