What is Frailty in Older Adults?
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Did you know that frailty and being frail are two different things? Frailty is a medical condition, whereas describing someone as “frail” can have many meanings. In this article, we will explore:

  • The definition of frailty
  • Strategies for coming back from frailty
  • Tips for caring for an elder adult who experiences frailty
  • Adaptive equipment for frail seniors

What is Frailty? How is it Different from Being Frail?

Frailty doesn’t have an official medical definition, and it can have a variety of causes. However, it is widely agreed that frailty involves:

  • Decreased strength
  • Decreased endurance
  • Difficulty bouncing back from injuries, such as falls

Between a quarter and half of people older than 85 experience frailty. Frailty is a natural consequence of aging.

Frailty impacts the body and mind. When we age, our brain, hormones, immune system, bones, and muscles all undergo changes. These changes happen to everybody, but can have a bigger impact on some people and may result in frailty.

Symptoms of frailty include:

  • Fatigue
  • Weight loss
  • Frequent infections
  • Worsening balance
  • Confusion

People with frailty will have good days when they’re fairly independent, and other days when they may have more symptoms and need much more support.

There are many tests that diagnose frailty. One common method is the Edmonton Frail Scale, which looks at nine different areas of functioning, called domains.

The Edmonton Frail Scale Domains include:

  • Cognitive ability
  • General health status
  • Functional independence
  • Social support
  • Medication use
  • Nutrition
  • Mood
  • Continence
  • Functional performance

The Edmonton Frail Scale includes a combination of questions and physical tests. For example, the functional performance part of the test involves timing a patient as they stand up, walk three meters, walk back, and sit down. The combined score from all categories determines if frailty is diagnosed. The test takes less than five minutes to complete, so it can be done at a routine doctor’s appointment.

blue dumbbells, berries, fitbit, water bottle

Treating Frailty

There are a lot of factors that cause frailty, from genetics to the environment. Not every older adult will experience frailty, and it is possible to take steps that might prevent it. Even if someone is diagnosed with frailty, it’s possible to treat the condition and improve health outcomes.

Prevention and treatment include diet changes and exercise. Studies have shown that women who are anemic are more likely to experience frailty. Anemia involves low levels of iron in the blood. A diet high in iron-rich foods can prevent anemia.

Also, weight loss in older adults can worsen frailty. Especially in those with low weight to begin with. Many older adults have decreased appetite, making it difficult for them to consume enough calories. Encouraging a high-calorie, high-protein diet can prevent weight loss and improve strength.

Exercise can improve muscle tone and flexibility. This can improve strength, balance, and mobility. Exercise is also good for the mind – studies show that exercise improves memory and brain function, and that exercise may protect against Alzheimer’s disease. Since confusion is a symptom of frailty, exercise is an important element of managing the condition.

There are programs out there that you can discuss with your loved one’s medical team that are proven to help people with frailty. However, exercise might not be beneficial for people with severe frailty, so you will want to work with your loved one’s doctor to decide whether exercise is a good idea. Studies have also shown that Vitamin D can slow the progression of frailty.

Tips for Caring for a Frail Elder

It’s important to diagnose frailty early, so you should ask their doctor for a frailty screening if your loved one:

  • Is older than 70
  • Has lost a significant amount of weight
  • Is showing other symptoms of frailty

Frailty can be a scary thing for families. It’s difficult to accept the fact that your loved one is getting older and isn’t as strong as they once were. Many elders are worried about losing their independence and may be reluctant to seek a diagnosis.

Diagnosing frailty is emotionally difficult but can improve your loved one’s quality of life. Knowing that frailty is present can help with decision-making. If you know that your loved one is more prone to infections, you can make sure you monitor cuts and scrapes to prevent an infection. If you’re aware of the risks, you’re able to prepare yourself.

Bouncing Back from Injury

People with frailty are not able to recover from injuries as quickly or easily as they used to. If someone with frailty falls, they may experience more severe injuries than they would have before they became frail, and they may never fully recover. Also, recovery from surgery or a minor infection might be more difficult.

If you are caring for a loved one who experiences frailty, preventing injury or infection should be a top priority. You can take simple steps to keep your loved one safe at home, such as:

  • Installing a shower chair in their bathroom
  • Removing tripping hazards from the home
  • Installing grab bars in the bedroom and bathroom
  • Making sure they’re taking care of hygiene
  • Limiting sick visitors

Take some time to look for everyday hazards that your loved one encounters and see if there’s a way to minimize the hazards.

main in wheelchair in front of fountain

Day to Day Changes

People experiencing frailty may be completely different from one day to the next. Your loved one may be independent one day and off-balance and confused the next. Make sure someone is checking on them often. Everyone wants to be independent, and older adults are no exception. Your loved one might downplay their symptoms, especially if they don’t have them every day. Frequent check-ins and time spent with your loved one will give you a more accurate picture of how well they’re doing and what supports they need.

It’s also important to practice encouraging independence while still providing support to your aging loved one when it’s safe and possible. If your loved one is able to walk safely some days, you should encourage them to walk. They should use their wheelchair on days when their balance isn’t as good. If your loved one is still able to do some cooking but is forgetful, you may encourage them to cook meals when there is someone else present.

Encouraging independence will show your loved one that you still see them as capable. As trust builds, they will be more likely to ask for help when they need it because they will know that you value their independence. The old saying “use it or lose it” also applies here. If your loved one can walk but always uses a wheelchair, they may begin to lose muscle strength and will eventually need to use the wheelchair all the time. Remember, exercise is an important step for preventing and managing frailty.

Confusion and Cognitive Impairment

Frailty doesn’t just affect the body – it can affect the mind as well. People experiencing frailty often experience mild confusion and forgetfulness. This might not be obvious right away, especially if you don’t live with your loved one. It’s important to stay alert to their mental state. They may forget to take their medications or get lost in settings that used to be familiar. If you notice these things you may want to put more supports in place. Supports could include help with medication management, such as alarm reminders or a caregiver’s help.

Responding to Injury

Injuries can take a major toll on someone with frailty. Physical therapy has been shown to improve long-term outcomes in older patients following an injury. Generally, when a frail elder is injured, intensive post-hospital rehabilitation is very important for helping them regain their abilities and independence. If your loved one experiences a fall or injury, advocate for physical therapy, occupational therapy, and other rehabilitative services.

Medical frailty is a natural part of aging but can be difficult for families to accept and manage. Frailty is hard for caregivers because you’re watching someone you love change significantly. It’s difficult for elders because they may begin to lose independence or abilities. Families can take steps to work with a loved one’s frailty and safely manage frailty. Managing diet, encouraging exercise and independence, and putting appropriate safeguards in place will provide peace of mind for all. Empower your loved one to approach frailty head-on and enjoy all that life has to offer.

Adaptive Equipment for Seniors

Although many older adults are reluctant to use adaptive equipment, older adults who experience frailty can greatly benefit from using adaptive equipment. It is difficult to talk about the changes that come as we age. It is important to have these conversations, especially if your loved one is at increased risk of falling.

Older adults are at increased risk of falling. Falls are serious for seniors and often lead to hospitalization. Seniors may lose muscle mass while recovering from a fall. This is because they’ll have less physical activity while they recover. It’s important to prevent falls in seniors by taking proactive measures. If a fall does occur, there are ways to support recovery and independence.

There are many types of walkers and wheelchairs available for seniors. If you have a loved one who needs a walker or wheelchair, choosing the right one will help them be successful.

The Best Walkers for Seniors

Walkers are great for seniors who are at risk of falling, and for those recovering from a leg or foot injury. The main types of walkers are:

  • Standard walker
  • Two-wheel walker
  • Four-wheel walker
  • Knee walker

Standard walker

A standard walker has four legs with no wheels. The user must lift the walker to move it. A standard walker is very stable because it doesn’t slide, but it requires some strength to use because it has to be lifted. Standard walkers are lightweight and inexpensive. They’re best for those who need some support with stability. They’re not the best for long distances because they must be lifted.

Two-wheel walker

A two-wheel walker has four legs with wheels on two of them. The user must lift part of the walker to move it. Two-wheel walkers provide stability and can be easier to use for those who can’t lift a standard walker. They’re better for traveling longer distances than a standard walker and provide more support than a standard walker because the user can put weight on them while stepping forward.

Four-wheel walker

Four-wheel walkers have wheels on all legs. These walkers are bulkier than standard walkers and have brakes. Some four-wheel walkers have seats, so the user can sit if they need to rest. These walkers are versatile. Users can equip them with bags, cup holders, and other accessories. They are perfect for long-term use.

Knee walker

Knee walkers are also called knee scooters. They have wheels on all legs and include a platform for one knee. Knee walkers are best for those recovering from a leg or foot injury and are a good alternative to crutches. If your loved one is using crutches and having a difficult time, consider a knee walker.

Successfully Using a Walker

  • Choose the correct walker from the options listed above. If you need help choosing a walker, ask your loved one’s doctor.
  • Make sure you correctly adjust the walker. The walker’s handgrips should be at wrist height when the user’s arms are by their sides.
  • When going out, make sure walkways and buildings are accessible. Your loved one may be reluctant to use a walker if they feel self-conscious about being unable to get around.

The Best Wheelchairs for Seniors

Wheelchairs empower those with physical disabilities to access their communities. The main types of wheelchairs are:

  • Standard wheelchair
  • Power assist wheelchair
  • Power wheelchair
  • Transport wheelchair

Standard Wheelchair

The wheelchair user operates a standard wheelchair. Standard wheelchairs have two large wheels used for steering. A support person can also push a standard wheelchair. Some models are foldable for easy storage and transport.

Power Assist Wheelchair

These operate like standard wheelchairs but have motors. This makes it easier for the wheelchair user to use. Using a manual wheelchair builds strength. Power assist chairs also build strength but are usable by those with less strength.

Power Wheelchair

Power wheelchairs are fully motorized. They are often bulky and take time to learn how to operate. Power wheelchairs are usually for long-term use. They are great for people with significant physical disabilities because they lean back. This reduces pressure sore risk for those who can’t shift their weight. They only need one hand to operate, and some models are even mouth-operated!

Transport Wheelchair

Transport wheelchairs need a caregiver or someone else to operate them. They don’t have large wheels that a wheelchair user can reach. They’re lightweight and easy to fold and transport. Transport wheelchairs don't offer much independence and are best for short-term use. They are a good option for seniors who sometimes need help with mobility due to fatigue and are also helpful for seniors when they’re recovering from a recent hospital visit.

Successfully Using a Wheelchair

Make sure your loved one is successful with their wheelchair by following these tips:

  • Ensure that your loved one is using the correct wheelchair. Choose the correct style from the options above. Wheelchairs come in narrow and wide sizes, so choosing the correct size will make a big difference.
  • Make sure the wheelchair is comfortable. You may need to buy a cushion to make the seat comfortable.
  • Use proper etiquette if you’re transporting someone in a wheelchair. Don’t move someone without asking them first.
  • If you’ll be driving, make sure the wheelchair fits into your vehicle. Use parking lots instead of street parking whenever possible.

Resources

Walker Tips

Types of Walkers

Types of Wheelchairs – A Visual Tour

Standard vs 2-Wheel vs Rollator Walkers (Comparison and Differences)

Frailty Consensus: A Call to Action

Validity and reliability of the Edmonton Frail Scale

Impact of Anemia and Cardiovascular Disease on Frailty Status of Community-Dwelling Older Women

Weight Change in Old Age and its Association with Mortality

Vitamin D Status Predicts Physical Performance and Its Decline in Older Persons

Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review

Frailty in elderly people

Exercise and the brain: something to chew on

Is there a role for physical activity in preventing cognitive decline in people with mild cognitive impairment?

A Program to Prevent Functional Decline in Physically Frail, Elderly Persons Who Live at Home

Physical Frailty is Associated with Incident Mild Cognitive Impairment in Community-Based Older Persons

Effects of physical exercise therapy on mobility, physical functioning, physical activity...

About the Author(s)

Ashley Krollenbrock has been a caregiver for her mom for 10 years. She has her Masters of Public Health and JD with a concentration in Health Policy & Law. Ashley has done legal work for two state protection and advocacy agencies for people with disabilities. She is passionate about disability justice, aging justice, health equity, and aging in place. Ashley blogs at themillennialmatriarch.com, and her goal is to empower families to keep their aging loved ones at home by sharing her story and practical knowledge. Ashley lives in Oregon with her wife and mom, and when she’s not writing or caregiving she loves to travel, garden, and hike with her dogs.

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