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Years of Interacting Ills Foster Old Age Frailty

Posted By Prucia Buscell, Thursday, June 28, 2012

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 preventive intervention.

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.

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