Frailty, or old age debility, is the age-related exhaustion and reduced capacity that can be considered natural. Pathologic frailty is when it increases to what is known as frailty syndrome. This is characterized by an increased susceptibility to infections compared to people of the same age, concomitant diseases and a strong increase in weakness. Frailty syndrome is not curable, but its progression can be halted.
What is frailty
Frailty is not a disease in its own right; it is a complex aging condition. As people age, they experience memory, organ, and functional problems that require medical and nursing support. Frailty is considered a normal, natural sign of aging, for which there is initially no need for therapy. Only the so-called frailty syndrome, which is associated with increased physical and mental weakness compared to the age group and symptoms such as exhaustion, weight loss and unsteadiness of gait, requires treatment. The consequences of frailty include muscle breakdown and weakness, osteoporosis, and increased risk of fractures.
Causes
The primary cause can be identified as the age of those affected. After a certain age, old age weakness and frailty usually seem unstoppable and natural. For this reason, medical research is only concerned with the frailty syndrome, as only this is considered medically relevant and in need of treatment. Various risk factors and developmental processes appear to underlie frailty syndrome, including diseases such as diabetes mellitus and hypertension, chronic inflammatory processes in the body, and sociodemographic and psychological factors. Affected individuals have been found to have an increase in the likelihood of inflammation in the body, a weaker immune system than is common in the age group, anemia and altered hormone levels. An elevated CRP level appears to be typical of frailty syndrome. A reduced testosterone level could also be found and, in combination with a too low vitamin D level, leads to muscle weakness. An age-dependent prevalence of the frailty syndrome could be found, so this increases significantly from the age of 65 years.
Symptoms, complaints, and signs
Frailty is usually manifested by a decrease in physical performance. Affected individuals are quickly exhausted and subsequently less active. Movements are slowed and responsiveness is usually also greatly reduced. In general, physical activity is also limited, which leads to an increase in symptoms. The lack of movement leads to a reduction in muscle mass, resulting in muscle weakness. Gait is usually slowed and unsteady. In some patients, muscle loss is compounded by bone loss. Osteoporosis is manifested by bone pain, frequent fractures and other typical symptoms. Another sign of frailty is sudden weight loss, which is difficult for those affected to control. The physical weakness also affects the mental state, often causing emotional exhaustion. Frailty usually occurs at an older age. Hormonal disorders or a genetic predisposition can cause the symptoms to appear at a young age and increase in intensity over time. A characteristic of frailty is that the complaints become stronger with age and cannot be permanently alleviated.
Diagnosis and progression
If people of a certain age suffer from a conspicuously strong frailty of old age, which is intensified in comparison with persons of the same age, a physician should be consulted. If the doctor also suspects the presence of frailty syndrome, he or she will examine the senior citizen more closely.The classification according to Fried is established for this purpose: If three or more of the following five symptoms occur, the frailty syndrome is considered certain:
A severe, uncontrolled weight loss of more than 10% in twelve months,
An objectively detectable muscle weakness with loss of strength (measurable with strength tests), subjectively perceived mental, physical and/or emotional exhaustion, gait and stance instability with increased risk of falling, immobility and physical instability often accompanied by slowed reactions, and reduced physical performance and activity. If only one or two symptoms can be diagnosed, but age-related deterioration can be assumed, the prefrailty syndrome is diagnosed. Other diseases of old age, such as dementia or Alzheimer’s disease, must be distinguished from the frailty syndrome. These may occur in addition, but their therapy is quite different from that of frailty and frailty syndrome. So far, there are no conclusive studies on the course of frailty syndrome. However, researchers draw a comparison to age-related frailty and assume an increasing burden of disease with years of life. Age-related frailty and frailty syndrome are not curable, but with adequate treatment methods, the progression can be halted.
Complications
Frailty in old age or after illness is usually accompanied by various complications. For example, frailty, which predominantly occurs in old age, also increases the risk of accidents. Affected persons are less mobile than before and suffer from gait and standing insecurities, which can lead to falls and serious injuries. A typical complication of frailty is primarily femoral neck and groin hernias. Older people who already suffer from joint or bone disease are particularly affected. However, frailty can also occur as a result of another disease and cause serious complications. For example, in connection with type 2 diabetes, high blood pressure and inflammatory processes, irreversible deterioration of bones, muscles or nerve cords often occurs. As a result, other physical ailments subsequently develop, which can exacerbate the original frailty. The reduced performance capacity can also be accompanied by psychological stress. Thus, as frailty increases, affected individuals often develop depression and anxiety, which must be treated immediately. If frailty in old age is left untreated, it can progress to a severe course with falls and the development of further physical and mental ailments.
When should you see a doctor?
Frailty is part of the natural aging process of man, there is usually no need to see a doctor. If it occurs in old age, it is considered of little concern and rather requires a change in lifestyle. An adjustment of the physical possibilities to the way of life can be done independently. Daily tasks must be performed more slowly, as the body no longer has the usual strength and capacity. Therefore, there is often no need for further action from a medical point of view. If young people or adults in middle age suffer from frailty, they should consult a doctor. Diseases are present that need to be examined and treated, as this is by no means a natural occurrence. If additional pain occurs or if there are severe impairments in coping with everyday life, a visit to the doctor is advisable. As soon as independent living is no longer possible, help is needed. Frailty is a gradual process that develops over years. A doctor is needed as soon as the affected person suffers from the developmental state or the impairments lead to mental problems. If it comes to phenomena such as suicidal thoughts, an undersupply of the organism or a lack of hygienic measures, a doctor should be consulted.
Treatment and therapy
Important for the treatment of age-related frailty is a balanced diet, especially as a supply of all necessary nutrients and sufficient fluid intake. If those affected are too weak or forgetful to eat adequately, relatives or caregivers are called upon. In extreme cases, intravenous nutrition is possible. Building up muscles and thus physical strength is also advisable.This is done either with independent fitness training or with, if necessary, supervised senior sports and physiotherapy. A combination of strength training and coordination exercises trains muscles and brain and reduces the risk of falls.
Outlook and prognosis
Regarding frailty itself, it can be said in terms of prognosis that it will continue to increase with age. Accordingly, the objective and subjective weakness of the affected person will worsen additionally. Further illnesses, falls and the like accelerate this. Conversely, frailty worsens the prognosis for the affected person in very many situations. For example, the risk of complications for operations and hospital stays increases with increasing frailty. Recovery processes also become slower. Bone fractures become more likely as a result of greater susceptibility to gait abnormalities and falls. Frail people are generally expected to have a more severe course of illness. Also, the consequences of illness in combination with frailty syndrome more often lead to mobility limitations. Those affected are more likely to be dependent on assistance in everyday life and lose their autonomy more quickly. Frailty can also worsen the prognosis in terms of cognitive abilities. Affected persons are also more susceptible to states of confusion. Emotional stress is sometimes less well tolerated, which can lead to increased depressive moods or stress reactions. Overall, frailty can significantly reduce the quality of life and life expectancy of those affected. The prognosis for frailty can be improved if measures are taken to preserve physical functions. If the general health of the affected person is improved, he or she may regain some of his or her strength.
Prevention
The most important preventive measure is lifelong avoidance of risk factors through a balanced diet and sufficient exercise. Social contact with young people also keeps seniors mentally and physically fit.
Aftercare
Frailty can develop due to a variety of factors. What is meant by this is currently being redefined. Muscular weakness, increased risk of falling, and inability to manage on one’s own are among them. Among the most common reasons for increasing frailty is advanced age. The issue here is follow-up care only when frailty has led to a fall or serious illness. Rather, it is about care and prevention, for example, fall prevention. The frail person should use a walking stick or rollator to walk more safely. Frailty can also occur due to serious illness or as a result of chemotherapy. While medical treatment usually focuses on the clinical picture, aftercare may include psychosocial care, physical therapy or a rehabilitation program. After a severe stroke, there is usually a higher degree of need for care. In this case, many aftercare measures become necessary – from the purchase of a nursing bed to gait training. The goal of all aftercare measures is to reverse the frailty as far as possible. The patient should be enabled to gradually regenerate. Aftercare for brittle bone disease can be even more complex. The frail patient will usually be wheelchair dependent. He may need a high level of care. Many frail people rely on the help of outpatient care services.
This is what you can do yourself
An increase in frailty with age is completely normal, but countermeasures are indicated at the latest when the disorder assumes pathological proportions or even reaches the stage of the so-called frailty syndrome. One of the most important self-help measures is a healthy lifestyle. In old age, people often suffer from loss of appetite, which can very quickly lead to considerable weight loss in conjunction with an acute lack of nutrients. Seniors who no longer enjoy eating should therefore have a nutritionist put together a diet plan consisting of mainly small but substantial meals. It is also often easier for seniors to take in calories and nutrients in liquid form. Those who still live in their own homes should purchase a blender and process fruits or vegetables into fresh smoothies.This involves far less work than cooking and can be done even by people whose physical capacity is already severely limited. The tasty and healthy vegetable porridge also supplies the body with fluids, which is important because seniors often drink too little. Acute nutrient deficiencies can also be countered by taking nutritional supplements. Furthermore, it is important to stimulate the circulation and muscles through regular exercise. In addition to physiotherapy, senior gymnastics, swimming for seniors or regular walks can be considered for this purpose. In addition, mental stimulation should not be neglected. Whereby even simple measures such as regularly reading the daily newspaper and completing the crossword puzzle already have a positive effect.
