Brief overview
- Definition: markedly diminished physical (and possibly mental) resistance and capacity.
- Symptoms: reduced strength and endurance, rapid fatigability, slowed walking, loss of muscle mass, unwanted weight loss, impaired organ function
- Causes & risk factors: older age, certain diseases (such as high blood pressure), malnutrition, social isolation, possibly female gender
- Treatment: strength and endurance training, fall prophylaxis, protein and vitamin-rich diet, sufficient fluid intake, treatment of any existing chewing and swallowing problems as well as concomitant diseases, avoidance of unnecessary physical and mental strain
- Prevention: The same measures are recommended for this as for treatment.
Frailty Syndrome: Definition and Symptoms
The English term frailty means “frailty”. For a long time, this was considered a normal concomitant of old age. However, with the development of geriatric medicine (geriatrics) as an independent field of research, the progressive decline in performance in old age is viewed in a more differentiated way.
The geriatric term frailty syndrome means more than the natural aging of body and mind. It describes a complex clinical picture with several possible symptoms:
- low strength and endurance
- rapid fatigue
- slowed walking
- reduction of muscle mass
- decreased organ functions
Effects
The symptom complex causes significantly reduced physical (and sometimes mental) resistance and performance. The physical susceptibility is referred to by physicians as increased vulnerability. It results, for example, in sufferers having a higher risk of falls, developing complications more often during or after surgical procedures, and taking longer to recover.
The risk of further illnesses, longer inpatient stays, need for care and disabilities as well as the risk of death are also increased in connection with the frailty syndrome.
The increased vulnerability also means that people with frailty syndrome often cope less well with hospitalization or unwanted changes in daily routines and habits than their non-affected peers.
In the medium term, frailty syndrome can increasingly restrict the autonomy of those affected and their ability to participate in society. Mental problems, including depression, can then further worsen the clinical picture.
Frailty syndrome: causes and risk factors
In medicine, a wide variety of causes and risk factors for the development of frailty syndrome are discussed.
Age
Diseases
People who suffer from certain diseases have an increased risk of frailty. Typical diseases include high blood pressure, stroke, heart attack, cancer and diabetes mellitus. But cognitive impairments (such as those caused by dementia) and mental illnesses can also trigger frailty syndrome.
Muscle mass often decreases with age. This also favors the development of frailty syndrome with the typical symptoms of loss of strength and endurance.
Malnutrition
Studies show that many frailty patients are deficient in certain nutrients. In particular, a deficiency of vitamin D, vitamin E, carotenoids and proteins is considered by nutritionists to be a contributory cause of frailty syndrome.
Deficiency symptoms are favored by the often declining appetite, sense of smell and taste in old age, as well as by age- or disease-related problems with chewing and/or swallowing.
Social isolation
Loneliness and lack of mental stimulation are other possible causes or risk factors for frailty syndrome.
Gender
Some scientific research suggests that women have a slightly higher risk of frailty than men. However, this has not (yet) been clearly clarified.
Frailty syndrome: Diagnosis
- Weight loss
- slow gait speed
- muscle weakness
- exercise intolerance
- low activity
The extent to which the individual criteria apply is assessed in a personal discussion between the physician and the patient. In addition, various tests can be used. For example, the physician can test muscle strength by checking the intensity of the handshake, or ask the patient to stand up from the chair freehanded.
In practice, the so-called FRAIL screening in the form of a questionnaire is also frequently used for diagnosis. The following criteria are queried:
- Fatigue: Are you tired most of the time?
- Resistance (muscle strength): Are you able to climb one floor of stairs?
- Ambulation (walking ability): Are you able to walk 100 meters without any problems?
- Illness: Do you suffer from more than five illnesses?
- Loss of Weight: Have you unintentionally lost more than five kilograms in the past six months?
If three criteria apply, the diagnosis is frailty syndrome. If only two criteria apply, it is called prefrailty – a preliminary stage of frailty syndrome in which the further development of the syndrome can often be prevented with the help of preventive therapeutic measures.
Frailty syndrome: therapy and prevention
The following measures can help against the frailty syndrome:
- Fall prevention: Exercising strength and balance can prevent falls. Gentle sports such as Tai Chi have proven effective for this purpose.
- Nutritional therapy: A high-protein diet with adequate intake of vitamin D, vitamin E and carotenoids can compensate for or prevent malnutrition. Adequate hydration is also important – the elderly usually feel thirst less often and therefore often drink too little, which can exacerbate frailty.
- Chewing or swallowing problems: If people with frailty syndrome have problems chewing and/or swallowing, it is important to treat them properly to ensure adequate food intake.
- Treatment of concomitant diseases: Existing concomitant diseases such as hypertension or heart problems should be treated effectively. If the patient is taking various medications, a physician should check these medications for possible interactions and adjust them if necessary.
Frailty Syndrome: Prevention
All measures recommended for the treatment of frailty syndrome are also suitable for its prevention – for example, a diet rich in protein and vitamins, sufficient fluid intake, strength and endurance training, and a fulfilling social life. Taking this advice to heart at an early stage lays the foundation for a fulfilled life without frailty syndrome, even in old age.
