1) What is Frailty?Those of us who have worked in long-term care are aware that two people can be the same age and take the same medications for the same diagnoses, and yet have very different life trajectories. Doctors continue to struggle with ways in which we can measure “frailty” and its associated health risks among older adults.Thanks to Christa Monkhouse for posting a new study from BMC Geriatrics, detailing the SHARE-FI (Survey of Health Aging and Retirement in Europe Frailty Instrument), which was tested on over 30,000 community-dwelling men and women, with a mean age of 64 and a 2-1/2 year followup.The instrument measures 5 variables (4 are self-reported):– Exhaustion (recent lack of energy)– Weight loss (with decreased appetite)– Weakness (direct handgrip measurement)– Slowness (ability/inability to walk or climb stairs)– Low activity (measured as ability/inability to do moderate-energy activities)The survey identified frailty in 7.3% of women and 3.1% of men, as well as “pre-frailty” in an additional 25.8% of women and 14.6% of men (a combined total of over 8000 of the 30,000 adults tested–and they aren’t that old!). The survey was reliable and predicted a doubled mortality risk for the pre-frail group and nearly 5-fold in the frail group. This association was independent of the person’s age (reminding me of a comment made to me years ago by a local cardiologist: “Age should be measured, not as number of years from birth, but as number of years from death.”)Our local healthy aging guru, Dr. Bill Hall was interviewed by Medscape about the study. Here are his comments, in part:
“In the old days, we would call this ‘old age’ but that has lost its cache a long time ago. A definition of frailty is important because you can’t really find out what is causing something if you don’t know what to call it. If one could categorize a clear subset of older people who seem to be frail, perhaps one could find a cause or a series of causes either to ameliorate, or even prevent it.”
“There is no disease code for frailty. You wouldn’t be able to bill for it at a hospital or use it as a description for a laboratory test. Frailty hasn’t found a niche within the insurance industry or with Health and Human Services. So in this time of health care reform, having an assessment tool becomes very important.”
Dr. Hall predicts that “this study will gain a lot of acceptance and I would predict that in a year or so, we will see some kind of an approved international index. This can be used right in the primary care office, which is really what the crying need is.”
I agree with the utility of this study. But to me, there is still one omission. As I said, a same-looking person can live at home or in a nursing home, and yet have a very different course of health. So I have a few more questions: (1) What are the effects of social capital (presence or lack thereof) on the frailty of the community-dwelling person? (2) What causes a more rapid decline when that same-looking person moves to a nursing home? Is it (a) a subtle increase in medical illness, (b) loss of social support, (c) negative effects of institutionalized life, or (d) all of the above?
Finally, what is the potential for age-friendly communities to change the course of frailty??2) Dementia Advice for FamiliesEden Board member Sarah Rowan and I recorded a 1-hour interview with Dr. Gordon Atherley on his VoiceAmerica internet show “Family Caregivers Unite!”. The interview will be broadcast online, on Tuesday September 7th at 1 PM edt (4 PM gmt), and will be available as a podcast afterward.In the interview, we discuss my new book and some of its ramifications for family care partners. Sarah adds her wisdom and her remarkable perspective as a former care partner to her husband Joseph, and as an educator.The internet link for the broadcast.