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Frailty and Aging

Frailty is a decrease in the body's ability to handle stress and is a predictor of poor outcomes.

Frailty is an increasingly recognized geriatric syndrome. It is a chronic and progressive process described as an age-related decline in physical function and reserve in multiple body systems. It can be manifested in many ways, including decreased strength, balance, nutrition, poor thinking skills, mobility, endurance, and physical activity. Although there is no specific medical definition of frailty, Webster's dictionary defines frail as weak and vulnerable. Most simply put, frailty is a decrease in the body's ability to handle stress and is a predictor of poor outcomes.

Frailty is common among older adults!

Frailty is just as common as Alzheimer's disease and the risk increases with age. 7-12% of adults aged 65 and older, and 40% aged 90 and older suffer from frailty. Women are at increased risk of developing frailty, and African Americans are two times more likely to be frail than Caucasian older adults.

A study in the Journal of the American Geriatric Society found that older adults had a higher risk of death when they suffered from frailty, depression and loneliness combined.

Frailty As a Concept

Frail older adults are at a higher risk from stressors such as infection, hospitalization, and surgery. Frail older adults are more likely to have delayed recovery, be hospitalized, develop functional impairment (dependency), and die.

Primary Frailty

The core component of primary frailty is decreased lean muscle mass. Low muscle mass can be caused by a reduced ability of the body to produce certain hormones. Other factors leading to reduced muscle mass include decreased exercise, poor nutrition, and advancing age. An older adult is more likely to suffer from clinical frailty as they experience problems with multiple systems. The presence of multiple abnormal systems, increases the likelihood of developing clinical frailty.

Secondary Frailty

Secondary frailty is defined as a combination of multiple disease states that become the overall picture of frailty. Secondary frailty is the most common type of frailty. Frailty is almost unavoidable in certain disease states such as severe heart failure, severe kidney disease, severe COPD, uncontrolled diabetes, and advanced cancer. Most conditions that increase a person's likelihood of developing frailty can be controlled and/or prevented with healthy lifestyle choices.

Signs of Frailty

Men and Women Can show different signs of frailty

A man may notice they are less active or have decreased strength, whereas a woman's first sign of frailty could be incontinence. Although there are different incontinence causes, one reason could be related to reduced walking speed and the inability to make it to the bathroom on time. Decreased walking speed can increase a person's risk of falling, which is another sign of frailty. Research suggests women with incontinence would benefit from geriatric consultation.

Frailty is a predictor of falling, consider reading a short blog from GeriAcademy on Falls.

Evaluation of Frailty

The earlier a health care provider can detect frailty signs, the easier it is to intervene and hopefully reverse some of the processes.

Geriatricians are particularly good at recognizing signs of frailty. A Geriatrician evaluates frailty be performing a comprehensive geriatric assessment. A comprehensive geriatric assessment includes history taking, measure of independence and dependence, functional status, review of medications, fall history, review of multiple disease states, and a physical examination. A comprehensive geriatric assessment can often take up to two hours.

Independence to Dependence

Independence to dependence is a spectrum. Completely independent means a person can take care of themselves without any help from others. Initially, we may need more help with things like laying out medications, driving, and managing finances. Later on, our families and friends may notice frailty signs like slowing down or decreased activity. As we continue down the spectrum, we may need help with more basic activities like dressing, bathing, walking, moving around, toileting, and possibly feeding ourselves.

The risk of developing medical problems increases with aging; this can further increase the risk of losing independence and relying on others for help. By managing medical problems well, we may be able to maintain independence longer. Any geriatrician's goal is to keep their patients functional and independent for as long as possible.

Dependency Spectrum

Other ways that health care providers evaluate frailty includes:

  • Weight Loss, unintentional, more than 10 pounds in one year

  • Inability to perform tasks due to exhaustion

  • Decreased walking speed

  • Decreased Activity Level

  • Weakness, a good measure is decreased hand strength

Don't Worry, there is hope!

You can reverse or prevent frailty by;

Keeping Active! Try to exercise 3-5x a week. A recent study suggests that increasing step count by 1000 steps a day, which is about 10 minutes of activity, could prevent frailty. For best results, strength, balance, and flexibility regimens should be combined with cardiovascular exercise. The National Institutes on Aging at NIH has a great free booklet with sample exercise routines called Workout to Go.

Keep up good nutritional habits; studies suggest that a Mediterranean diet can prevent frailty. The American Heart Association has good information on the Mediterranean diet.

Keep your medical issues under good control! Persons with chronic medical problems should take their medications as directed. Talk to a health care provider about stopping any un-needed medications, read our post, Am I Taking Too Much Medicine.


I hope you found this post to be helpful, recognizing signs of frailty is the first step to maintaining independence. Talk to your health care provider, or consider consultation with a geriatrician.

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This post was written by Dr. Mckenzie Cannon DO. Board Certified in Internal Medicine, current geriatric fellow at Carolinas Health Care System Blueridge in Morganton, North Carolina.

References used to write this blog

Hoogendijk, E.O. et al., (2020), Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life. J Am Geriatr Soc, 68: 2587-2593.

Watanabe, D., et al. (2020), Objectively Measured Daily Step Counts and Prevalence of Frailty in 3,616 Older Adults. J Am Geriatr Soc, 68: 2310-2318.

Kojima, G., et al. (2018), Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta‐Analysis. J Am Geriatr Soc, 66: 783-788.

Atmis V. ,. Guler B. Association Between Walking Speed and Urinary Incontinence in the Older Women. Which Patients Should be Referred to Geriatricians?. Gynecol Obstet Reprod Med [Internet]. 2020Mar.20 [cited 2020Dec.30];26(1):44-50. Available from:

Collard RM, Boter H, Schoevers RA, Vosharr RCO. Prevalence of Frailty in Community Dwelling older Persons: A Systematic Review. J Am Geriatric Soc 2012: 60:1487-92

Fried LP, Tange CM, Walston J, et all. Frailty in older adults; Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001: 56 (3): M 146-156


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