Old Age, Thy Name Is Frailty

Musings

Dr Rajagopal Soondron

As the global population ages, medical authorities are increasingly recognizing the emerging challenges, necessitating a shift in how we approach the pathologies undermining the health of senior citizens. They are now viewing frailty through a new lens.

In 2020, research at Dalhousie University, Canada, proposed the concept that frailty is a state of being rather than a specific disease: it is a “combined accumulation of different physiological deficits ranging from functional limitations to diseases”. It is characterized by reduced resilience and diminished physiological and anatomical reserves; consequently, individuals discover that their ability to bounce back after stress is impaired. They fail to respond adequately to adverse physical or psychological events, whether illness, surgery, or the loss of a loved one. By their 50s, some 10% of people may be affected, and by their 80s the figure rises to 50% — all characterized by muscle loss, bone resorption, and the emergence of dementia. Consequently, with advancing age, more senior citizens may experience falls and become more prone to hospital-acquired infections.

Prefrailty

Nowadays, doctors are readily identifying the prodromal signs and symptoms that may predict an impending full-fledged stage of frailty; hence the concepts of prefrailty and the stages of frailty. In a study involving 500,000 people, around 35% of prefrail individuals aged between 37 and 45 years exhibited bodily functions operating under strain while still capable of adaptation, yet already showing some deficits, such as tiredness, subtle loss of strength, reduced physical activity, and slower movement.

Furthermore, according to Linda Fried of the Johns Hopkins Medical Institution, frailty can be predicted by five warning signs: 1. Unintentional weight loss. 2. Recurrent exhaustion. 3. Low physical activity. 4. Reduced walking speed. 5. Weak grip strength. One or two of these signs indicate a prefrail stage, whereas the presence of three signifies that one is already frail.

The study points out that a progressive decrease in walking speed is a major indicator that frailty is imminent because it reflects loss of muscle mass and strength, accompanied by deterioration in balance, while spatial awareness and cognition have already begun to decline.

Our Gut’s Role

Yet again, our gastrointestinal system — with its billions of microbes — is the prime suspect in the frailty process. With a predominance of beneficial bacteria, we can walk into our 80s and 90s with minimal frailty. However, if harmful microbes predominate, the inflammation triggered in our gut will eventually impair our immune system. This, in turn, leads to the accumulation of more ageing cells in our body that refuse either to grow or die, instead surviving indefinitely. These senescent cells, as they are called, continue producing harmful metabolites that spread throughout our body, organs, and muscles, leading to inflammation, disease, and a wide range of symptoms.

At that point, some of us, being better informed, may decide to exercise and increase our protein intake, but the persistent low-grade inflammation originating in the gut puts a brake on muscle regeneration. This failure of the body to mount an effective response is known as anabolic resistance.

During illness, if our body cells are kept functioning optimally by suppressing and controlling inflammation, they will be capable of metabolizing the body’s fat stores to produce sufficient energy for us to recover from that adverse event. Those who cannot do so may progress from a prefrail state to frailty. Likewise, individuals with a negative attitude towards ageing, who have become socially withdrawn and lead lonely lives, are more likely to deteriorate rapidly.

Prevention

In some countries, research is underway to screen people over the age of 40 in order to identify those who may become frail. Walking speed, grip strength, and psychological parameters are among the factors being assessed. Furthermore, particular attention is being paid to those experiencing low energy levels and muscle weakness.

French medical professionals are keen to identify prefrailty and frailty within the population in order to prevent falls and fractures, while also assessing nutritional status and the condition of sensory faculties, such as vision and hearing, which may contribute to medical emergencies. Even individuals who are already frail are encouraged to consume more prebiotics such as inulin and fructooligosaccharides. In major centres, patients with declining health and an excess of harmful gut microbes are being offered Faecal Microbiome Transplantation using processed stool from younger, healthy relatives. The transplanted microbiota are introduced directly into the intestines, and patients have shown measurable improvements in health.

For many years, people have been encouraged to adopt a Mediterranean diet rich in vegetables, nuts, fibre, and adequate protein as they age, while also maintaining healthy blood levels of calcium, zinc, magnesium, and selenium.

At the same time, alcohol consumption should be reduced, vaccinations against as many diseases as possible should be encouraged to minimize the chronic inflammation associated with these illnesses, and people should begin or continue resistance exercise.

As the powerhouses of our cells — whether in the lining of the gut or within the immune system — the mitochondria are increasingly being recognized as among the first structures to fail during inflammation and disease. Every possible strategy should therefore be adopted to protect them, with vitamin B3 potentially playing a beneficial role. Eating fruits such as blueberries, strawberries, citrus fruits, peas, mushrooms, soybeans, and fermented foods may all help support mitochondrial function and optimize energy production.

In this way, prefrailty and frailty may be kept at bay for as long as possible.

Mauritius Times ePaper Friday 17 july 2026