Frailty—and Its Dangerous Effects—Might Be Preventable

The differences between a 70-year-old who is robust and one who is frail are easily detectible. Frail older patients are visibly more vulnerable, withdrawn, unsteady, and weak, and they tend to have more complications as they age and a higher rate of hospitalization. In short, doctors know frailty when they see it. But until recently, diagnosing frailty was mostly subjective, and physicians seldom thought of specific treatment. Now medicine has an objective method for diagnosis, and this new method is opening the door for potential treatments. Specialists in the field are moving away from the common view of frailty as an inevitable part of old age toward a new view of frailty as an avoidable condition.

Some frailty experts have likened the changing view of frailty to that of Alzheimer disease. Whether frailty is a disease or a set of related medical disorders remains unclear, but some frailty experts believe that frailty may someday be an official ICD (International Classification of Diseases) diagnosis, replete with U.S. Food and Drug Administration–approved treatments and interventions. “We would hope that with objective criteria now available this should happen,” said John E. Morley, MB, BCh, a professor of gerontology at St. Louis University Medical School and editor of the Journals of Gerontology, Series A: Medical Sciences. Jeremy D. Walston, MD, a practicing geriatrician and an associate professor of medicine at Johns Hopkins University School of Medicine, concurred. “It is likely that the diagnosis will be based on both laboratory tests and physical exam findings, and that treatments will target hormonal and or inflammatory pathways and include exercise prescriptions,” Walston said.

A recent study defined and validated frailty as having 3 of the following 5 attributes: unintentional weight loss, muscle weakness, slow walking speed, exhaustion, and low physical activity (1). Using this definition, …