Growing older does not affect everyone in the same way, and a new focus on frailty is helping doctors identify older people who may face a higher risk of serious health problems.
Two people can be the same age but have very different levels of physical resilience. Researchers have long observed that older adults at greater risk of illness and death often walk more slowly, have weaker grip strength and show other signs of frailty.
The British Geriatrics Society describes frailty as a long-term health condition rather than an unavoidable consequence of ageing. Experts say it is becoming increasingly important as populations grow older.
Dr Kenneth Rockwood, a professor of medicine at Dalhousie University in Canada, said rising numbers of people reaching their mid-70s are likely to make frailty more common in the years ahead.
Frailty can be identified through a comprehensive geriatric assessment, in which medical professionals evaluate several aspects of a person’s physical and general health.
Doctors may also look for signs that can be noticed without extensive testing. Walking at less than about 0.8 metres per second can be a warning sign, according to research. Another commonly used measure is the timed up and go test, which records how long someone takes to rise from a chair, walk about three metres, turn, return and sit down.
A longer time on the test can indicate reduced mobility and greater vulnerability.
Identifying frailty is important because it can affect how doctors approach treatment. A healthy older person may recover quickly from a minor fall, infection or surgery, while the same event can trigger serious complications in someone who is frail.
Dr Sara Espinoza, a geriatrician and researcher in Los Angeles, said she had seen patients respond very differently to hospital treatment. Some recovered quickly, while others experienced a rapid decline in mobility and developed additional complications.
Research has also linked frailty with a greater risk of complications following planned surgery. Knowing whether a patient is frail can therefore help doctors decide how urgently to treat certain conditions and whether an elective procedure is appropriate.
Experts stress that frailty is not necessarily permanent. Rockwood said substantial aspects of the condition can be reversed during an important period.
Physical exercise appears to be one of the most useful interventions. Studies have found that resistance training can improve strength and reduce signs of frailty when performed consistently over several months.
A 2023 clinical trial found that a daily 20-minute programme focused on strengthening the arms and legs and improving balance and coordination, combined with adequate protein intake, produced significant improvements over three months.
Participants improved their grip strength, bone mass and physical activity compared with a control group.
The findings suggest that detecting frailty early and responding with exercise, nutrition and appropriate medical care could help older adults maintain independence and recover more effectively from illness or injury.
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