Physical symptoms that mark frailty often reversible

In a study to determine how older people progress through different states of frailty, researchers at Yale School of Medicine have found that the physical symptoms that mark frailty are often reversible and therefore amenable to intervention.

Published in Archives of Internal Medicine, the study included 754 participants age 70 or older, who were not disabled in their basic activities of daily living, such as bathing and dressing. Their frailty, assessed every 18 months for 54 months, was defined on the basis of weight loss, exhaustion, low physical activity, muscle weakness and slow walking speed. Participants were classified as "frail" if they met three or more of these criteria, as "pre-frail" if they met one or two and as "non-frail" if they met none of the criteria.

"Frailty, like disability, is a dynamic process with older individuals moving back and forth between different frailty states, and there are surprisingly high rates of recovery," said lead author Thomas M. Gill, M.D., associate professor of internal medicine/geriatrics at Yale. "On average, we found more transitions from less frail to more frail states."

Because the transition to frailty is often a gradual progression that occurs over the course of several months or years, Gill said there is opportunity for prevention, but a person who has already entered the frail state is unlikely to transition back to no frailty. "This highlights the importance of focusing on individuals in the pre-frail state before they get to full-blown frailty," he said.

The results are part of the ongoing Yale Precipitating Events Project (PEP), which seeks to better understand how older persons manage day-to-day activities and remain independent at home. Titled "Epidemiology of Disability and Recovery in Older Persons," the PEP study includes 754 participants age 70 or older from the Greater New Haven area. Gill and his team will next focus their research on identifying risk factors for the development and progression of frailty, such as depressive symptoms, cognitive impairment, poor nutrition and intervening health events, in the hope of developing strategies for preventing frailty and disability.

Other authors on the study include Evelyne A. Gahbauer, M.D., Heather G. Allore and Ling Han, M.D.