When you’re in your 20s, your chronological age can tell your doctors a lot about your health. While young, you tend to be healthy, and have a much smaller variation in your health status compared to older adults. This, to a degree, tends to be true for middle aged adults as well. But when you reach your twilight years, your age will tell doctors less. Some people are highly active and functional well into their 80s, while some seniors who may be younger will have difficulty getting out of their chair or their bed.
This is where measuring frailty comes in. Frailty is a state of vulnerability that comes from the loss of built in reserves in your body, and they build up over time as the age related changes accumulate. It highlights your physiological age due to these changes, which makes you more vulnerable.
Geriatricians, the doctors who specialize in the elderly, are always thinking about frailty and vulnerability. But the perception of one doctor in regards to frailty isn’t always going to be the same as another’s. Standardizing how frailty is measured can open the door to better clinical decision making. The data makes it possible for the targeting of the most at-risk patients, with interventions that can slow the progression of frailty.
There are two main concepts of frailty today. The first is the physical frailty phenotype, which measures frailty by assessing five key criteria. Slow gait speed, weakness, unintentional weight loss, and exhaustion. The second is the deficit accumulation approach. The idea is that, as people age, they develop health deficits that contribute to frailty. Many chronic conditions, such as hypertension, cognitive impairment, or difficulty walking, can all count as deficits. These deficits can then be counted up to quantify how frail a person is.
The problem with either method is that there’s no hard and fast rule about which deficits should be counted, which results in the creation of multiple frailty indexes, many of which compete and overlap. Many of the indexes were created through studies, which means the researchers only counted the deficits specific to their studies, which may or may not be regularly measured by doctors in their patients.
If you go to a hospital for an elective surgery, your frailty level can make a huge difference in the outcome of the surgery. If your frailty score is high, then your expected recovery may be poor. You may need prehabilitation to get you ready for your surgery, to maximize your chances of recovery.
While the risk of frailty increases with age, it is certainly not inevitable, and in many cases it is reversible. Your doctors can recommend a treatment plan that will include changing modifiable lifestyle factors. Geriatric care experts can look at every aspect of your health and your surrounding environment, and come up with an individual plan for you.
Exercise is the most important part of a frailty treatment plan. Pre-frail or mildly frail individuals can engage in regular exercise, but those who are more frail may require physical therapy.