What is frailty?

Frailty is a state of increased vulnerability and decreased physiologic reserve that impedes the body’s ability to withstand and recover from minor challenges.[1] Frailty is multidimensional and consists of psychological, social, and physical aspects, and puts people at risk of adverse health outcomes, including falls, disability, admission to hospital, and death, and has been reviewed in the CMAJ.[2]

Despite what one might intuit, frailty is not an inevitable part of aging, although its prevalence does rise with age, from 16% of people 65 years old to over 50% of those over 85.[3] Mounting evidence suggests that early identification and intervention can not only slow the progression of frailty but even prevent it. The interventions include physical activity, nutritional support, and social networking.[4]

How can frailty be assessed?

One can start assessing frailty with the PRISMA 7 questionnaire[5] and the Timed Up and Go test.[6] Additionally, the Clinical Frailty Scale, developed and validated in 2005, is still in use today. More recently, the Fraser Health Authority launched the Community Actions and Resources Empowering Seniors (CARES) model in BC, a collaborative primary care model using an electronic comprehensive geriatric assessment and coaching to prevent frailty. A patient’s comprehensive geriatric assessment is loaded into the physician’s EMR, which calculates a frailty index. Once the frailty index is determined, supports such as health coaches can be put in place to assist the pre-frail senior. Preliminary data from a pilot CARES study show that with 6 months of coaching, the number of participants exercising frequently increased by 65%, and walking independently increased by 30%. Moreover, participants endorsing a positive health attitude increased by 59%.[7]

What programs are feasible to address frailty?

In a current project targeting seniors (but including other ages), the White Rock–South Surrey Division of Family Practice partnered with the Peace Arch Hospital and Community Foundation to offer subsidized personal exercise prescriptions through the MOVE for LIFE program.[8] Other divisions can team up with local groups such as the YMCA to offer programs suitable for their communities, and many already are.

For a home-based program, the Go4Life website[9] from the National Institute for Aging provides seniors with simple tools to prevent frailty and maintain independence. This includes exercises and videos focused on improving flexibility, strength, balance, and endurance.

How early should frailty be addressed?

We know that obesity rates are increasing in both children and adults, and obesity is associated with type 2 diabetes, cardiovascular disease, and musculoskeletal impairments. We also know exercise improves cardiorespiratory fitness, enhances psychosocial well-being, and reduces obesity.[10] Habits established in childhood and reinforced throughout life are more likely to endure later in life. Additionally, regular exercisers are less likely to live with chronic diseases that contribute to frailty. BC programs such as Be Active Every Day[11] are one way for family physicians and educators to collaborate in establishing healthy exercise and eating habits early in school-age children.

As our population ages, frailty becomes an increasingly prevalent condition that threatens the health of seniors and the viability of our health care system. We know it can be prevented by targeted assessments at the primary care level with specific interventions that can begin early in life. Preventing frailty is consistent with the foundational concepts of the patient medical home, and should be considered in the evolution of primary care networks and public policy decisions.
—Steven Larigakis, MD

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This article is the opinion of the Athletics and Recreation Committee, a subcommittee of Doctors of BC’s Council on Health Promotion, and is not necessarily the opinion of Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-495.

2.    Abbasi M, Rolfson D, Khera AS, et al. Identification and management of frailty in the primary care setting. CMAJ 2018;190:E1134-E1140.

3.    Hoover M, Rotermann M, Sanmartin C, Bernier J. Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Health Rep 2013;24:10-17.

4.    Puts MTE, Toubasi S, Atkinson E, et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: A protocol for a scoping review of the literature and international policies. BMJ Open 2016;6:e010959.

5.    BC Guidelines. PRISMA-7 questionnaire. Accessed 15 January 2019. https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/frailty-prisma7.pdf.

6.    Centers for Disease Control and Prevention. Timed Up and Go assessment. Accessed 15 January 2019. https://www.cdc.gov/steadi/pdf/TUG_Test-print.pdf.

7.    Garm A, Park GH, Song X. Using an electronic comprehensive geriatric assessment and health coaching to prevent frailty in primary care: The CARES model. Med Clin Rev 2017;3:9. doi: 10.21767/2471-299X.1000051.

8.    Peace Arch Hospital Foundation. Move For Life South Surrey White Rock. Accessed 15 January 2019. www.pahfoundation.ca/projects/move-for-life.

9.    National Institute on Aging at NIH. Go4Life. Accessed 15 January 2019. https://go4life.nia.nih.gov.

10.    Paes S, Bouzas Marins JC, Andreazzi AE. Metabolic effects of exercise on childhood obesity: A current view. Rev Paul Pediatr 2015;33:122-129.

11.    Doctors of BC. Be Active Every Day. Accessed 15 January 2019. https://be-active.ca.