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Understanding Frailty in Older Adults

Lewis Lipsitz, M.D.'s picture
Understanding Frailty in Older Adults
Understanding Frailty in Older Adults

We often associate the term “frail” with older adults, particularly the “oldest old,” defined as individuals 85 and older. Frailty has become a particularly important geriatric topic as the ranks of seniors continue to grow at an unprecedented rate. As someone who has devoted a career to aging research, I have focused a significant amount of my work on understanding frailty— how we define and treat it.

I often say that frailty is hard to define, but we know it when we see it.  We might describe someone as frail who is bent over, walks with a slow shuffle, if at all, perhaps is very thin and may appear tired or even depressed. I also describe a patient as frail when he or she, for a variety of reasons, is vulnerable in the face of illness or injury— lacking the reserves to fully recover.

So what is going on in a frail person?

To stay healthy and function normally, our bodies must effectively integrate complex networks and control systems, feedback loops and other regulatory mechanisms, which exist at molecular, subcellular, cellular, organ, and systemic levels of organization.

Let me use a car to help explain this concept. As far as you can tell, your car is functioning properly if it moves steadily at a given speed toward a destination without knocking, pinging, sputtering, or stalling. The car in general seems to be working just fine thanks to an underlying and complex dynamic interaction between the fuel, electrical, cooling, and power transmission systems.

Although this mechanical analogy is an oversimplification, physiology can be similarly understood. We refer to the process used by the body to maintain a stable internal environment as homeostasis. In a healthy individual, the body’s complex and dynamic system is working as it should, making adjustments where necessary to keep the body functioning well as a whole. 

Let’s take blood pressure as an example of a homeostatic mechanism. The blood vessels can sense changes in blood pressure, triggering a feedback loop to bring blood pressure back to normal. The vessels send signals through the nervous system to the brain, which then sends back signals telling the heart how to respond.  Using this example it becomes clear how recognizing the dynamic interplay between the complex mechanisms that make up the human body is important in order to understand what exactly keeps us strong, resilient and vital and conversely what causes frailty when things go awry.

Because the human body is a complex system, its function in health and disease cannot be fully explained by an understanding of only one of its component parts.  Therefore, we define frailty as a breakdown in the dynamic interactions between multiple bodily systems that ultimately results in an impaired ability to adapt to the stresses of everyday life.  When one’s body can no longer compensate for challenges to its complex physiologic systems, it becomes difficult to deal with common daily stresses such as moving about, digesting a meal, taking medications, fighting infections, or dealing with difficult social situations.

This is frailty.

Treatments that have an impact on multiple bodily components, like Tai Chi, have been found to be more effective in addressing frailty than standard one-dimensional approaches. Interventions that look at a variety of causes for a certain condition have been shown to be effective treatments for common geriatric syndromes such as falls or delirium, which are associated with frailty and often due to interacting abnormalities in multiple organ systems.

Certainly it stands to reason that the complex control systems in the human body lose some of their adaptive capacity with age—think about that car at 100,000 miles compared to when you drove it brand new off the dealer’s lot. And, researchers are still working to untangle the complex interaction between genes, lifestyle and environmental issues that impact health and promote adaptation. But more and more, our research is showing that with lifestyle interventions and improved medical care tailored to the multiple conditions affecting older patients, growing old does not have to mean growing frail. 

About Hebrew SeniorLife Outpatient Health Clinic
The health clinics within Outpatient Services at Hebrew SeniorLife offer high-quality, specialized care for Boston-area seniors. We offer a wide range of medical services including treatment for conditions such as hearing loss, memory disorders, osteoporosis, difficulty with speech and language, chronic illness, rehabilitation and wound care. When you visit Outpatient Services, you'll be treated by experts who understand the unique health needs of older adults, working to improve each patient’s health and quality of life.

 

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Vice President, Academic Medicine Director, Institute for Aging Research

Lewis Lipsitz, M.D., has spent most of his career in geriatric medicine at Hebrew SeniorLife (HSL), where he currently serves as vice president for academic medicine and director of the Institute for Aging Research. He also holds the Irving and Edyth S. Usen and Family Chair in Medical Research. In addition to his positions at HSL, he is a professor of medicine at Harvard Medical School and chief of the Division of Gerontology at Beth Israel Deaconess Medical Center.

Dr. Lipsitz's research interests include falls, fainting, blood pressure regulation, cognitive dysfunction, and...

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