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Frailty in Elderly May Be Prevented or Reversed if
Addressed Early
March 3, 2006 - 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 can be altered by
intervention.
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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."
"Frailty is increasingly recognized as a geriatric
syndrome," say the authors', "distinct from disability and comorbidity,
that results from a multisystem reduction in reserve capacity, confers
high risk for an array of adverse outcomes, and is potentially amenable
to prevention and remediation."
Other researchers have
proposed that frailty be defined on the basis of the following 5
features: unintentional weight loss, exhaustion, low physical activity,
muscle weakness, and slow walking speed, with the presence of 3 or more
of these features denoting frailty.
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.
The study was funded by Grants from the National
Institute on Aging.
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