Facing the Reality of Frailty

What is frailty? It is a condition that overwhelmingly affects people as they age, but it is not an inevitable part of aging. It is characterized by declines in strength, energy and walking speed, as well as increased fatigue and unintended weight loss. Through lifestyle changes, we can greatly reduce the risk of our becoming frail, and as a society, we need to start thinking about frailty much more than we do now. The consequences of not doing so are severe.

When discussing frailty, we need to recognize that in a sense, we are victims of our own success. Thanks to the miracles of modern medicine, we are living longer than at any other time in history. We have gotten extremely good at adding years to our lives. Where we are lagging behind is in adding life to our years. Frailty is one of the best examples of that. Frailty reduces quality of life, for both sufferers and their caregivers. It also increases the need for health care services as older adults living with frailty frequently require visits to the ER, often end up hospitalized and need long term care.

Frailty is a condition that often presents itself alongside other chronic diseases. Older people living with frailty are more susceptible to large declines in health from relatively minor illnesses such as the flu or a fall. Simply put, people living with frailty need more care from our health care system, and from family and friend caregivers.

Dr. Kenneth Rockwood is one of Canada’s leading frailty specialists. He is a geriatrician, researcher and creator of the Clinical Frailty Scale, which has been widely adopted as a tool for assessing frailty in Canada and internationally. Currently there are more than 1.5 million Canadians living with frailty and by 2030, that number is expected to be higher than 2 million. This is something that Dr. Rockwood worries about a lot.

“We need to look long and hard at the frailty math,” he says. “We need to look at it, we need to be honest about what the numbers are telling us, and then we need to act.”

What the numbers are telling Dr. Rockwood is that if we don’t face up to the realities of frailty soon in this country, the increased utilization of our healthcare system may not be sustainable. What we need to do about this, he says, is implement a better, society-wide approach to caring for people with frailty, and also do a better job of educating people about how to avoid it in the first place.

Dr. John Muscedere is the Scientific Director of the Canadian Frailty Network (CFN). In a very real sense, his job is to meet the challenge issued by Dr. Rockwood. CFN was established in 2012. The organization’s mission is to improve care for older adults living with frailty and support their families and caregivers. Over the last several years, CFN has worked to improve our collective ability to recognize and assess frailty, increase the body of evidence available for decision-making, and educate the next generation of care providers.

“We need to understand that past a certain age, everyone is at risk for frailty,” says Dr. Muscedere. “If we can do a better job of screening them, we can identify frailty sooner, we can design interventions sooner. This will allow people to remain in their homes and communities and to be as functional as possible for as long as possible.”

Furthermore, says Dr. Muscedere, older Canadians who are not frail, and even those living with frailty, can adopt preventative measures to help them reduce the risk of becoming frail, and even reverse some elements of frailty. CFN has launched a public education campaign around this that spells out the steps required to AVOID frailty and improve the aging process. The risk of frailty can be reduced, but frailty must not be ignored, because it cannot be wished away.