Frailty

What is frailty?

Frailty is when your body can’t get through and recover from illnesses and injuries on its own. Your body is more vulnerable with frailty, making it harder to recover from health issues. As it worsens, frailty can disable you. It can keep you from doing day-to-day tasks that are part of being self-sufficient. It can also shorten your life expectancy. Frailty is sometimes reversible, but that varies from case to case.

Frailty and physical weakness aren’t the same thing. With frailty, your endurance, mental health and brain function also play a role. Frailty is like a spectrum, ranging from least severe to most. And frailty can happen to anyone, not just adults over 65.

What are the symptoms of frailty?

There are many possible symptoms you can experience with frailty, including:

• Frequently feeling fatigued or exhausted.
• Muscle weakness or reduction in strength.
• Moving slowly or having other trouble moving around (due to decreased strength and/or flexibility).
• Having trouble with balance and stability (you might fall more easily or more often).
• Leaking pee or poop by accident (urinary or bowel incontinence).
• Avoiding spending time out in public or with loved ones (social isolation).
• Depression.
• Needing help with activities of daily living (ADLs) like feeding, dressing or bathing yourself.
• Losing weight without trying.

What causes frailty?

Frailty happens when your body isn’t healthy enough to recover from injuries or illnesses. This can happen over time if you have chronic medical conditions, take certain medications, have a limited diet and aren’t physically active.

Your health is like a bank account. It covers the cost of everything you do. That includes simple actions like breathing and blinking your eyes, or complex actions like bathing yourself. It also includes your body’s ability to endure and recover from illnesses and injuries. The bigger your balance, the farther from frailty you are.

You develop frailty if your health can’t cover the costs of everyday life. When that happens, it’s like you overdraw your account and need outside support just to keep your body running.

The things that help improve or maintain your health are like deposits into your bank account. They can help prevent frailty. These include:

• Your genetics, family history and how you naturally grow and develop from a child to an adult.
• Physical activity.
• Proper nutrition.
• Stress management.

But there are also things that reduce your health like withdrawals on your bank account. Things that can contribute to frailty include:

• Short-term illnesses like influenza or food poisoning.
• Minor injuries like muscle sprains and strains and stress fractures.
• Chronic conditions and severe injuries, like a broken hip.

Chronic conditions

The more chronic (long-term) conditions you have, the easier it is to develop frailty. Things that can contribute to or make frailty worse include issues with your:

• Bones, like osteopenia or osteoporosis.
• Brain, like movement disorders and progressive diseases that affect memory and thinking.
• Heart and circulation, like heart disease.
• Immune system, like multiple sclerosis, rheumatoid arthritis and other autoimmune diseases.
• Joints, like arthritis and joint replacements.
• Metabolism and changes in weight or muscle mass, like having obesity, underweight, sarcopenia or diabetes.
• Organs, like your liver or kidney.
• Respiratory system, like asthma and chronic obstructive pulmonary disease (COPD).

What are the risk factors for developing frailty?

Research links the following with a higher risk of developing frailty:

• Age. About 1 in 10 people over 65 have frailty. That number climbs to 1 in 4 among people 85 and older.
• Severe illnesses or injuries. The more severe a condition is, the more it raises your risk of developing frailty. Examples include sepsis, which can cause permanent organ damage, and hip fractures.
• Treatments for severe illnesses or injuries. Treatments may strain your health, but providers still recommend them when the pros outweigh the cons. Examples include cancer treatments like surgery, chemotherapy or radiation therapy, or transplant surgery for organ failure.
• Congenital (present at birth) conditions. Congenital heart diseases are a common cause of frailty in children. Congenital conditions — not just heart disease — may also increase the risk of frailty after childhood.
• Support network. Providers often weigh whether or not you have a support network when determining if you have frailty. Support networks include family, friends or other loved ones. Not having a support network may make developing frailty more likely. That’s because it can make it harder to get food, medical care, and join in physical and social activities.

What are the complications of frailty?

Frailty can lead to the following complications:

• Lower your immunity. Frailty can leave you vulnerable to new illnesses and slow down recovery from illnesses you already have.
• Increase your vulnerability to injury. Frailty can make you prone to and slow to recover from injuries.
• Make other conditions more severe. Even minor conditions can turn into dangerous or even fatal complications.
• Limit your treatment options. People with frailty may not be able to safely undergo certain procedures or surgeries.
• Cause disability. Frailty can cause you to develop a disability.
• Take away your independence. People with frailty may not be able to live alone and in their own homes.
• Shorten your life expectancy. When health issues accumulate and worsen, frailty can make them life-threatening.

How is frailty diagnosed?

A healthcare provider can diagnose frailty using a combination of methods. That includes a physical exam and using frailty scales or scoring systems. These scales or systems help your provider determine if you have frailty and how severe it is.

There are more than a dozen scales and scoring systems in common use around the world. And there’s no consensus on one being any better than the rest. Five of the most common criteria found on those scales and scoring systems include:

• Losing weight without trying (at least 10 pounds or 4.5 kilograms in the last year).
• Weaker hand grip strength compared to others with similar body characteristics and sex.
• Low energy or endurance, or feeling fatigued or exhausted often.
• Slow movement or walking speed.
• Low activity level.

Experts often use measures of physical strength — like how strong your grip is — to determine if you have frailty. That’s a key reason behind the common misconception that frailty is the same as having physical weakness.

The scales and how they use the criteria vary. Some scales use criteria that relate to your mental functioning, incontinence, whether you have a support network and other factors.

Other tests might be possible, depending on your needs. Examples include a body mass index (BMI) measurement to check for muscle loss or undergoing a fall risk assessment. Your provider can tell you more about the tests they recommend.

How is frailty treated?

Frailty can be managed — and sometimes reversed — with treatment and support. Some of the most common ways to do that include:

• Managing conditions tied to frailty. Treating medical conditions you have can reduce strain on your body and help you recover.
• Physical therapy. This can help increase physical strength and endurance and improve balance.
• Specialized rehabilitation programs. Rehab programs can help you recover from serious events that contributed to your frailty. Examples include pulmonary rehabilitation and cardiac rehabilitation.
• Nutritional support. Working with a nutrition expert can help with vitamin and mineral deficiencies, or with weight-related issues that increase your risk of frailty (having overweight/obesity).
• Physical activity programs. These are often group activities that help you stay active socially and physically, which is good for your mental health and overall well-being.
• Community supports. Frailty may lead to you needing more help for care and activities at home. Many companies and programs in the community can help provide this care. This may be one way for you to remain at home if you have frailty.
• Long-term care. When frailty worsens and living in your home becomes too difficult, that may make assisted living or group home facilities the best option for you. When it’s more severe, a skilled nursing facility (commonly known as a nursing home) may be your best option. And if you have very severe, end-of-life frailty, you may need hospice care.

Depending on your specific circumstances and needs, other treatments are possible. Your healthcare provider can tell you about other treatment options.

Can frailty be prevented?

Frailty isn’t 100% preventable, but there are ways to reduce your risk of developing it. This usually involves keeping you as healthy as possible and managing or avoiding issues that make developing frailty more likely. Steps you can take include:

• Staying physically active.
• Reaching and maintaining a weight that’s healthy for you.
• Focusing on proper nutrition.
• Getting regular preventive care and screenings.
• Practicing good handwashing habits.
• Wearing seat belts and protective gear to avoid head injuries.
• Preventing injuries around the home, especially fall-related injuries.

These steps are also important if you live with frailty. They can slow its progress and may even reverse it. There may be other ways you can prevent frailty, depending on your specific life circumstances, needs and preferences. A primary care provider can offer guidance and ideas on other steps you can take.

What’s the outlook for frailty?

The outlook for frailty depends on how severe it is and whether it’s possible to reverse it. When you can reverse frailty, the outlook is better. When it isn’t reversible, slowing down frailty or keeping it from getting worse are the next best options. Frailty is unique from one person to the next, so your healthcare provider is the best person to tell you the outlook for your case.

A note from Cleveland Clinic

Frailty isn’t just about physical weakness. It’s your body’s way of signaling that it can’t handle the strain it’s under. While frailty is most common in people over 65, it isn’t inevitable. It's never too early to take steps to prevent or delay it. And if you have frailty now, that doesn’t mean you have to deal with it forever. Supportive treatments and medical care may help reverse or slow frailty down. And even in cases where that isn’t possible, there are ways to try to keep your quality of life high for as long as possible.