Symptoms of Frailty

Frailty 101: Symptoms, Causes, Diagnosis & Management

Frailty is an ageing-related syndrome that causes older adults to have weakened health or strength. Learn more about frailty, its symptoms, causes and how you can help an elderly living with frailty.

by Calvyn Ee

What is Frailty?

Frailty syndrome, or frailty, is a medical condition where an elderly person goes through significant physiological decline and is more vulnerable to negative health outcomes. A frail person will have lower energy reserves that can prevent them from doing regular activities of daily living (ADL). While a decrease in energy levels is a normal part of ageing, frailty also greatly increases the risk of weakness, fatigue, and other adverse outcomes such as falls, disability, frequent hospitalisation, or a need for long-term care. Frailty can be considered a long-term health condition.

Frailty can affect anyone at any point in life but is more prevalent among the elderly. Among those aged 85 or above, it is estimated that one in four elderly persons will have frailty. Frailty can still be prevented in the long term if it is detected early. Its severity can depend from person to person.

Causes & Risk Factors of Frailty

The exact causes of frailty are not fully understood, and there is still no gold standard to determining frailty. There are currently two models that explain what might cause frailty.

The first model is based on a landmark 2001 study. This phenotype model defines its cause as an elderly person meeting three of the five criteria listed below:

  • Lower grip strength (can also mean requiring help to stand up)
  • Lower energy (easily exhausted)
  • Slowed walking speed
  • Low or reduced physical activity
  • Unintentional weight loss

Having one to two of these criteria is known as pre-frailty and can be a sign of an increased risk of frailty. Having none of these criteria indicates the person is “robust”. This model has helped guide medical research on frailty even today.

The second model is a frailty index (FI) which takes note of accumulated health deficits over time; these include disability, diseases, physical and cognitive impairments, psychosocial risk factors, and geriatric syndromes such as fall risk. The higher the number of deficits in a person, the greater the risk of developing frailty.

There is also growing evidence that shows the loss of skeletal muscle function, or sarcopenia, is a central cause of frailty. It also increases the risk of falls and fractures, which can further exacerbate adverse health outcomes and take away a person’s independence. Various studies have noted the presence of inflammation markers in persons with frailty, denoting chronic inflammation. This can lead not only to a reduction in muscle functions but may potentially cause anaemia and impair heart functions as well.

In terms of risk factors, age is still the central component that determines one’s risk; older persons, especially those above age 85, are at higher risk of developing frailty. Other risk factors may include:

  • Malnutrition
  • Depression
  • Sarcopenia
  • History of hospitalisation due to injury, disease, etc.
  • Inadequate health care

You must remember that having a risk factor does not mean you or your loved one will contract the disease.

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Determining Symptoms of Frailty

How your loved one is assessed for frailty might depend on the doctor, but as a simple rule of thumb, you can use the phenotype model’s five criteria as a starting point. Pay attention to your loved ones while you provide care for them. Ask them how they feel from time to time. If you find your loved one having any, or a combination of, these criteria, consult a doctor immediately.

Note that frailty can also lead to other symptoms such as:

  • A higher risk of falling
  • Immobility, or sudden changes to mobility
  • Delirium
  • Incontinence
  • Higher susceptibility to side effects caused by medications

Falls are an especially paramount symptom to look out for. Falls can lead to more severe instances of frailty exacerbated not only by a long hospital stay but a much slower recovery rate and a risk of becoming more ill due to other stressors or illnesses.

Diagnosing Frailty

Frailty is caused by multisystem dysregulations that greatly weaken a person’s health but may be misattributed as a part of the ageing process. A measured diagnosis will be needed in order to accurately determine if it is indeed frailty.

The simplest method to diagnose frailty comes in the form of a physical examination. The doctor will check your loved one’s physical health based on a number of criteria. They may also test your loved one’s motor abilities. For example, they may conduct a “timed up and go” test to see how long it takes your loved one to stand up from a chair or to walk a certain distance, walk a short distance, then turn and walk back to the chair, and finally sit down.

They may use a variety of clinical assessments to diagnose your loved one’s condition, and it may require multidisciplinary approaches to get a complete picture and exclude false-positive cases. They may also ask questions pertaining to their overall health. The British Geriatrics Society recommends the use of the PRISMA-7 questionnaire, a seven-item questionnaire used to identify disability and has been used in many frailty studies.

Treatment of Frailty

Treatment requires a comprehensive, multidisciplinary care plan to treat the underlying complications that cause or exacerbate frailty syndrome. The multidisciplinary approach will bring together medical professionals from different fields to help address your loved one’s health from a holistic approach.

The type of treatment given may also depend on how the initial assessment was made. If doctors use the phenotype model to assess your loved one’s frailty, for example, then they will aim to target any of the five criteria that define your loved one’s condition. These may include treatments for sarcopenia (generally through physiotherapy and exercises, coupled with a healthy diet) and other conditions that may impair your loved one.

Generally, physical interventions are the best way to effectively treat frailty. Treatment should generally aim to alleviate frailty and help promote independence in your loved one. As such, targeted physical interventions that aim to improve physical conditions, such as building muscle mass and strength, together with balance training, can greatly improve outcomes: reducing falls while also strengthening and maintaining your loved one’s health.

Supervised interventions can also benefit your loved ones by ensuring that they adhere to the provided regimen, while also giving them a confidence boost over their slow but steady improvement in their current condition. Moreover, supervision helps to ensure that your loved one is not at risk of falls, which could potentially reverse the benefits gained from interventions.

Frailty Prevention

Frailty becomes a higher risk with increasing age, and as its severity increases, the risk of further health deterioration, and eventually death, also increases. Preventing frailty is still a possibility, though. One such example is the Canadian Frailty Network’s AVOID checklist that can help prevent frailty in your loved one.

Activity

Staying active is a surefire way to keep frailty away. Physical activity helps to strengthen and improve muscle and heart functions and can slow (and potentially even reverse) the effects of frailty as well. Be sure that your loved one starts slowly first so as to not overexert themselves during physical activity. Carefully consider what activities they can do and those they should avoid; getting the advice of a physiotherapist can also provide other options. It is never too late to start exercising.

At the same time, adequate sleep is also a must for senior citizens. While being active is important, sleeping is also an important activity too. A lack of sleep and poor sleep quality are known to lead to a higher risk of developing frailty. Sleep allows your loved one’s body to rest and recharge in preparation for the next day, so be sure to give them a comfortable space for which to rest at night. Check with them that they are comfortable, and make adjustments if they need it. It is advisable that they have six to seven hours of sleep in a day.

Vaccinate

Immune system responses become weaker as we age, and that makes our elderly loved ones more susceptible to infections and disease. It is therefore recommended that they stay vaccinated against infectious diseases and illnesses that can hamper their overall health. Vaccines are safe and effective at protecting people from infectious diseases and illnesses, from hepatitis to influenza and even COVID-19. Make sure to speak to a doctor on the vaccinations your loved one will need to protect them, as well as if some vaccinations may require a booster dose to further improve the protection they receive.

Optimise Medications

As your loved one ages, you might notice that they need to take a lot of medications for various health complications. This might not seem like an issue, but some medications might need to be replaced entirely (especially if they cause significant side effects) while new ones are needed as your loved one’s condition changes. As the number of medications increases, so does the risk of harmful effects, some due to adverse drug interactions that can cause confusion or poor nutrient absorption, and subsequent hospitalizations.

It is thus advisable to have your loved one’s health care provider review the medications and even supplements they are taking. Check with the doctor about changes to the medication routine, possible side effects of prescriptions, and the proper way to take these medications.

Interact

Frequent social interaction is a good way to improve your loved one’s quality of life and help prevent frailty. Studies have found that social isolation can increase the risk of frailty and lead to a variety of complications, including depression, dementia and hypertension. It helps to give them an outlet to communicate with other people, whether it is other family members, long-time friends, or even new friends. Consider letting your loved one be part of a support group, or a local community, where they can freely interact with others in various activities.

Be sure to check in with them from time to time, too. Do they feel alright?  What’s on their mind? Have candid, heartfelt conversations with them when you can, and let them know that they are not alone. Give them comfort and reassurance when they need it.

Diet & Nutrition

A balanced diet is always beneficial to people at any age. It provides sufficient nutrients that the body needs to function optimally. As a person ages, their dietary requirements will inevitably change, and their diet must cater to their current health condition. In the case of preventing frailty, having sufficient protein, vitamin D and calcium will help to keep muscles and bones strong. A balanced diet also needs to take other factors into account, such as physical activity, as a combination of healthy practices leads to much better outcomes. For example, studies have found that frailty risk increases in persons with obesity, especially in conjunction with unhealthy behaviours such as inactivity, poor nutrition and smoking.

Frailty is not the end of the world for your loved one. With the right support and care given, persons with frailty can still be able to enjoy a relatively good life. Prevention is still better than cure, though, and steps you can take to keep it at bay will go a long way into ensuring your loved one’s health and independence are guaranteed for a much longer time.

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About the Writer
Calvyn Ee
Calvyn is an aspiring author, poet and storyteller. He spends his time reading, gaming and building stories with his action figure photography.
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