We’re learning that frailty can quietly arrive decades before old age, with some people in their 30s or 40s unknowingly in a pre-frail state. There are surprising ways to stay strong – and it’s not all about weight training
If we live long enough, many of us will eventually start to exhibit telltale signs of frailty, from unsteady feet to mental confusion. Yet not all. Think of Julia Hawkins, who set world records in the 100-metre sprint after taking up running at age 100. Or the journalist Leonard Barden, who still files weekly chess columns at the age of 96. Such people defy the odds and seem to dodge the destiny of frailty. The question is: why?
The answer lies in new insights into frailty, which show that it is a far more complex and diverse condition than it first appears. Surprisingly, we are also discovering how it can start developing early in our life, with a significant number of people in their 30s or 40s unknowingly in a “pre-frail” state.
The good news is that we have more control over our future frailty than we might realise. Many of the factors that lead to it are modifiable, and midlife is a great time to take action. What’s more, this new understanding of how to age strongly is revealing unexpected ways to fight frailty – and it’s not all about exercise and weight training.
Becoming vulnerable
Roughly speaking, frailty affects around 10 per cent of people in their 50s, rising to around half of all those in their 80s. Although it is linked to ageing, it is also highly variable among people of the same chronological age.
Most of us are familiar with physical frailty, which includes the loss of muscle mass known as sarcopenia, which can make it difficult to get out of a chair without assistance, as well as osteoporosis, which leads to brittle bones and fractures. But people can also be cognitively frail, making them markedly more vulnerable to dementia. Overall, people who are frail have fewer biological reserves, so are much less resilient to any kind of trauma – whether that’s an infection, an operation or the sudden death of a family member – which leaves them prone to a significant decline in overall health.
“Frailty is more of a state of being than a specific disease,” says Mary Ni Lochlainn, a specialist in geriatric medicine at King’s College London. “It’s a state of reduced resilience, reduced reserve, so your ability to bounce back after a stressor is impaired.”
Frailty is increasingly being recognised as something that is important to spot as early as possible. Not only are older people with severe frailty five times more likely to die within the next year than those without, but frailty is linked to an increased risk of falls, delirium, hospital-acquired infections and dementia.
But frailty isn’t a sudden event. We now know that it represents the endpoint of a gradual continuum that can begin surprisingly early in life. One 2018 study of nearly half a million people in the UK found that 38 per cent of women aged 37 to 45 and 35 per cent of men had indicators of pre-frailty, a state that Tom Brennan, an ageing researcher at Flinders University in Australia, describes as “an early-warning stage”.
Read the full story: Frailty sets in far earlier than you’d expect, but you can reverse it (New Scientist)