Earlier I did a blog post about how our bodies begin to lose muscle mass while we are in our 30s and that loss of muscle mass is how we become frail as we age.  You can read it here.

This is part 2 of the two-part post on frailty. In the first part we discussed the definition of frailty, how it affects us as we age, and the very important symptom of muscle mass loss. In this part, we’ll talk more about muscle mass, what to look for, and how to reverse its loss. We will also discuss how doctor’s measure frailty.

What I’m Doing Now

As mentioned in part 1, the primary treatment for loss of muscle mass is exercise, mostly resistance training or strength training, so I joined a gym and bought weights for my home.  If I failed to make it to the gym, I tried to lift weights at home in the evening.

I also tried to increase muscle strength and endurance by other means, such as carrying bags of grocery instead of using a cart and by unloading them myself instead of asking for help.  I tried to pick up my own bags of fertilizer, straw bales, etc. when gardening.

The other night I moved my own furniture like I used to do.  I compete with my husband to handle my own luggage.  He’s always worried I’ll hurt my back. I try to take stairs and ride my bike twice a week on the hills of Tallahassee.

At the next appointment, Dr. Emhof noticed an increase in muscle mass in my arms and chest, but I was still lacking from the waist down.  I had to do all this and do at least four exercises just for my hips and thighs.  Finally, my legs responded.  Dr. Emhoff is pleased, and I don’t have to go see him every three months now.

But Frailty is More Than Muscle Loss

Our fifties trigger lots of problems. When we get to our fifties, the risk of heart disease increases along with problems such as cholesterol, high blood pressure, and diabetes.  If you are a smoker, this is when it really catches up with you, holding your body back from repairing itself as it did in the past.

Degrees of Frailty

Remember the discussion earlier about how frailty increases about the time we get to be 75?  That downward spiral accelerates if we don’t begin to worry about our muscle mass and our heart by our fifties.

Doctors Use An Index to Determine How Frail We Are

So frailty is when we have many things wrong with us. When your doctor notices this, a geriatric assessment is made and he counts the number of things we have wrong or the number of deficits. It shows how fit or frail we are. There is a frailty index to help them determine to what extent one is frail.

The medical community measures frailty several ways, but two stand out.

Fried et al in “Frailty in Older Adults: Evidence for a Phenotype” defines frailty as an imbalance of the “physiologic triad” of sarcopenia, immune, and neuroendocrine regulation. The latter is a big word, but our nervous system and our endocrine system work together to regulate the physiological processes of our body, otherwise known as homeostasis. It regulates reproduction, energy utilization, blood pressure, our metabolism, and much more.

Using this index, patients are considered frail if they have three or more of the following:

• Reduced activity; maybe even a slower gait

• Slowing of mobility

• Weight loss, such as an unintentional loss of ten pounds or more during the past year

• Diminished handgrip strength

• Exhaustion

Someone who has only one or two of these items is said to be “pre-frail”; someone with none is said to be “robust”. I don’t know about you guys, but I don’t plan to get anywhere near my doctor when I’m having a bad back day.

The assessment takes about fifteen minutes.

Another way to measure is The Frailty Index which is based on the concept that frailty is a consequence of interacting physical, psychological, and social factors. It was developed by Dr. Kenneth Rockwood and Dr. Arnold Mitnitski at Dalhousie University in Halifax, Nova Scotia, Canada.

Frailty Index (FI) = (number of health deficits present) ÷ (number of health deficits measured. These deficits include diseases, signs, symptoms, laboratory abnormalities, cognitive impairments, and disabilities in activities of daily living.

As these deficits accumulate, people become more vulnerable to unfavorable outcomes. In short, this frailty index is based on a comprehensive geriatric assessment. It includes functional dependencies as deficits, such as say the patient needs help dressing.

My Cousin

I have a cousin, an octogenarian, who took to her chair and later her bed due to rheumatoid arthritis. She looked as if a puff of wind could blow her over.  Her gait was slow and unsteady, and later she hardly rose from her chair. On my last visit she took to her bed–never getting up again. Hers was a classic case of frailty.

So as you can see and as I learned, the word frail means so much more.  It is important to realize that the whole person is in a process of aging, and it is a very dynamic process.  Some of us will be helped by knowing and will try to keep ourselves from going farther down the index.

For all the rest of us.  It is good to remember what one doctor said–that there seems to be a natural order of life. When we are well, we walk around a lot. And when we get sick, we move around less.

When we really get ill, we may take to our bed. And at some point, we might not get out. And finally just before we die, we hardly move at all.

Another doctor noted that people fail in predictable ways.