The word “frail” might conjure up images of sick patients in hospital beds, but have you ever thought of a close friend as frail? Or your parents? Or yourself? In medicine, the word “frail” has a very specific definition that is used to help determine which older individuals are in poor health and who might be at risk for serious decline. New research out this week has added to the understanding of what that definition means by surveying more than 7,000 older individuals to see who ends up getting defined as frail in the hopes of helping identify who might be at risk for health problems. They found that falling into that frail category can have major implications for your health in the long run.
What does it mean to be frail?
Calling someone frail might seem negative or even offensive, but the term has a very different meaning for medical doctors. As the U.S. population has aged, physicians have had to come up with ways to classify older people in different states of health, regardless of their age, since some people age better than others. Some remain healthy well into their twilight years, while others aren’t so lucky and end up with many disabling health problems even when they’re relatively “young.” Figuring out who’s young by health standards and who’s old is important in medicine because it helps doctors identify who might be at risk for health problems and who might need closer attention. As a result, when a doctor describes someone as being frail, they usually mean that person’s health is starting to decline and worry that a small attack on their system, from an infection for example, could put them in serious trouble.
How do we determine who’s frail?
Physicians use a few different clinical scales to keep an eye out for signs a person is declining and becoming frail. No one scale is definitive, but they all give hints that something might be wrong. Warning signs can include:
- Significant weight loss over the past year.
- Often feeling exhausted or fatigued.
- Being weak.
- Walking very slowly.
- Having difficulty getting up from a chair.
- Having multiple medical conditions.
- Not being as active as you used to be.
These are just a few signifiers physicians can use. No one symptom labels you as frail, but having several signs of frailty raises the suspicion that your health might be at risk.
Why does frailty matter?
The purpose of labeling someone as frail is to recognize the problems that might be contributing and to take action before things get worse. The researchers in this study wanted to use frailty definitions on a large population of people from a variety of backgrounds and health conditions. They hoped that analyzing this data and following these people over time would help to show what sorts of health complications frailty can predict and whether there might be a group of people who don’t qualify as “frail,” but who might still be at risk and in need of more help.
How did the team test their questions about frailty, and what did they find?
The researchers used data on more than 7,000 people from a national survey of older adults. The survey, called the National Health and Aging Trends Study (NHATS), included health information on older adults over time. The researchers used this health information to determine which people qualified as frail and looked for patterns in different groups of people. They also looked at the types of health complications that frail people were more likely to have.
The data showed that almost one in every six older adults in the U.S. qualifies as frail, with that number increasing from one in ten in those between 65 and 70 to more than one in three amongst those older than 90. Those living in a residential care setting, like an assisted living facility, were twice as likely to be frail as those living at home.
Interestingly, frailty broke down along racial lines as well. African-American and Hispanic individuals were much more likely than whites to be frail. Those who were poor were also more likely to be frail compared to those who were wealthier. Most important, the researchers found that being frail made one much more likely to have a variety of chronic health conditions from diabetes and heart disease to osteoporosis and strokes. On top of that, those determined to be frail were much more likely to have a dangerous fall and to have been in the hospital.
Finally, the team identified a larger group of people it labeled as “prefrail,” who don’t quite meet the usual criteria, but who were nevertheless at higher risk for falls, hospitalizations, and serious illness than their healthy counterparts. Among adults 65 and older, almost half fit into this category.
What does this study mean for me?
This study reminds us that taking care of your health only when you get sick often isn’t a good idea in older adults, especially those who might have signs of decline. If you feel like your health is slowly getting worse or you’ve recognized a drop in a loved one’s function, you should make an appointment to see a doctor. Doing things as small as changing your diet, adding some exercise, or modifying your medications can be the difference between health and a dangerous fall that could put you in the hospital. If you’ve been in poor health for a long time, see your doctor to find out whether you could be acting to lower your risk of other complications. Taking action early can move you from the frail to prefrail category or even into the healthy category.