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Frailty in
the Elderly

The spring in your client's step, the healthy foods on his plate and the optimistic feeling in his heart all help him feel great today. But did you know that nurturing these factors in your clients could also help him sidestep or even reverse frailty — the loss of strength, speed and energy that can whittle away at independence as a person ages? 

So what is frailty exactly? Frailty is a medical condition of reduced function and health in older individuals. An estimated 7 to 12 percent of Americans age 65 and older are considered frail. Risk rises with age — from one in 25 people between ages 65 and 74 to one in four of those older than age 84. That’s a concern, because frailty increases the risk of infections, illnesses that have to be treated in the hospital, falls and even disabilities. In a study of 594 older adults, Johns Hopkins researchers have found that frailty doubles the risk of surgical complications, lengthens hospital stays, and increases the odds of leaving independence behind after a surgical procedure by as much as twentyfold.

Getting older doesn’t necessarily mean someone is frail, but it does increase the odds of developing multiple medical conditions and frailty. Things like inactivity, poor nutrition, social isolation or loneliness, and multiple medications contribute to frailty. When you are frail, your body does not have the ability to cope with minor illnesses that would normally have minimal impact if you were healthy. With frailty, these minor stressors may trigger rapid and dramatic deterioration.

Older adults living with frailty:

  • are more susceptible to large declines in health from minor illnesses such as the flu or adverse events like falls

  • are more likely to be hospitalized, need long-term care or die


The risk of becoming frail increases with age, but the two are not the same. Those living with frailty are at higher risk for deterioration of their health than what is expected based on their age alone. It begins when the health issues a person experiences over their lifetime start to have an effect on their overall health or their independence with doing everyday activities. Frailty may be observed as changes with memory or thinking, difficulties getting around, or increased medical problems.

Frailty isn’t all or nothing, but comes in levels or stages. While some people experience a slow and gradual progression of frailty, progression can happen suddenly if a new serious illness comes along (e.g. broken hip, stroke, heart attack, severe infection, etc.).

Frailty looks different at each level. Some of the factors affecting a person’s level of frailty may be helped by treatments and support from their caregiver and medical team. Research focuses on improving the person’s experience of frailty, slowing its progression, or addressing specific things that add to the frailty.


Your client may be considered frail if three or more of these criteria, developed by Johns Hopkins, apply to them:

  1. Shrinking. Unintentionally losing 10 or more pounds in the past year.

  2. Weakness. Having trouble standing without assistance or having reduced grip strength.

  3. Exhaustion. Everything takes a big effort, or you notice they just can’t get going three or more days most weeks.

  4. Low Activity Level. This includes formal exercise plus household chores and activities done for fun.

  5. Walking slowly. Pace is considered slow if it takes more than six or seven seconds to walk 15 feet.

Discuss frailty with your supervisor if you suspect your client may be suffering from it so it can be diagnosed by their doctor. It’s also important to keep chronic conditions like high blood pressure, cholesterol and diabetes under control.


While there is no cure for frailty, some interventions can improve a person’s experience and may even improve or reverse problems in mild frailty. Interventions may include:

  • Stopping inappropriate medications or treatments.

  • Activities like walking and easy strength-training moves to improve strength and reduce weakness – even in very old, frail adults. Every little bit helps, at any age.

  • Eat well. Aim for three healthy meals a day that provide fruit, vegetables, protein, good fats, whole grains and low-fat dairy products. Be sure to include enough muscle-nurturing protein. Women need about 46 grams per day, men about 56 grams but many older people don’t get quite enough.

  • Keep your mind active and your attitude optimistic. Positive feelings were shown to translate into a lower risk of frailty in one study. Staying socially connected with others and continuing to learn may also help, thus explaining why older volunteers who tutor in elementary schools sharpen their own thinking skills and improve their physical functioning, too. 

Most people who are frail need to depend on at least one other person for support in order to function in a community setting. The health and wellbeing of the support person is also important, so that they can continue to be there to help the person living with frailty. To put it simply, always take care of yourself so you can be there to care for your client!

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