Dr. Linda Fried
embraces complexity in her analysis of frailty syndrome in the elderly. In a sort of negative synergism, poor
nutrition leads to lost muscle mass, which reduces strength and walking speed,
which reduces overall activity and energy. These factors interact to
dysregulate the immune, endocrine and other systems of the body.
Dr. Fried, an epidemiologist and geriatrician who is dean of
the Mailman School of Public Health at Columbia University, believes research on aging and health
changes over the course of life are central to finding solutions to public
health problems in the twenty-first century. She is profiled in a New York Times
story by Karen Pennar.
Dr. Fried has done extensive research on aging and broke new ground in defining
frailty in the elderly. Listen to an interview here.
She also developed criteria for identifying frailty syndrome
in people 65 and older. Five criteria include unintentional loss of more than 10 pounds in a year, self-reported
exhaustion, weakness as measured by hand grip strength, slow walking speed,
and low physical activity. Presence of three of those criteria indicate frailty
syndrome, and two of them could suggest a person is "pre-frail” and in need of
The planet now has more old people than
at any time in history, and their numbers are expected to increase. Demographers estimate
that there will soon be more people over age 65 than there are under age 5. The UN estimates that by 2050 those over
age 65 will make up more than 16 percent of the world population. In the US, 74 million Baby Boomers will
retire in the next 20 years. The fastest growing
segment of the US aging population, those over 85 who need the most medical care and physical
help, may reach 19 million by
2050, according to government projections.
Dr. Kenneth Rockwood, geriatrician at Dalhousie University in
Halifax, Nova Scotia, has
developed other criteria for determining frailty, using a mathematical index of
dozens of specific deficits including inability to perform activities of daily
living. Despite his differing
approach—or perhaps because of it—Dr. Fried years ago invited him to be an external advisor to the Center on
Aging and Health at Johns Hopkins where she worked at the time. Dr. Rockwood’s recent research on aging suggests the
best way to ward off frailty, dementia and other geriatric afflictions is by maintaining
the best possible general health.
Dr. Rockwood’s research emphasizes that while the very old are most
likely to be frail, the deficits
that produce frailty develop over a life time.
In Canada, the population of people over age 85 grew 41
percent between 1991 and 2001, according to Dr. Howard Bergman,
professor of geriatric medicine at McGill University. Researchers for the Canadian Initiative on Frailty and
Aging, Bergman wrote, consider that biological, psychological, social and
environmental factors, including
clinical and cognitive history, interact over the course of a lifetime
in ways that promote a healthy old age or the emergence of frailty.