Frail is a term that can describe anyone, young or old. Refer to table 1.1 for common medical disorders and special needs that contribute to frailty. Frailty is not as much a definition as it is a syndrome of signs and symptoms. Some of the factors creating and affecting this frailty syndrome can include physical inactivity, nutritional status, cognitive and psychological conditions, preexisting chronic disorders, and aging (Signorile 2011).
The causes of frailty vary among people. Commonly identified causes of frailty include the following:
- A medical condition
- A loss of one or more senses
- A chronic disorder
- A chronic disorder along with a new medical diagnosis
- Adverse changes in the musculoskeletal system
- Psychological issues
- Sarcopenia (loss of muscle mass)
- Very old age
- Nutritional imbalances
- Intellectual disabilities
- Physical inactivity
Frailty is normally related to a combination of circumstances that leaves a person unable to accomplish normal activities of independent daily living. Some people in your exercise group who are quite elderly may appear physically frail but are not. Looks can be deceiving. Function is what determines level of frailty. The possibility that you may misidentify an elderly person who is not frail as frail is one of the many challenges in leading exercise programs for older adults.
The term frail elders combines the ideas of advanced age and frailty. Normally, the term refers to very old people who have difficulties performing activities of daily living without assistance from others. This term includes added complexities. A person with a chronic disorder such as arthritis might be considered frail because of another complicating factor, such as emphysema. The combined limitations from the two disorders may contribute to the frail condition.
You should know that not all frailty is chronic or long term. Some people find themselves in a frail state because of surgery or illness. When they recover, the frailty may decrease or disappear.
People may also decrease frailty by increasing their physical activity. Research has verified that exercise improves muscle strength, balance, coordination, and cardiovascular fitness in even the most frail and elderly participants (Fiatarone et al. 1994). Resistance training in particular has proven to be especially beneficial with deconditioned (not in strong or good physical condition caused by a sedentary lifestyle) elderly people (American College of Sports Medicine 2009b). Skeletal muscle weakness places a person at higher risk of falls. These falls can lead to fractured bones and hospitalization. Strengthening and stretching exercises (particularly specific balance exercises) help maintain balance and range of motion and are recommended in many fall-prevention studies.
Fatigue is another area that may contribute to the perception of a person as frail. Older adults tell us often that they are fatigued and do not have the energy to exercise or complete specific activities of daily living. In assessing an individual, you should consider all these factors and then go through a process of elimination (all the things that are not affecting function and energy level). Many of the common disorders reviewed in this chapter can affect energy and create a sense of fatigue.
The 2010 Surgeon General’s Vision for a Healthy and Fit Nation encourages even moderate exercise to help frail people recapture lost function, functional independence, health, and well-being (USDHHS 2010b). Your exercise class is profoundly important to this group.