CullmanTimes.com - Cullman, Alabama

Health

December 12, 2012

Treating frailty for what it is — a medical condition

(Continued)

How to stay healthy longer

To be sure, many older Americans continue to lead active and productive lives. However, the nation's increasing longevity is bringing new challenges for health and social programs. Americans' life span in 2009 was 78.5 years, according to the Centers for Disease Control and Prevention, about three decades more life than in 1900, when the average was 47.3 years.

"We've added 30 years to the human life span, which is an unparalleled success story for public health, medicine and education,'' Fried says. "As a result, it is critically important that we help these people who are living longer stay healthy.''

Of those living alone or with families, not in nursing homes or hospitals, about 4 percent of men and 7 percent of women older than 65 were frail, according to the parameters used by Fried and her colleagues in the 2001 study. The researchers, who studied more than 5,000 adults 65 and older, also found that the chances of frailty rose sharply after age 85, to about 25 percent. These numbers, the most recent data available, reflected conditions prior to 2001, leaving "an important but unanswered question as to whether the frequency of frailty is the same, increasing or decreasing" today, Fried said.

Also, women are more likely than men to be frail, possibly because women typically outlive men and "start out with less muscle mass than men and, once they lose it, they may cross the frailty threshold more rapidly than men,'' Fried says.

Stephanie Studenski, principal investigator at the Claude D. Pepper Older Americans Independence Center at the University of Pittsburgh, has been practicing in the geriatrics field for 30 years and sees "older people across the full spectrum, from frail 60-year-olds to vigorous 95-year-olds,'' she says. For the younger group, who usually are frail because of multiple chronic conditions, "sometimes medications can worsen frailty with their side effects, so adjustments can help,'' she says. "I tell these patients I can often make you better, give you more reserve and increase your resilience although not totally cure you. We can't change from black to white, but often can push the black into gray.''

For those in their 80s or older, however, the causes of frailty are sometimes less obvious.

Barbara Resnick, a geriatric nurse practitioner in Baltimore, remembers an 85-year-old woman, living at home, who "stopped going out to dinner with friends; she would say she was too tired and didn't have the energy. She wasn't walking out to get her mail anymore. She was eating less and losing weight rapidly."

Her adult daughter became concerned and brought her mother to Resnick "and asked us to fix the problem," recalls Resnick, who chairs the board of the American Geriatrics Society.

But there often is no quick fix. Clinicians checked the woman for underlying disease — they found none — and adjusted her medications. They also urged the woman to increase her physical activity, Resnick says. "That's really the best way to manage frailty: Engage as much as you can; optimize what you can do. What's important is resilience.''

The woman is doing better today. "She is still plugging along," Resnick says. "We actually stopped her meds, except for critical ones, and she did gain some weight. She's not really deeply engaged, but is surviving."

Similarly, Kaufman recalls "a wonderful gentleman'' in his 80s who had been doing quite well until his wife fell, broke her hip and had to enter a nursing home. The couple had been married 60 years. After she left, he began to slow down physically, and he stopped eating.

"He just gave up,'' Kaufman says. "There was no one specific thing. But within a few months, he died. What do you put on a death certificate? If it was a pediatric case, we'd say 'failure to thrive.' He died of frailty.''

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