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Health

December 12, 2012

Treating frailty for what it is — a medical condition

As a medical resident 30 years ago, Ava Kaufman remembers puzzling over some of the elderly patients who came to the primary-care practice at George Washington University Hospital. They weren't really ill, at least not with any identifiable diseases. But they weren't well, either.

They were thin and weak. They had no energy. They tired easily. Their walking speed was agonizingly slow. "We couldn't put our finger on a specific diagnosis or problem,'' Kaufman says. "We didn't have a word for it then.''

Today we do. It's called frailty. There have always been frail people, but only in recent years has the term "frailty" become a medical diagnosis, defined by specific symptoms and increasingly focused on by those who deal with the medical issues of the elderly. Clinicians now are looking at ways to prevent or delay frailty, sometimes even reverse it.

"Frailty is not an age, it's a condition," says Kaufman, a Bethesda, Md., internist and geriatrician. "We know it when we see it, and it's always been with us."

While frailty is most often associated with the elderly, some old people never get frail. Experts now regard it as a medical syndrome, that is, a group of symptoms that collectively characterizes a disease, one that probably has biological and genetic underpinnings and can afflict even those in middle age if they have some other debilitating chronic disease. Frail people usually suffer from three or more of five symptoms that often travel together. These include unintentional weight loss (10 or more pounds within the past year), muscle loss, a feeling of fatigue, slow walking speed and low levels of physical activity.

"The symptoms are causally linked together in a vicious cycle,'' says Linda P. Fried, an internist who is dean of the Columbia University Mailman School of Public Health. In 2001, Fried and research colleagues were the first to define the physical characteristics of frailty in a landmark paper published in the Journal of Gerontology. "These are people at risk of very bad outcomes."

The signs of frailty can be obvious, even to the layperson. The frail often look "as if a puff of wind could blow them over," Fried says. Their gait is slow and unsteady. Over the years, they seem to shrink in size, the result of muscle wasting that occurs naturally as people age. Everyone loses muscle mass as they approach their 90s, although studies have shown that resistance training — weightlifting — can slow this process.

Because it typically worsens over time, frailty often leads to more serious consequences, such as a disabling fall, even death. Frail people are, in fact, at higher risk of falls, and have a much more difficult time recovering if they become ill or enter the hospital. "Putting a frail person in the hospital often is the beginning of the end,'' Kaufman says.

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