What is frailty?
Frailty is defined in the Mariam Webster dictionary as being “physically weak”. The sprightly step is no longer there. But wait, we can do something before that happens; and if it has begun, we can prevent it from progressing too rapidly.
What can be done?
There are five things according to the five letters of FRAIL that we can check ourselves. The FRAIL scale was developed by John E Morley and his colleagues and published their work on this in 2012. He and his team call it a modern-day geriatric giant. So we have a road map to take care of things. Let me share it with you.
The FRAIL Scale
First to get to know that is the FRAIL scale and how to use it to decide if someone you know or yourself is frail
The road map of actions to reverse frailty
- Fatigue — deal with fatigue
- Resistance. Aerobic — Prevent muscle weakness — take up walking exercise and resistance exercise
- Illnesses — review the medication list for unnecessary side effects and medications whose side effects may be contributing to frailty
- Loss of weight — review causes of weight loss. To help in this there is even a mnemonic called MEALSONWHEELS!!!
M= Medications causing poor appetite. E= Emotions — namely, depression. A= Abuse of alcohol. L=Late life paranoia. S=Swallowing problems. O= Oral problems. N=Nosocomial infections e.g., H. Pylori infection-causing poor appetite. W=Wandering and other dementia-related issues. H=Hyperthyroidism, hypercalcemia, hyperglycemia, hypoadrenalism. E=Enteral problems e.g. celiac disease. E=Eating problems. L=Low salt, sugar, and cholesterol diets. S=Stones – cholecystitis. See reference [1]
Aerobic exercise
This is a “low lying fruit”. Get hold of yourself, alone or with spouse or friends, and start walking. Anytime is best. Walk often enough and it will become a habit. “The sky gets dark slowly”: walking prevents the “sky getting dark” too fast.
What if the person is now frail?
The Japanese community has a solution. This is called the sit-stand exercise. The frail person sits in front of a table. He or she stands and counts from 1 to 10 (a thousand and one, a thousand and two etc). Sits down and count 5. That is one cycle. Repeat 10 cycles to form a set. This person will need a helper to provide a “contact guard” i.e., be around in case assistance is needed to prevent a fall.
Take home message
Walking 5 days a week can prevent frailty. Walk a length that is comfortable and manageable everyday. At the age of 75, many of us can still manage 30 to 60 mins. If you are still up to it, regard it as a blessing. Keep those thigh muscles strong and able by walking.
Reference for further reading
John E Morley. Frailty and sarcopenia: the new geriatric giants. Rev Inves Clin. 2016;68:59-67 https://pubmed.ncbi.nlm.nih.gov/27103041/ (Free article)
Dr LG Goh
Dr GOH Lee Gan is a retired Associate Professor in the Department of Family Medicine, National University Health System. He has an interest in learning and teaching how we can age well everyday (AWE).
