Frailty yet again

I regularly scan the medical literature for articles about all sorts of conditions which relate to physical activity or lack of it. My main concern is for older people for whom lack of physical activity is such a risk factor for frailty – a sign of my own increasing age?. Recently the number of  articles about frailty has been increasing and I can detect a neat sequence  – its causes, possibilities for prevention and treatment, the increasing numbers ending up in A&E, increased risk of dying in A&E, length of stay in hospital and ultimately the overall risk of premature death.

Frailty – the increasing frailty at different ages

A growing body of research, particularly from the United States, suggests that more recently born generations, particularly those born since 1945, may be experiencing worse health than previous generations as measured by chronic disease and disability. This trend of worsening health across cohorts at the same age has been labelled “generational health drift.”

I reported briefly on this article from the Journal of Gerontology four weeks ago. The authors examined data on more that 100,000 people from several generations in England, the US and Europe. They estimated differences in the age-adjusted risks of poor health across groups born before 1925 and groups born within ten year periods from then until 1959.

The risk of doctor-diagnosed chronic disease increased across all groups in all regions with similar trends in disability. In other words for all age groups individuals were more unhealthy after the war than they would have been at the same age before the war. “Baby boomers” born after WW2 were about 150% more likely to suffer cancer, lung disease and heart problems when they were in their 50s and 60s  than were those born before the War were at the same age. This trend is likely to continue with Gen Z being more likely to be obese and have diabetes than are baby boomers.

The prevention and treatment of frailty

A paper published in Geriatric Nursing analysed the results from 28 studies of exercise-based treatment for older people with muscle loss – sarcopenia which is the main underlying pathology of frailty. Both grip strength and general muscle strength were significantly improved by exercise programmes.

Another analysis of 46 studies of the effect of a variety of general practice interventions for frailty, half of which involved physical activity. They found that muscle strength training was the easiest and most effective treatment for improving the indicators of frailty. Resistance training was more effective than other forms of exercise. Protein supplementation was also found to play a part in treating sarcopenia.

A preventive treatment for mild frailty has been trialled in general practice in England. 388 people aged 65 or more with mild frailty were randomly assigned to either “usual management” (ie not much) or a “HomeHealth” programme which involved about six face-to-face meetings with a support worker over six months. The consultations included discussion about what was important for the subject in trying to live well, including mobility, nutrition, psychological wellbeing, and socialising. Participants and support workers then agreed on an overall outcome goal, SMART goals (ie, specific, measurable, achievable, relevant, time-bound) to achieve this overall goal, and an action plan. Action plans were tailored to individuals and included strength and balance exercises, dietary changes, and increasing social contacts. Exercise equipment, such as resistance bands, ankle weights, and grip strengtheners, was provided for free where needed. Also, some participants attended local group classes.
At one year follow-up, the main findings included improved quality of life in the treated group – and a lower incidence of adverse events in the treated group (55 vs 85).

Guidelines on prevention and treatment

Guidelines for the management of sarcopenia and frailty are being developed by health organisations across the world. I came across one particularly good example produced by a combination of several centres in Italy

“Moretti A, Tomaino F, Paoletta M, Liguori S, Migliaccio S, Rondanelli M, Di Iorio A, Pellegrino R, Donnarumma D, Di Nunzio D, Toro G, Gimigliano F, Brandi ML and Iolascon G (2025) Physical exercise for primary sarcopenia: an expert opinion. Front. Rehabil. Sci. 6:1538336.”

Prevention and treatment of frailty can clearly be effective, and the emphasis should be on prevention. If frailty has not been prevented, the sooner the treatment begins the better. The HomeHealth programme seems an excellent place to start.

Next time I will discuss the ill effects of frailty.

The OrtoMed exercise programme:

Aerobic exercise: