INTRODUCTION
What is Frailty?
- Frailty is a condition common among the elderly. It is usually an aging-related syndrome characterised by decline and reduced function, and is a warning sign for high risk of poor outcomes.
- Frail older adults usually suffer from unintentional weight loss, muscle loss and weakness which may lead to falls, disability, increased hospitalisation, and even death.
- Although frailty can be predisposed by aging, it is not equivalent to aging and it can be preventable and reversible, especially at the earlier stages of frailty.
- Hence, it is important to understand what is frailty so early identification and intervention can be carried out to delay the onset and progression of frailty.
Signs and symptoms of frailty
- When one is frail, it can be manifested through his/her physical and psychological health. He/she may feel:
- More exhausted than before
- Walking slower than before
- Participating in less physical activity than before
- Weaker grip strength i.e.: unable to carry heavy objects as before
- Experience unintentional weight loss
- May also feel more depressed/down/hopeless than before
- Do consult your doctor if you or your loved ones experience these symptoms so that early identification and treatment of frailty can be carried out to delay the onset and progression of frailty.
What are the risk factors of frailty?
- Advanced age
- Female sex
- Low socioeconomic position
- Living alone/loneliness
- Multiple chronic diseases
- Taking multiple medications
- Obesity
- Malnutrition
- Impaired cognition and depression
- Physical inactivity
- Low protein intake
- Increased alcohol consumption
- Smoking
FRAILTY MANAGEMENT
Management of frailty can be categorised into these three aspects:
Physical well-being
● Provide treatment and control for chronic medical conditions
● Address visual, hearing and eating problems
● Address polypharmacy - review and adjust medications
● Identify and treat potential reversible medical conditions
● Exercise regularly; stay active
● Eat well to ensure adequate nutrition
● Prevent falls by evaluating the home
Psychological well-being
● Look out for problems of low mood and treat appropriately
● Look out for memory difficulties and address appropriately
● Maintain a positive outlook
Social well-being
● Remain connected by engaging in social activities
● Have a strong support network
Frailty and exercise
● Exercise and physical activity is important to help prevent or delay the onset of frailty and may help to reverse frailty at the earlier stages.
● Exercise, especially resistance exercise (muscle training), helps to improve muscle mass and strength which will help to prevent or reverse frailty.
● Aim for 150 minutes of exercises each week consisting of resistance exercises and aerobic exercises (i.e.: brisk walking, cycling, swimming).
● Starts gradually and slowly increase the duration and intensity.
These are some of the exercises programmes in the community:
● Gym tonic
- An effective and proven strength training programme that uses specialised gym equipment to progressively train muscle strength and resistance.
● Day care centres/community rehabilitation centres/senior activity centres
- These centres offer structured programmes such as exercise and social activities to help maintain the physical and social well-being of the elderly.
- You may visit
https://www.aic.sg, or speak to your doctor/nurse/therapist to find out more information.
● The Otago exercise
- Developed to reduce falls in older persons, the Otago exercise consists of 17 strength and balance exercises and a walking program, performed three times a week by the older adult in the home or outpatient or community setting.
- You may search “otago exercise fall prevention” on YouTube, or speak to your doctor/nurse/therapist to find out more information.
● Seven exercises for an active lifestyle by the Health Promotion Board
- Designed to promote active aging, these exercises are effective in building up strength, balance and flexibility.
Frailty and nutrition
- Nutrition plays an important role in preventing or slowing down the onset or progression of frailty.
- Food high in protein helps to maintain muscle strength and food high in calcium and vitamin D help to preserve bone mass, thus reducing the risk of falls and fractures.
Knowing your risk of malnutrition
- You are at risk of not having enough nutrition if you:
- Have been losing weight without trying
- Experience loss of appetite and are eating less than usual, e.g. less than half what you usually eat for a period of five or more days
- Have difficulties eating, e.g. poor dentition, swallowing problems
- Find yourself getting weaker and less able to do daily activities, e.g. wash the dishes, cook, go to the toilet and marketing.
- Are underweight.
Tips to help you improve your nutritional intake
- Eat your biggest meal when your appetite is best, such as at breakfast.
- Eat small, frequent meals throughout the day, e.g. every 2-3 hours or 5-6 meals/day.
- Drink nourishing fluids, e.g. milk, soy milk, milo or fruit juice instead of plain water
- Eat your food in the following order to maximise your calorie and protein intake:
(i) Protein-rich food (e.g. meat, fish, egg, tofu),
(ii) Starches (e.g. rice, noodles, bread),
(iii) Fruit and vegetables
(iv) Soup
- Drink fluids at least 30 minutes apart from meals to prevent you from feeling full or bloated.
- Enjoy your meal times by eating with family or friends, or by listening to your favourite music.
- Make your food available wherever you go, e.g. a thermos filled with your choice of smoothie or a small bag filled with nuts and/or dried fruits.
- Choose foods with pleasant aromas that you enjoy. Boost the taste and smell of food with seasoning and spices such as sesame oil and marmite.
- Use a larger plate and put small food portions on it to make the amount of food appear less overwhelming.
Protein intake
- Protein is important in the management of frailty as our muscles are made up of protein.
- Having enough protein intake will help to maintain your muscle health and prevent muscle loss.
What are the sources of protein in our diet?
How much protein do you need per day?
- Aim for 2-3 servings of protein per day to maintain muscle mass and strength (together with exercise).
- In general, frail elderly people need at least 1-1.2g of protein per body weight (in kg). Do follow your doctor/dietitian’s advice on the amount of protein to take if you have any renal conditions or have been advised otherwise.
- 1 serving of protein is equivalent to:
1 block soft tofu (300g) or ½ block tau kwa (150g),
¾ cup beans, lentils or peas
- Tip: Include some exercise soon after the meal to help your body further build your muscles.
Calcium intake and Vitamin D
- Calcium and Vitamin D are essential in maintaining strong bones to prevent and delay the progression of osteoporosis (weak and brittle bones) in older adults.
- Good sources of calcium include dairy products (milk, yoghurt, cheese), calcium fortified soymilk and tofu/tau kwa.
- The best source of Vitamin D is the sun. Try to let the sun shine on your arms and legs for 2-3 times a week. The best time to do so is anytime between 10am and 3 pm, for about 5 to 30 minutes.
- If you are unable to get adequate sun exposure, you can include some vitamin D-rich foods into your diet:
eggs,
liver and
oily fish like salmon, cod and mackerel
- If you are taking a calcium supplement or multivitamin, choose one that contains Vitamin D.
- If you feel that you are still struggling to increase your nutritional intake and are still losing weight, please speak to your doctor about seeing a dietitian.
Frailty and Polypharmacy
- Polypharmacy is taking more than five types of medications. Studies have shown that polypharmacy increases the risk of frailty.
- It is therefore important to optimise your medications by the following steps:
- Always ask your healthcare provider to review your medications/supplements/Traditional Chinese medication (TCM) regularly.
- Ensure you do not take any medications that you do not need.
- Clarify with the doctors or pharmacists if any of your medications cannot be taken together.
- Report any side effects (e.g. drowsy/confusion) or new behavioural changes that arise with any of the medications.
