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Frailty Is More Than Meets the Eye

        Steven Buslovich, MD, MSHCPM, CMD, a New York–based geriatrician, talks about frailty and what this means for your loved one’s health and care options.
        Picture two 80-year-old nursing home residents. Both women take pride in their appearance, love a good cup of tea, and play scrabble every Sunday night. On the surface they are very similar, but both could have different frailty levels. As a result, they could have very different outcomes from the same illness.
        When you think of the word “frail,” you may picture someone who is physically delicate, weak, or underweight. Frailty is much more than how someone looks. Frailty is a common part of the aging process, as the body loses its built-in reserves, leaving people vulnerable to extreme, sudden changes in health triggered by small events. However, not all older people have the same level of frailty.
        A person’s frailty level is related to his or her history of illnesses and lifestyle. Additionally, how frail someone is depends on things like functional status (such as ability to perform activities of daily living such as bathing and dressing), comorbidities (including chronic illnesses such as kidney disease or diabetes), socioeconomic issues (such as access to regular health care and medications), presence of geriatric syndromes (such as dementia, incontinence, and falls), polypharmacy (taking several prescription medications), and nutrition (maintaining a healthy weight and having access to adequate nutrition).
        Frailty is marked by sudden declines as well as slow recovery or lack of recovery from even minor illnesses or injuries. The frailer an older person is, the more difficult it is for him or her to recover from an acute illness such as the flu or an accident such as a fall. As frailty increases, so do the risks for problems such as infections or other unwanted outcomes while the ability to recover goes down.
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        Frailty — a common part of the aging process — is much more than appearance. Two people who look similar could have very different frailty levels.
        Photo by Willian Oliveira from Pexels
        It is important to consider an older person’s frailty level to predict illness trajectory and possible prognosis, as well as to care plan and identify realistic goals of care. Assessing frailty can help identify who may benefit from various activities or services. For instance, strength training with free weights may delay or even reverse frailty in some individuals.
        Going back to the two women at the start of this article, let’s call them Mary and Beth. They both have similar chronic illnesses, but Beth takes more prescription medications, needs help getting out of bed into a chair, and is starting to have some memory issues. Mary is fit and fairly independent but has difficulty walking more than 100 feet. Based on her health, Mary is more like a 65-year-old, while Beth is more like someone in her late 90s. If they both contract the flu or an infection like COVID-19, Mary is more likely to recover. Beth may get much more ill.
        There are frailty assessment tools available, some are very brief and can be completed in about 10 minutes. Through such an assessment, your loved one’s frailty risk score can be tallied, and you can get information about what factors contributed to the score. You then can talk to your practitioner about what preventive measures may benefit your loved one and what treatments might be most effective if he or she gets sick.

        Questions to Ask Your Practitioner

        • Is it important to assess frailty if my loved one seems healthy?
        • Can frailty be delayed or reversed?
        • What is considered a “good” or a “bad” frailty level or score?
        • How does my loved one’s frailty level affect what treatments might be helpful if he/she gets sick?

        What You Can Do

        • Talk to your practitioner about your loved one’s frailty and what conditions may have contributed to it.
        • Make sure that your loved one gets adequate nutrition and hydration.
        • If possible (talk to your practitioner), see that your loved one gets some physical exercise.
        • Help keep your loved one’s mind alert with reading, singing songs, and sharing memories together.

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