What is Frailty and How Can PT Help

What is Frailty?

Frailty is often discussed in terms of a phenotype which is a set of observable characteristics of an individual. The frailty phenotype is also called Fried’s Phenotype. Fried’s Phenotype is when three or more of the following characteristics is present in an individual: unintentional weight loss, fatigue, weakness, slow walking speed, and low physical activity¹. Frailty causes an individual unable to withstand the stresses of everyday life leading them vulnerable to any stressor including illness or a fall^2,3. The frailty phenotype is independently predictive of increase incidence of falls, worsening mobility, activities of daily living disability, hospitalization, and death¹. Individuals may become frail for various reasons including trauma, chronic pain, decreasing physical activity, or even experiencing chronic conditions like high blood pressure and diabetes². Frailty is not a normal part of aging³. Good news! The earlier stage of frailty is preventable and reversible; therefore, early recognition by a health care provider is essential³. “Prefrail” is a condition between being healthy and frailty where individuals are at risk for progressing to frailty³. Your physical therapist is the perfect health care provider to intervene at this stage of “prefrail”. The following are characteristics you should look out for when it comes to frailty:

• Unintentional Weight Loss: Greater or equal to 10 pounds in the last year, or greater than or equal to 5% of your body weight in the last year³. Illness, decreased mobility, or lack of proper nutrition could all be potential factors leading to unintentional weight loss and should be addressed by a medical provider³.
• Fatigue: Low energy and significant fatigue is often assessed through a self-report of exhaustion based on a questionnaire³. Fatigue is often a barrier to engage in physical activity and limits participation in social activities and hobbies³.
• Weakness: Muscle weakness is assessed through maximum grip strength³. When an individual is in the lowest 20% of their gender and body mass index category then they are at risk for frailty³. This item can be indicative of being dependent for mobility and activities of daily living³.  
• Slow Walking Speed: Gait speed or walking speed is measured in meters per second at your comfortable pace. Gait speed is often considered the sixth vital sign because of its ability to predict mortality³. A decrease of 0.1 m/s increases your risk of mortality while an improvement of 0.1 m/s increases your survival by 8 years³.
• Low Physical Activity: Your activity level is assessed through a questionnaire of how many calories you expend during the week³. This energy expenditure could be walking, general exercise, or even chores around the house³. The more sedentary an individual is the less physical activity capacity they have and less able they are to access different areas of their home and community³.

Physical therapists are the best health providers to assess for frailty and create a plan of care to intervene in the areas that put you at risk. The foundation of Live Your Life is to help our clients reach their maximum potential. If you are looking to reduce your risk of frailty or even to improve your current fitness level, contact us today to learn how we can meet your needs and achieve your goals for function and wellness.

References

¹Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156. doi:10.1093/gerona/56.3.m146

²Guide | Physical Therapy Guide to Frailty. Choose PT. Published August 26, 2021. https://www.choosept.com/guide/physical-therapy-guide-frailty

³Cabrera J. Physical Therapist Management of a Person with Frailty Across the Continuum. Topics in Geriatric Rehabilitation. 2023; 39(2): p 131-148. doi: 10.1097/TGR.0000000000000391.