Read this if you have a frail loved one

Here’s a prescription that seniors should not take sitting down. The best way to stay vital is to stand up and keep moving.
As of July 2015, there were more Canadians aged 65 and older than there were Canadians younger than 15, according to Statistics Canada. (David Donnelly/CBC)

Seniors face many health challenges, but the greatest may come from a condition doctors call frailty.  As many as one million Canadians are considered medically frail. A study published today in the Canadian Medical Association Journal (CMAJ) has a prescription to stay alive.  

We're talking about people who look like they've lost vitality. They are usually very thin. They look tired. They walk as if just doing so might make them fall down. It's one of those conditions that physicians and non-physicians alike kind of know when they see it. It has always been around, but it's only in the past 30 years or so that frailty has gotten a formal definition. Frail people typically have at least three of five symptoms, including unintended weight loss of roughly five kilograms or more within the past year, tiredness, loss of muscle mass as well as weakness, walking slowly and physical inactivity.

Frailty also means that your health is precarious. Compared to people who are robust, frail people can't cope with minor stresses, such as bladder infections. When they get one, their health can plummet quite rapidly.

We know that people who are frail tend to be less physically active than people who are robust. Many studies have looked at the health benefits of physical activity. Few have looked at the impact of physical activity in people who are frail.  

Researchers from Dalhousie University and University College in London looked at more than 3,000 adults age 50 and older who are part of a long-term study called the U.S. National Health and Nutrition Examination Survey.Participants were equipped with Fitbit–type devices that tracked how much time they moved around. They were followed for years. Frail people who sat in a chair all day tended to die; those who got up and moved around tended to live. For people who aren't frail, getting up and moving wasn't life or death. 

Compared to robust people, those who are frail have much less in reserve. They've lost muscle mass. Sitting all day makes them lose even more, while getting up helps preserve what they've got. Likewise, when they are sedentary, they don't move their legs. When that happens, the brain gets fewer signals from moving joints. That makes it more likely that when they finally do get up, they'll fall down. Falls are a major cause of death in older people. In addition, when they sit most of the day, their lungs don't fill with oxygen as much as when they move around. As a result, they have less reserve function in their heart and lungs. Less oxygen going to the brain means less engagement in the world, and less ability to cope with the stresses of being old and frail.

There's no magic cookbook, but there are some general principles. The first is to be active on most days of the week. Walking and easy strength training can improve strength and reduce weakness. It doesn't have to be a lot. Even a little bit helps. Eating well is very important. That means trying to have three healthy meals a day with fruit, vegetables, protein, good fats, whole grains and low-fat dairy products. Men need 56 grams of protein per day, and women need 46 grams.* Keeping your mind active and your attitude optimistic is helpful. Positive feelings mean a lower risk of frailty. Learning new things and staying socially connected with others and continuing to learn new things also help.  

There are also some important implications for younger Canadians. On an individual level, there are simple yet important things to do to prevent frailty down the road. Started early, some sort of strength or resistance training can help delay and possibly even prevent frailty. This may sound paradoxical, but even though frailty is associated with weight loss, obesity earlier in life is a risk factor – a connection that probably has to do with inactivity.

On a societal level, caring for frail seniors is expensive. Canada spends $220-billion on health care each year. Close to half of that is spent on seniors. Falls – one of the major consequences of frailty, cause serious injuries that drive health care costs higher.  At present, we have an estimated one million frail Canadians. Within a few short years, we'll have two million, and the cost will be higher. We can help the wellbeing of older Canadians and save a lot of money in the process by addressing frailty.

Dr. Brian Goldman is host of @cbcwhitecoat, which returns next month with new episodes.

* Since the blog was first published, we have learned that there is good evidence that consumption of 1.0 to 1.3 g/kg/day dietary protein combined with twice-weekly progressive resistance exercise reduces age-related muscle mass loss. Older people appear to require 1.0 to 1.3 g/kg/day dietary protein to optimize physical function, particularly whilst undertaking resistance exercise recommendations.


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