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HEALTH Research may determine cause of frailty

Monday, January 20, 2003

Frailty occurs more often for older women than for older men.
Often overlooked these days in the attention being given to overweight Americans is the fact that many older adults are frail. Frailty is difficult to define, but several ways of doing so have been employed in gerontological research.
One way is in terms of a clinical syndrome in which three or more of the following are present: an unintentional weight loss of 10 pounds or more in the past year, self-reported exhaustion, weakness as measured by grip strength, slow walking speed and low physical activity. A method used by French researchers is one in which frail elders have disability for at least one instrumental activity of daily living (e.g., shopping, transportation).
Researchers at Washington University have succeeded in discriminating among those elders who are not frail, those who are mildly frail, and those who are moderately frail by their performances (time scores) on a series of nine physical tasks. Included are putting on and taking off a coat and ascending 10 steps. Researchers at Yale University define frailty by needing more than 10 seconds to walk back and forth over a 10-foot course or inability to stand up from a hardback chair with their arms folded.
The percentage of older Americans who are frail has been estimated to be 25 percent. By contrast French researchers have found it to be over 30 percent.
Contributing conditions
Conditions producing frailty in late adulthood include years of heavy drinking, smoking, physical inactivity, and social isolation. Of course, during late adulthood itself a primary condition is an inadequate diet. A survey by researchers at the Ross Laboratories of Ohio of the food intake of nearly 500 normally aging adults age 65 to 98 years revealed that 40 percent of them had energy intakes from food that were well below the recommended amount. Alarmingly, more than 20 percent of the participants reported that they normally did not eat lunch. In another study of a large sample of women over age 70, 16 percent were underweight and nearly 30 percent failed to consume adequate amounts of the basic nutrients.
Inadequate diet is generally assumed to be due to uncertain food availability, accessibility,. and affordability brought about by limited financial resources. People of all ages can be affected by such food insecurity, but older people are especially adversely affected by limited resources. Not only do many of them have low incomes, but they also have a greater likelihood than younger people of having poorer health or a physical disability that affects their eating behavior Hispanics who have the highest incidence of food insecurity, followed by African Americans.
Proper nutrition and diet for older people may also be impaired by conditions that interfere with normal eating. Eating commonly occurs in the presence of others at the same time, and it therefore serves as a source of (usually) pleasant social interactions. Unfortunately, many frail older people Iive lonely lives. An especially serious condition is widowhood. A study of 50 recently widowed older women revealed that the loss of their spouses had negative effects on their motivation to cook and to eat and to visit restaurants.
Physical therapy helps
Researchers at Yale University found that physical therapy resulted in a 45 percent reduction in disability of frail elders within seven months. Those receiving the therapy improved the participants ability to perform the activities of daily living and lowered the risk of additional physical decline.
Frailty occurs more often for older women than for older men. It has also been found in some studies to be associated with low education, although researchers at the University of Georgia found no effect of either economic status or educational level on the incidence of frailty.
Frail elders have been found to have a greater risk of heart disease, stroke, and depression than nonfrail elders. They also have a greater risk of falling Mental functioning has been found to be less proficient for many frail older adults than for nonfrail older adults.