Early Warning Signs You're Becoming ‘Frail’—and How to Prevent It as You Age
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“Being frail” may not sound like that big of a deal—maybe you even assume it’s kind of inevitable as you get older. But frailty is actually a legitimate medical condition that can make it harder for you to bounce back from health-related setbacks as well as heighten your chances of earlier mortality, Linda P. Fried, MD, a physician expert in geriatric medicine and dean of Columbia University Mailman School of Public Health, tells SELF.
According to the frailty phenotype, which was developed by Dr. Fried and her colleagues in a 2001 study and is one of the main screening tools used to diagnose frailty, you’re considered frail if you have at least three of the following: muscle weakness, a slower walking pace, low physical activity levels, diminished energy, and unintentional weight loss.
Not only does frailty affect your independence and quality of life, but it makes you more susceptible to medical curveballs. Say you get pneumonia; a resilient person might recover quickly at home with antibiotics. But someone with frailty has a higher chance of ending up at the hospital and developing an infection. It can set you up for other not-great outcomes, too—a recent study of nearly 30,000 people suggests frailty may increase dementia risk. And once it starts, things can really accelerate: People who are frail sometimes feel so nervous about their ability to safely get around that they become even less active, then decline faster, according to Dr. Fried.
There’s uplifting news, though. “There are opportunities to reverse frailty, [which] doesn’t get talked about enough,” Robert Allison, DO, a geriatric medicine physician at West Virginia University tells SELF. Admittedly, he says, it can be harder to improve very advanced muscle weakness, but there’s plenty you can do to take charge of your strength at any age. Read on to better understand this condition, plus how to prevent and even reverse frailty in its earlier stages.
“Pre-frailty” signs can be early red flags that you’re starting to lose strength and energy.
Experts often use the term “pre-frailty” to describe a person who meets some but not all of the frailty criteria. These can look like really subtle changes, Hermes Florez, MD, a public health physician-scientist and executive director of the MUSC Center for Healthy Aging, tells SELF. But they’re critical early clues that you’re becoming a little more vulnerable.
Dr. Florez recalls one pre-frail patient who started complaining of weakness after having difficulty opening jars. “That requires grip strength,” he says, which is one possible sign of frailty you might notice early on. Another realized their walking pace had slowed when they struggled to safely cross a busy street as quickly as they once could.
Some people might notice they can’t walk around their neighborhood as long as they used to without stopping for a breath, Dr. Florez says. Or they might get surprisingly fatigued walking up stairs. Any dip in energy, unexplained weight loss, and trouble exercising are all tell-your-doctor signs, too.
Staying active in any way can lower frailty risk—but strength training is the real MVP.
You may already be familiar with the *official* physical activity recommendations for adults, which suggest 150 minutes of moderate-intensity exercise each week plus at least two muscle-strengthening sessions. These guidelines exist because—no surprise here—exercise benefits both your mind and body in endless ways. But it’s an especially important tool for fighting fragility, since research has found that a sedentary lifestyle can seriously up frailty risk. “If you engage in physical activity, you’re preventing the loss of muscle and preserving that degree of resilience,” says Dr. Florez.
And while cardio workouts like running, swimming, and biking are always a must-do for your heart health, it becomes critical to emphasize strength training as the years go on. That’s because, as we get older, it’s trickier to maintain muscle mass—and this can start as early as age 30, Dr. Florez says. “After that, we start declining, and it happens to everyone—super athletes and regular people alike.” Fitting in those twice-weekly strength workouts (whether it’s weight lifting or bodyweight exercises like push-ups), has been found to improve muscle mass and slow frailty’s progression.
And while you’re at it, don’t sleep on exercises like yoga and tai chi. “The third piece that’s really important to frailty prevention is balance exercises,” says Dr. Allison. Frailty can make you more prone to falls, he explains, which can then lead to fractures. One study found that combining balance and functional exercises (think: squats, lunges, deadlifts) reduced fall rate risk by 24%.
Packing more protein might make a difference, too.
Right now, there aren’t specific nutritional recommendations to prevent frailty, “although we always suggest a balanced diet,” Dr. Allison says. However, one specific nutrient may be worth focusing on more than others: protein. Researchers spotted a link between lower protein intake and frailty in a 2020 literature review, so making sure you’re getting enough of this all-important macronutrient may help safeguard against long-term weakness. “Adequate protein intake in one’s diet [can] maintain muscle mass,” explains Dr. Fried.
As for how much you need? The amount can really vary from person to person, per the US National Library of Medicine, and depends on factors like your age, how much you exercise, and your sex assigned at birth. The Recommended Dietary Allowance (RDA) is .8 grams per kilogram of your body weight, or .36 grams per pound, and the US Department of Agriculture’s DRI Calculator can give you a target protein goal to aim for. (An active 40-year-old woman weighing 140 pounds would need about 51 grams a day, for example, according to the USDA’s calculator.)
But FWIW, to really prevent frailty, you may need a little more than the standard recommendation. Researchers in that 2020 review noted that higher-than-average protein intake may be best to protect against the condition. They also observed that breaking up your daily intake into multiple meals that have at least 30 grams each may be more beneficial than, say, packing all of it into one super high-protein meal.
For more personalized dietary recommendations, though, reach out to your health care provider or consider speaking with a registered dietitian. They can help you come up with a dietary plan that takes your lifestyle and other factors into consideration and allows you to check all your nutritional boxes, protein included.
Don’t assume frailty is just a future-you problem.
When you’re in your 20s, 30s, and even 40s, it’s easy to dismiss frailty as an older-person issue—not something you need to worry about yet. Actually, though, any adult can develop frailty, Dr. Allison says, especially if you have a health condition that starts to slow you down from a younger age. “Although we do see it [more] as we get older, it’s definitely not something that just happens when you’re 65.”
So-called frailty markers—symptoms many doctors check to make a diagnosis using Dr. Fried’s frailty phenotype—can appear earlier than you might expect. For example, a large prospective analysis published in 2018 identified signs starting in the late 30s: Between ages 37 and 45, 38% of women and 35% of men were already considered pre-frail, meaning they had at least one of those symptoms. Additionally, 4% of women and 3% of men met the full frailty criteria by ages 45 to 55.
Frailty symptoms might look a little different when you’re younger. In that same prospective analysis, researchers observed that unexplained weight loss and exhaustion are most common among the 37- to 55-set, while complaints like a weaker grip and slower walking pace increase after age 55.
These might feel like pretty minor inconveniences, and not the kind of issues most people even think to mention to their doctors. Take shorter or slower walks: Dr. Florez points out that many of his patients probably wouldn’t bring this symptom up unless they were also having more alarming issues like chest pain. But being tuned-in to changes in your body and alerting your doc as early as possible gives them an opportunity to improve your weakness while you’re still in the pre-frail window—and this is harder to do, though not impossible, once you’ve progressed to full-on frailty.
“There are studies that suggest, and I’ve seen it too, that frailty can be reversed,” Dr. Allison says, which means it’s never too late to take charge of your overall health and focus on building strength. “It’s easier if someone is pre-frail, and harder if someone is frail—but it’s not a one-sided progression.”
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Originally Appeared on Self
