(Reuters Health) - Frail older people don’t live as long as their stronger peers, and loss of mental function further increases their risk of death, recent research shows.
The good news: Older people can live longer, healthier lives by maintaining their strength and cognitive abilities, Dr. Yunhwan Lee of Ajou University School of Medicine in Suwon, South Korea, and his colleagues report online October 9 in Maturitas.
“Frailty is a dynamic state, meaning that it is potentially reversible with proper care and management. Cognitive impairment, particularly in early stages, is also malleable,” Lee told Reuters Health in an email. “It is important to recognize that these geriatric conditions affect a large number of older people, often co-occurring, and need to be targeted for developing effective interventions.”
Frailty occurs when an aging person becomes less able to bounce back from stressors such as chronic illness or injury, Lee explained. “It places one at risk for falls, loss of independence, hospitalizations and death. A typical frail person appears weak, lacks energy, walks slowly and has low appetite, eventually losing weight without intending to,” he added.
While both frailty and cognitive impairment increase mortality risk, many people have both at once, and it’s unclear whether their effects are independent, the study team writes. To investigate, they looked at data from a 2008 Korean study on 11,266 men and women age 65 or older. During three years of follow-up, 6.5% died.
Nearly half of the study participants were “pre-frail,” meaning that they were likely to progress to frailty if they did not receive appropriate care, while 43% were not frail and 8% were already frail. Roughly one-fourth of the study participants also had cognitive impairment.
Pre-frail individuals were 38% more likely to die during follow-up than those who were not frail, while the risk of death was increased 78% among those who were already frail at the start of the study period.
Cognitive impairment also increased mortality risk by 30% overall. The relationship between frailty and mortality was strongest in cognitively impaired study participants, suggesting that cognitive problems may exacerbate the risks of frailty.
About 10% of people classified as pre-frail will move into the non-frail category over time, while 25% of frail individuals improve to pre-frail status, Lee said. About 1% of frail individuals will become non-frail.
“Increasing evidence suggests that exercise (resistance and aerobic) with balanced nutrition (especially protein intake) helps reduce the risk of frailty,” the researcher said. “Some studies have indicated that its progression can be delayed, and even reversal may be possible for those who are frail.”
He and his colleagues now plan to investigate whether cognitive impairment and frailty are associated with other poor health outcomes, such as becoming disabled or being institutionalized, and whether certain types of cognitive function may be more important than others for raising the mortality risk associated with frailty.