Frailty in Older Adults
What is frailty?
Growing older often means getting tired faster and moving slower than before. But some older people become very weak, and everyday activities become hard to do. This may be a health problem called frailty.
Frailty is more than just "slowing down." An older adult may be "frail" if a combination of these two things is happening:
- The person feels very weak and tired. He or she has no energy.
- The person has been losing weight without trying.
What happens when an older adult becomes frail?
People who are frail may have trouble doing everyday tasks—going shopping, getting dressed, getting in or out of bed, or using the toilet. They may feel weak and off-balance and worry about falling.
Experts think frailty develops because of changes in how the body works. These body changes are more likely to happen when a person has certain other health problems, such as diabetes or dementia. These other health problems can cause frailty to get worse quickly.
People who are frail are more likely to have depression and to get infections. And it's much harder for them to recover when they get sick or injured.
How can you care for a frail older adult?
Encourage your loved one to keep up as many healthy lifestyle habits as possible.
Food provides calories, which provide energy and can help stop weight loss. Encourage your loved one to:
- Eat more. Talk to your loved one's doctor about nutrition. Getting calories may be more important than avoiding fat for other reasons.
- Eat more protein. This may help keep muscles strong. If needed, you can add protein powder to soups and other dishes.
- Get enough vitamin D. This vitamin may help keep muscles working well as you get older. Talk to the doctor about having your loved one's vitamin D level checked.
- Keep bones strong. Talk to the doctor about vitamin D and calcium supplements.
- Try liquid meal replacements, such as Boost, Ensure, or instant breakfast drinks. Smoothies, milk shakes, and milk also may help limit weight loss.
- Eat many smaller meals rather than 3 larger meals a day.
Talk to the doctor about exercises to help build your loved one's strength and balance. Examples include:
- Resistance exercises, such as pushing against a wall or sitting in a chair and raising the legs. These are an easy way to tone muscles.
- Walking, but ask the doctor how often and how much walking is best for your loved one.
- Tai chi, which is moving in a slow, rhythmic way. This can help with muscle tone and balance.
If your loved one often feels tired, he or she may not feel like going out or seeing people. But it's important to connect with others and stay positive.
Keeping the mind active
Encourage your loved one to:
- Play games, like card games or board games that make you think.
- Do puzzles, like crossword puzzles or number puzzles.
- Take classes, in the community or online.
People who are frail don't recover as well from injuries, so preventing falls is very important.
- Check the house. Get rid of things that might cause tripping, such as raised thresholds, throw rugs, and electric cords.
- Check those stairs. If stairs are a problem, put in handrails or a ramp.
- Light the way. Keep the house well lit, especially stairways, porches, and outside walkways. Use night-lights.
- Make washing safe. Install shower chairs and bath benches.
People who are frail often are taking medicine for other problems. It's important to review those medicines regularly with the doctor to make sure they're not causing side effects that can make frailty worse.
Planning for extra time
When a loved one is frail, everything takes longer because he or she is moving more slowly.
Plan ahead, knowing that you'll need extra time. For example, going to a restaurant or a doctor's appointment may take longer because it's harder for your loved one to get to and from the car.
Other Works Consulted
- Chou CH, et al. (2012). Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 93(2): 237–244.
- Gill MG, et al. (2006). Transitions between frailty states among community-living older persons. Archives of Internal Medicine, 166(4): 418–423.
- Smit E, et al. (2012). The effect of vitamin D and frailty on mortality among non-institutionalized US older adults. European Journal of Clinical Nutrition. Published online June 13, 2012 (doi: 10.1038/ejcn.2012.67).
- Sternberg SA, et al. (2011). Identification of frailty: A systematic literature review. Journal of the American Geriatric Society, 59(11): 2129–2138.
Current as of: April 15, 2020
Author: Healthwise Staff
Kathleen Romito MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Carla J. Herman MD, MPH - Geriatric Medicine