However, as older people slow down, lose muscle strength and find it increasingly difficult to cope with everyday life and physical activity, this can go beyond “normal” ageing. If severe, these limitations are summarized under the generic term frailty. Doctors often use the English term frailty for this.
Frailty increases the likelihood of needing long-term care, being hospitalized more frequently and surviving acute illnesses less well. Those affected also suffer from a significantly lower quality of life. The degree of frailty is also important for assessing whether a person can survive a planned treatment or operation. This is because very frail people are more susceptible to complications or infections and have a shorter life expectancy, e.g. after an operation.
Overview: How does frailty manifest itself?
Almost all people in old age suffer from chronic illnesses, some even from several at the same time (so-called “multimorbidity”). It is clear that they are no longer as fast and fit as young people. Nevertheless, the physical condition of even very old people varies greatly. Biological age is a more important factor than the date of birth alone. Some of the ailments and frailties associated with old age can be prevented or treated if they are recognized in good time. Experts therefore speak of frailty in order to recognize and assess frailty on the basis of clear scientific criteria.
An assessment of frailty is particularly important when it comes to deciding for or against surgery in older people. The question of fitness or frailty arises more and more frequently – for example, when an artificial hip or knee joint is implanted, during heart surgery or before the start of chemotherapy. Those who are less resilient and have little resistance may not survive such an operation or therapy well. It is then important to carefully weigh up the expected benefits against the potential harm.
Frailty criteria
The extent of a person’s frailty is very individual. Everyone has things that are easier or more difficult for them. Nevertheless, doctors try to classify the restrictions in a standardized way. There are various methods of assessing a person’s frailty. Some doctors have included psychological and social factors in their list of criteria in addition to physical factors. Doctors often use the “Fried phenotype” to assess frailty. Fried has defined five criteria that are easy to determine:
- Has the person concerned unintentionally lost more than 4.5 kilograms in the past year?
- Does the elderly person often feel exhausted?
- Does a measurement of hand strength reveal muscle weakness?
- Is the walking speed less than 0.8 meters per second?
- Does the person concerned show a low level of physical activity?
If at least three of these five characteristics are fulfilled, Fried classifies the examinee as frail. If two criteria are present, Fried interprets the affected person as pre-frail, which means an increased risk of developing frailty. Both sexes are affected by the problem in roughly the same way. From the age of 80, the number of frail people increases significantly.
Frailty: causes and prevention
Around one in seven people over the age of 65 is affected by frailty. However, the frequency of frailty is very dependent on the “sample” studied. This means that frailty is much more common among residents of nursing homes, for example, than among older people living independently at home. The development of frailty is often a gradual process. The older people get, the more their strength and mobility decline. However, something can be done about this: If you exercise regularly and do gymnastic exercises, you will keep your muscles and joints fit. There are also gyms that specialize in older people and offer gentle strength training. Regular exercise sessions can also help with physical training and stimulate social interaction at the same time. Walks, light gardening or household chores or a home exercise program also help.
Another problem for some elderly people is their diet: those affected often lose their appetite, find it difficult to prepare meals and therefore only eat a little or one-sided meals. Mobile delivery services that bring healthy and balanced meals home can help here. Relatives can also provide good support in this case: They can bring shopping or ready-prepared meals to those affected and regularly ask them about their diet. Shared meals usually increase the appetite. Nutrition specialists have found that older people are particularly often deficient in vitamin D and protein. If you eat consciously, you can avoid this. Overall, doctors estimate that a body mass index (BMI) below 23 is to be classified as a risk in old age. The company of other people often helps to keep you mentally and physically fit. After all, mental stimulation is also important for a sense of fitness. Senior groups or hobbies are a good way to maintain or build up contacts.
Symptoms: Exhaustion due to frailty
The five symptoms Fried has identified can have a variety of causes:
- For example, the reason for unwanted weight loss may be that an artificial denture fits poorly and causes pain. The intake of certain medications or polypharmacy (i.e. the regular intake of many different medications), a chronic illness or a tumor can also cause unwanted weight loss. The slow loss of the sense of taste typical of old age can also lead to a reduced appetite.
- Noticeable fatigue can be a sign of heart failure, cardiovascular disease, chronic lung disease or depression. It is therefore important to clarify these factors for frail people.
- Muscle weakness is often a vicious circle: muscle mass decreases due to hormonal changes or malnutrition. This leads to insecurity when walking and increases the risk of falls. As a result, those affected move less and the body continues to break down muscles, which can lead to so-called sarcopenia.
- There are many possible causes for conspicuously slow walking . Sometimes the joints hurt, sometimes the eyesight has deteriorated or coordination no longer works so well. Here too, a closer look at the causes can sometimes provide relief.
- Low physical activity can be due to many of the reasons mentioned above. Sometimes, however, depression or a general feeling of loneliness is the reason why an elderly person rarely leaves their home. Then social interaction or psychological treatment can help.
Frailty: Diagnosis with us
Often the first glance at a person with frailty is enough to raise suspicion: slow and cautious movements are quickly noticed. The doctor will usually weigh the patient and ask whether they have lost weight in the past few months. Then they find out how independent and active the person is in their everyday life. With the help of a grip strength meter, the doctor can determine how much strength someone has when shaking hands. This provides information about muscle strength. The doctor also usually wants to know something about your diet and in many cases uses a questionnaire for this purpose.
In addition, the doctor will often have blood tests carried out to identify any previously unknown pre-existing conditions. Some doctors also use other questionnaires, which can contain up to 70 criteria for a diagnosis of frailty. An important point is nutrition. According to studies, up to 60 percent of people admitted to a geriatric ward are malnourished. A targeted diet and plenty of encouragement to eat healthily can help here.
Frailty: operations more dangerous
Assessing the degree of frailty is particularly important when an operation is imminent. Studies have shown that frailty significantly increases the risk of dying after an operation. Frail people are more likely to suffer complications after operations and often have to stay in hospital longer than their fit peers. It also plays an important role whether patients can return to their home after their hospital stay and manage their everyday life there. The frailer a person is, the higher the risk of suffering delirium after the operation. This perceptual disorder, combined with a loss of orientation and often a high level of agitation, sometimes occurs after anesthesia.
Plan surgery for frailty well
Doctors try to prevent these post-operative problems in frail patients in a targeted manner: for example, they can minimize the time patients spend fasting – by operating on frail patients first thing in the morning. The University Hospital Zurich continues to use special measures to recognize and treat delirium as quickly as possible. Anesthetists are very sensitive to the depth of anesthesia in order to avoid delirium. In some older patients, anesthesia has a stronger effect than in younger people. Pain should be treated well after an operation. As some very elderly people only express their pain to a limited extent, the nursing staff must act with empathy.
Intensive cooperation between the hospital and GPs is also helpful in the care of frail patients. Personalized treatment concepts have already shown good results.
Frailty: prevention before an operation
If there is enough time before an operation, it helps to strengthen frail people beforehand. On the one hand, this can be achieved through a diet based on plenty of protein and vitamins. On the other hand, physical and mental training can significantly increase a person’s general fitness. Studies have shown that this can put frail people in a much better position for an operation. However, it is best to activate people at an early stage. For this reason, relatives should be informed about the factors that lead to frailty after the first signs of frailty – such as a fall.