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Factors impacting the aging population: Frailty (1/4)

By: Vrati M. Mehra



Canadians aged 65 years and older make up approximately 20% of the population as of 2023 (Older Adults and Population Aging Statistics, n.d.).Older adults are part of the fastest-growing age group in Canada (Older Adults and Population Aging Statistics, n.d.). The COVID-19 pandemic brought attention to the low quality of care and attention provided to older individuals in our society. Insufficient focus on addressing the unique challenges facing older individuals led to distressing conditions in nursing homes and assisted living facilities. Many found themselves isolated in cramped quarters, devoid of meaningful human interaction, and tragically, some passed away without the comfort of seeing their loved ones, owing to stringent visitor regulations. Moreover, the pandemic underscored the vulnerability of older adults to instances of abuse and neglect, particularly within institutional settings characterized by insufficient oversight and accountability.


As longevity becomes increasingly common, the inevitability of aging becomes more apparent. It affects not only those we cherish but also stands as a shared future experience for most of us. Consequently, there arises a pressing need to invest in comprehensive, long-term strategies that prioritize the integration of older individuals within their communities, safeguarding their dignity and well-being.


Central to implementing such solutions is fostering awareness and understanding of the multifaceted challenges faced by older adults. As such, in the coming weeks, this series will identify one factor impacting this group each week and propose potential solutions for these issues.


What is frailty?


It is no surprise that aging comes with increasing frailty. Although the term “frail” is often used colloquially, frailty is a multidimensional syndrome that has been well-defined in the medical literature. The World Health Organization (WHO) defines it as “a clinically recognizable state in which the ability of older people to cope with everyday or acute stressors is compromised by an increased vulnerability brought by age-associated declines in physiological reserve and function across multiple organ systems”(WHO Clinical Consortium on Healthy Ageing Topic Focus: Frailty and Intrinsic Capacity, 2016). Frailty isn't a binary condition; rather, it exists along a spectrum, implying that it can fluctuate within an individual from one day to the next. Moreover, it manifests differently from person to person, highlighting the diverse nature of this concept.


Risks associated with Frailty


Frailty has been associated with increased falls, dementia, loss of strength, weight loss and chronic fatigue. It has also been found to be associated with an increased risk of all-cause mortality(Ekram et al., 2021). 


Gender differences 


Although frailty impacts both men and women, a study by Pérez-Zepeda et al. (2021) using the Canadian Longitudinal Study on Aging noted that frailty was higher among Canadian females when compared to males of the same age. 



Potential solutions


Prevention is the best strategy against frailty. However, the following can also help those experiencing frailty. 


Physical activity: Group physical activity has been found to be effective at reducing or postponing physical frailty (Apóstolo et al., 2018). Exercise has many benefits for older adults including increased comfort in performing activities of daily living, decreased falls, improved balance, gait, bone mineral density, and general well-being (De Labra et al., 2015).


Improving nutrition: Ensuring sufficient nutrition is paramount. Offering a variety of healthy food choices that reflect individuals' cultural preferences can enhance acceptance and uptake. Furthermore, supplements like Calcium and Vitamin D contribute to bolstering skeletal health. Services such as Meals on Wheels offer cost-effective food solutions for seniors and individuals with disabilities, promoting accessibility to nutritious meals.


Interaction with friends and family: Engaging with others in meaningful activities and general social participation has been associated with lower rates of frailty (Duppen et al., 2019). Many Canadian local community centres now have “Age Friendly Initiatives”(Age-Friendly Communities - Canada.Ca, n.d.). These not only help older individuals stay healthy but also help reduce loneliness and social isolation. 


References


Age-Friendly Communities - Canada.ca. (n.d.). Government of Canada. Retrieved May 15, 2024, from https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/friendly-communities.html

Apóstolo, J., Cooke, R., Bobrowicz-Campos, E., Santana, S., Marcucci, M., Cano, A., Vollenbroek-Hutten, M., Germini, F., D’Avanzo, B., Gwyther, H., & Holland, C. (2018). Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 16(1), 140–232. https://doi.org/10.11124/JBISRIR-2017-003382

Buta, B. J., Walston, J. D., Godino, J. G., Park, M., Kalyani, R. R., Xue, Q. L., Bandeen-Roche, K., & Varadhan, R. (2016). Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Research Reviews, 26, 53–61. https://doi.org/10.1016/J.ARR.2015.12.003

De Labra, C., Guimaraes-Pinheiro, C., Maseda, A., Lorenzo, T., & Millán-Calenti, J. C. (2015). Effects of physical exercise interventions in frail older adults: A systematic review of randomized controlled trials Physical functioning, physical health and activity. BMC Geriatrics, 15(1), 1–16. https://doi.org/10.1186/S12877-015-0155-4/TABLES/2

Duppen, D., Van der Elst, M. C. J., Dury, S., Lambotte, D., & De Donder, L. (2019). The Social Environment’s Relationship With Frailty: Evidence From Existing Studies. Journal of Applied Gerontology, 38(1), 3–26. https://doi.org/10.1177/0733464816688310/ASSET/IMAGES/LARGE/10.1177_0733464816688310-FIG1.JPEG

Ekram, A. R. M. S., Woods, R. L., Britt, C., Espinoza, S., Ernst, M. E., & Ryan, J. (2021). The Association Between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review. Journal of Frailty and Aging, 10(4), 320–326. https://doi.org/10.14283/JFA.2021.20/FIGURES/1

Older adults and population aging statistics. (n.d.). Statistics Canada. Retrieved May 14, 2024, from https://www.statcan.gc.ca/en/subjects-start/older_adults_and_population_aging

Pérez-Zepeda, M. U., Godin, J., Armstrong, J. J., Andrew, M. K., Mitnitski, A., Kirkland, S., Rockwood, K., & Theou, O. (2021). Frailty among middle-aged and older Canadians: population norms for the frailty index using the Canadian Longitudinal Study on Aging. Age and Ageing, 50(2), 447–456. https://doi.org/10.1093/AGEING/AFAA144

Rockwood, K., & Mitnitski, A. (2007). Frailty in relation to the accumulation of deficits. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62(7), 722–727. https://doi.org/10.1093/GERONA/62.7.722

WHO Clinical Consortium on Healthy Ageing Topic focus: frailty and intrinsic capacity. (2016).

 


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