As a primary care doctor, I understand that aging is a natural part of life, bringing with it a host of changes, both visible and invisible. If you are an older adult, one of the most significant challenges you may face is frailty—a condition that can significantly impact your quality of life. Frailty is not an inevitable part of aging but rather a condition that can be managed and, in some cases, reversed with appropriate interventions. Therefore, it is important to understand frailty and its treatment options so you can best make decisions with your doctor or advanced practice provider* (APP).
Understanding Frailty
In the United States, 15% of older adults are frail and 45% are pre-frail, according to an article in the Journals of Gerontology. Frailty is a complex condition that affects many older adults and is characterized by a decline in physical and sometimes cognitive function. Having this condition can make you more likely to have poor health outcomes and adverse events including falls, dementia, and disability. The defining features of frailty include:
- Muscle Weakness: Reduced muscle strength, making daily activities more challenging.
- Weight Loss: Unintentional loss of weight, often due to a decreased appetite or underlying health issues.
- Exhaustion: Persistent feelings of tiredness and a lack of energy.
- Low Physical Activity: Decreased levels of physical activity, further contributing to muscle weakness and fatigue.
- Slow Walking Speed: A noticeable reduction in walking speed, reflecting compromised mobility and balance.
Treatment Options
A new study published in the Journal of General Internal Medicine found that the effectiveness of treatment options often varied by a patient’s frailty level. This means that if you have frailty, it is an important factor to consider with your doctor or APP when considering your treatment plan. Below are examples of medical treatments whose effectiveness varied based on the level of frailty according to the study mentioned above:
- Pharmacological (Drug) interventions: Some treatment effectiveness varied according to the degree of frailty (e.g., anticoagulants (edoxaban, prasugrel), heart failure medication (sacubitril/valsartan), and chemotherapy, whereas other treatments (e.g., antihypertensives, vaccinations, osteoporosis medications, and androgen medications) demonstrated consistent benefits across different frailty levels.
- Non-pharmacological interventions had greater benefits in patients with higher (e.g., chair yoga, functional walking, physical rehabilitation, and higher dose exercise program) or lower (e.g., intensive lifestyle intervention, psychosocial intervention) levels of frailty, while others (e.g., resistance-type exercise training, moderate-intensive physical activity, walking and nutrition or walking) produced similar intervention effects.
- Specific combined interventions (e.g., hospital-based disease management programs) demonstrated inconsistent effects across different frailty levels.
A common misconception is that frailty causes decreased treatment efficacy, which can lead to under-treatment. On the other hand, for frail patients near the end-of-life, efficacy and goals of care are important to consider to avoid over-treatment. As every individual's experience with frailty is unique, your primary care doctor or APP can develop personalized care plans tailored to your specific needs and preferences which can help to improve the effectiveness of treatments and interventions.
*An advanced practice provider is defined as a nurse practitioner or physician assistant.