Five Questions to Determine Frailty in Your Caree


Five Questions to Determine Frailty in Your Caree

Caption: John Morley, M.D., director of geriatrics at Saint Louis University, is the author of a consensus article from representatives of six international and national medical societies. They call for doctors to screen everyone older than 70 for physical frailty. Credit: Photo by Steve Dolan Caption: John Morley, M.D., director of geriatrics at Saint Louis University, is the author of a consensus article from representatives of six international and national medical societies. They call for doctors to screen everyone older than 70 for physical frailty.
Credit: Photo by Steve Dolan

If your caree is 70 years of age or older, you'll want to make sure he or she is checked for frailty. Frailty is a condition both easily treated and potentially deadly, according to an article by representatives from six major international and U.S. medical organizations.

"Frailty is extraordinarily common, affecting between 5 and 10 percent of those who are older than 70. Women are more likely to be frail than men," said John Morley, M.D., director of the division of geriatric medicine at Saint Louis University and lead author of the article that appeared in the June edition of the JAMDA.

"Over a period of time, frailty leads to increased death rates, poor function and increased hospitalizations. It's treatable and we're asking doctors to spend 15 seconds to conduct a screening that could prevent bad outcomes."

While they are not yet disabled, those who are frail have reduced strength and endurance and difficulty carrying out normal daily activities. They may lose weight, have multiple medical problems and are more likely to become dependent on others or even die. Their condition is tenuous; a health problem such as flu or a fractured hip can thrust them into disability or even could be deadly.

"Most people who are frail function reasonably well. However, these are the people who are afraid they're going to fall and are too tired to get out and do things. Many times, they are not as enthused about eating as the rest of the population," Morley said.

"If they walk into a doctor's office, the doctor is likely to say, 'You look fine.' Yet their frail condition is highly predictive of a bad outcome and many times can be fixed if doctors and patients are aware of the problem."

Representatives from international and national medical societies assembled last December to explore the characteristics of physical frailty and establish guidelines for treatment. The conference was convened in response to a white paper by the International Association of Gerontology and Geriatrics and World Health Organization recognizing the preference for older adults to age in their own homes instead of in long-term care facilities. The conference attracted experts in the field of frailty as well as representatives from the International Association of Gerontology and Geriatrics; Society on Sarcopenia, Cachexia, and Wasting Diseases; International Academy of Nutrition and Aging; European Union Geriatric Medicine Society; American Medical Directors Association; and American Federation for Aging Research.

In addition to recommending frailty screening for everyone who is older than 70, the group suggested checking "younger" older adults who have lost a significant amount of weight because of a chronic condition. The consensus recommendation is to use the simple FRAIL questionnaire that takes less than 15 seconds to administer, Morley said. Other low cost tools also can pick up on the problem.

To assess whether or not your caree may be frail,  asks the following five questions (the FRAIL tool):

  • Fatigue: Are you fatigued?

  • Resistance: Do you have difficulty walking up one flight of steps?

  • Aerobic: Are you unable to walk at least one block?

  • Illness: Do you have more than five illnesses?

  • Loss of weight: Have you lost more than 5 percent of your weight in the past six months?

If your caree (or you for your caree) answer yes to at least three of the questions, then schedule an appointment with your caree's physician.

The key to treating frailty is figuring out its root cause. In many cases, once frailty is identified, it can be treated with aerobic and resistance exercise, protein and caloric supplements, vitamin D and reduced medications, the scientists agreed.

  • Exercise: A number of studies show that exercise – sometimes as little as 45 to 60 minutes three times a week – has positive effects on frail older adults. It can increase walking speed, stair climbing, ability to get out of a chair and balance while decreasing depression and a fear of falling.

  • Nutrition Supplements: Weight loss often accompanies frailty, so adding a supplement can stabilize weight and reduce mortality in those who are undernourished. Protein supplements can improve strength and muscle mass.

  • Vitamin D: For those who are deficient in vitamin D, adding a supplement holds promise in reducing falls and hip fractures and improving muscle function.

  • Reducing Inappropriate Medications: Polypharmacy – or taking five or more medications -- increases the potential of bad side effects from poor drug interactions and possibly contributes to frailty. Those who are taking multiple medications should ask their primary care physicians specifically about side effects, potential effects of medicine combinations and if any medications can be cut out. Sometimes fewer medications are more beneficial than many.

"Both primary care doctors and specialists need to screen for frailty," Morley said. "With the aging of our population, we cannot wait and must implement the screening and management of frailty into clinical practice worldwide."

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To say that frailty in the elderly can be \"treated\" is a bit over-optimistic. If exercise, supplements, vit. D and avoiding excessive meds could treat frailty, my poor old Ma should be doing back flips by now!! She's old, she's frail, it isn't going to get any better. The \"treatment\" at best will help keep it from getting worse. For me personally, it's all about prevention!!!


Denise-\r\nThis came at just the right the time for me. One of my clients has really gone down hill. He had a stroke 19 years ago and is just tired. I read this and it helped me and I'm going to share it with his daughter.\r\nThanks!\r\nMaria


This is good information, but I find the doctors that my parents see to be resistant to any of this \"new\" information. My mom's oncologist told her to stop taking vitamins because he didn't know how they would interact with her chemo, but didn't provide any information on how to make up for that loss of supplement in other ways. I will say that my Dad's latest doctor has been much better about this - he was on six medications and he is now down to only two plus vitamins and supplements. Which is great (btw - for those following my story, he was doing much better this morning - my sister thinks he may have been withdrawing from the previous med that they just took him off). I just wish that the previous three doctors he had seen over the last three years would have done more of this earlier on in this process. \r\n\r\nI find that being an advocate for aging parents is much more difficult than being one for my young daughter. I don't know if it is that the doctors and nurses who go in to pediatrics are more on top of it or open to suggestion (I often hear \"you are the one who knows your child best\") or if it is a reflection of a bias against aging in our society or if we have just been really lucky in the doctors we've had for my daughter. But, advocating for my parents is like running a maze that has a ton of dead ends and only one path through that is concealed behind a secret dead end - I just keep running into walls...\r\n\r\nSorry - just a vent...but, thanks so much for sharing this. I think my mom should have it done for sure. The problem is that she has so many appointments, she hates making additional ones. But, maybe at the next scheduled appointment...