Dialing Back Frailty

Posted on | April 2, 2008 | Comments Off on Dialing Back Frailty

Addressing aging at conception

With the world’s population of people over sixty rapidly rising, we’re starting to pay increasing attention to age-related disease and disability. The good news is that some new concepts about disease and old age are on the way – including the theory that we might be able to avoid some diseases all together if we begin to plan and act at conception.

What’s at the heart of this idea? The concept of “frailty” gives us a clue. Frailty is a syndrome of progressive disability brought on by the gradual lifelong accumulation of molecular and cellular damage. Such damage presents itself as everything from anorexia to chronic exhaustion and impaired capacity to withstand any kind of stress. When one becomes frail, the gait slows, balance is impaired, weight loss is evident, and bones and muscles are fragile. As a result malnutrition, depression, social isolation, and heavy use of medications are familiar companions. Lives of inactivity, boredom and despair are interrupted by episodes of traumatic fractures, wandering confusion, adverse drug interactions, pressure ulcers and infections, and frequent hospital visits.

In the United States, your current possibility of being affected by frailty by age 80 is 3 out of 4, and that includes people who seem to be just fine at age 65.

Is there any way out? Experts say yes, but not with business as usual. They say that many of the features associated with age-based frailty are treatable and potentially preventable if we dial back health-planning and intervention all the way to conception. An example is frailty fractures in the aged due to osteoporosis. Bone mass reaches its peak between ages 16 and 18 with various determinants – including nutrition, exercise, behaviors like smoking, and genetics — all contributing to early outcomes. We now know that if you are a woman and you miss critical health markers at this time, the odds are high you will be in the ranks of approximately half of the women at age 50 with silent under-mineralized bones. If so, your chances of a frailty fracture later in life are close to certain. But the seeds for that calamity were laid many, many decades earlier.

Researchers now believe we can apply this same reverse timeline to heart attack, stroke, vision and hearing impairment, and cognitive disorders like dementia and Alzheimer’s.

This is not to suggest that aging is avoidable or that frailty will disappear as a reality for some as they age. It is simply to say that this does not need to be the destination for three out of four of us over the age of 80. Frailty, as we are learning, is malleable. We have tended to segment health care into periods of life, but are now beginning to wake up to the fact that disease and disability are cumulative, and build over a lifetime. And that means through concepts such as Lifespan Planning Records, we might be able live much more satisfying lives in old age.

Please watch this week’s video, embedded with this blog post or read the full transcript, below. Then tell me how you feel about this idea.