Researchers are looking for ways to recognise the onset of frailty in time to slow down the process, writes CLAIRE O'CONNELL
WE’RE ALL familiar with the term frail, but what does it really mean? And can you figure out when a person is headed towards frailty and intervene before they get there and have difficulty getting back to better health?
An ongoing study in Ireland is using non-invasive technologies to look for clues that could signal when a person is becoming frail, and make early intervention more of a possibility.
“The concept of people recognising what frailty is – it’s the bread and butter of gerontology,” explains Dr Chie Wei Fan, a senior lecturer in the department of medical gerontology at Trinity College Dublin.
“There’s increasing literature trying to put a context around it, define it and measure it specifically. And the most exciting thing about it is that we are able to define it through just five characteristics.” Those characteristics are unintentional weight loss, weakness, exhaustion, slowness and low physical activity.
Slowness of walking, in particular, is a marker that’s relatively easy to detect but it can be an important indicator, says Fan. “It’s quite a global measure. It could be a function of your heart, it could be a function of arthritis, of increasing impairment – it’s a lovely way of measuring overall function.”
If a person shows none of the signs of frailty, then they are robust, according to Fan. Having one or two can identify a person as pre-frail, and having three or more indicates frailty.
But gathering more of the markers hastens the decline, it seems.
“If a person transitions into pre-frail, the likelihood of transitioning into frailty is increased at least twofold,” says Fan. “And in the frail category if you want to get back to being robust the likelihood is markedly reduced. It’s like walking up a very steep hill.”
That’s why researchers at the Technology Research for Independent Living (TRIL) clinic in St James’s Hospital are looking for ways to figure out if people are starting to become frail.
Between 2007 and 2009, the clinic assessed more than 600 adults with an average age of 73 and last year they started a longitudinal follow up.
The team is looking for easy-to-measure, reliable signals of cognitive performance, cardiovascular-related responses, psychological stress and underlying depression, explains Dr Fan, who spent three years as TRIL’s director of clinical research.
One of the tests involves analysing the person’s walk, including monitoring various aspects of how they stand up from a chair and walk a defined distance along a special pressure-sensitive mat.
“We are using new technologies to study in detail how they are walking – not just how long it takes to walk, but whether they are exhibiting features of instability,” she says.
“What we are trying to find is if there is an even earlier marker, before you exhibit this slowness in walking. Then we are interested to see if we will be able to use these markers to predict that they could be hospitalised, that their health could deteriorate, that their cognition is going to be affected or that they could have more falls.”
One of the most useful aspects of TRIL – a virtual centre with researchers based in University College Dublin, Trinity, NUI Galway and Intel – is the involvement of experts with many different backgrounds, whose own special area of interest is in falls and blackouts and who works closely with Prof Rose Anne Kenny.
“There’s a whole range of biomarkers. We put it all into the pot. That is the brilliant thing about multi-disciplinary studies where you can put everything in,” Fan says.
Other studies are also ongoing around the world on how to spot and address a transition to frailty. As the research continues, what can people do if they suspect approaching frailty in themselves or in loved ones?
“Awareness is the main thing, and first and foremost I think they need to bring it up with their own family doctor,” says Fan.
She adds that physical activity is helpful, and that people who care for or interact with older people should encourage them to maintain their independence as much as possible.
“Rather than bringing the tea to older people, let them take part in daily living,” she says.
“Walking around, the whole effort of organising their thoughts – all these things are helpful in maintaining independence and engagement in life.
“So rather than saying you will do the shopping for them this week, invite them out and go to the market and walk around.”
Nor should we wait until old age to start protecting ourselves against frailty, she adds. “Encourage even teenagers to start exercising now.”
