Symptoms of frailty can start from age 30 and increase risk of death
SINGAPORE – At 52, Ms Maryanne Chua uses a walking stick whenever her knee acts up, but feels “generally healthy” otherwise.
A recent questionnaire she completed told a different story.
Ms Chua, who has a torn meniscus (cartilage that cushions the knee joint) and knee osteoarthritis, discovered she was pre-frail.
Being pre-frail is a precursor of frailty, which is the loss of physiological reserves marked by symptoms such as unintentional weight loss and slowness in walking. Frailty puts individuals at a higher risk of falls and hospitalisation, and is a state of health more commonly associated with the elderly.
“I’m a little surprised and never thought that at 52, I might fall into the category of pre-frail or frail. I thought it is one of those things you’d associate with much older people, like your parents or grandparents, not when you’re still working and moving around,” said Ms Chua, a manager, who is overweight and has obstructive sleep apnoea.
One of the most pressing issues of a rapidly-ageing population, frailty affects about 6 per cent of seniors above age 65 and one in four elderly above 85, according to local studies.
New research has highlighted the significance of frailty in the middle-aged, particularly those with multiple long-term illnesses.
A British study published in The Lancet Public Health in June found that the condition can occur in both men and women between the ages of 37 and 73, and is more common among those with chronic health conditions.
Diabetes was among the top long-term conditions associated with frailty. Additionally, the researchers, who studied nearly 500,000 people, found that frail individuals across all ages faced a higher risk of death.
Efforts to identify, manage, and prevent frailty should include middle-aged individuals with multiple chronic conditions, in whom frailty is significantly associated with mortality, the researchers concluded.
Frailty is a precursor to disability and death, said Associate Professor Reshma Merchant, a senior consultant and head of the division of geriatric medicine at the National University Hospital.
Frail individuals are weak, easily exhausted and are more vulnerable to stressors. When they fall ill, they may also find it harder to bounce back.
MULTIPLE POORLY-CONTROLLED CHRONIC ILLNESSES A RISK FACTOR
There are many causes of frailty; age is just one of them, said Assoc Prof Reshma.
A common misconception is that frailty is an inevitable part of ageing, when not all elderly become frail. Ms Chua’s father, who is in his eighties, is in robust health and does not use a walking aid.
For those with chronic conditions, particularly poorly controlled diabetes or hypertension, pre-frailty can start from the age of 30 onwards, said Assoc Prof Reshma.
But the early signs are often subtle and can go undetected until more complex health issues crop up. Hospitals here currently do not actively screen younger adults for frailty.
“I have seen people in their mid-fifties with multiple poorly controlled chronic diseases who are frail. They are often depressed and have a poor quality of life,” she said.
Dr Nur Farhan Mohammad Alami, a specialist in geriatric medicine and consultant at Raffles Internal Medicine, said it is rare for younger adults to be frail but serious underlying medical conditions, such as cancer, can contribute to frail symptoms in this age group.
“It is not just their illnesses that make them frail, but side effects of treatment that play a part too,” she said.
Other factors of frailty include depression, poor nutrition, depression and problems walking, for example, due to osteoarthritis of the knees, obesity and being on multiple medications such as those affecting gait and balance, said Assoc Prof Reshma.
In the clinical setting, a screening questionnaire is used to assess indicators of frailty, including fatigue, muscle strength, ability to walk a certain distance, number of illnesses and weight loss, said Dr Nur Farhan.
People with one or two indicators are classified as “pre-frail”, and those with three or more meet the criteria for “frail”.
Catching it in the early stages can prevent disability and other adverse health issues, said experts. Studies have shown that frailty and pre-frailty is reversible in at least 20 per cent of people, said Assoc Prof Reshma.
Now that Ms Chua is aware of her risk of frailty, she wants to make a more concerted effort to take charge of her health.
“I’m going continue with my Pilates sessions and try harder to lose some weight to better manage my knee issues and obstructive sleep apnoea (OSA). I might also consider surgery for my sleep apnoea if symptoms don’t improve,” she said.
Keep frailty at bay with tips from the experts.
1. Keep chronic conditions under control
Since frailty is more common in the elderly with many medical conditions and who are on multiple medications, it is helpful to seek medical help to detect any underlying illnesses and have them treated, said Dr Nur Farhan.
2. Do a mix of resistance training, balance and aerobic exercises
Aim to do resistance exercises at least twice a week, aerobic activities (brisk walking, swimming, dancing) for 30 mins each day, five days a week, and balance (walking, taiji) at least three days a week, said Assoc Prof Reshma. Do some stretching daily.
3. Eat well
Besides having healthy, balanced meals each day, Assoc Prof Reshma said a diet high in protein and leucine (an essential amino acid) is important for muscle protein synthesis and increase in muscle strength.
People who are pre-frail or frail will require 1.2 grams of protein for every 1 kg of body weight a day, with at least 20 to 30 grams per meal daily, she said. For instance, a 50 kg individual will require an average of about 60 grams of protein per day.
A 100-gram serving of lean chicken has about 28 grams of protein, a large egg has about 6 grams of protein and half a cup of cooked lentils has about 8 grams of protein.
Those with kidney problem must consult their doctor before taking high protein diet, she added.
4. Stay socially active
Preventing social isolation is important, said Assoc Prof Reshma. Studies by John Hopkins researchers found that older volunteers who tutor in schools sharpen their own thinking skills and improve their physical functioning too.
Meet up with friends and neighbours, have meals with the family, and participate in group activities such as joining a dance club, cooking club, or taiji group, she advised.
In conjunction with the International Day of Older Persons, the National University Hospital (NUH) is organising an event called #FitNotFrail on Oct 1 (Monday) from 12pm to 4pm at NUH Main Building Lobby B. Participants can enjoy performances from seniors and pick up tips on healthy ageing.
