5 simple questions to help avoid the slippery slope to senescence.

Age alone cannot tell whether a person is frail or even pre-frail. In a survey of over 30,000 people aged 50+, across 12 European countries, more than one in four females and just over one in six males met the criteria for being pre-frail. In the same study (SHARE) published in 2010, over 7% of females and 3% of males were classified as frail.

Fit people of any age are resilient. Frail people of any age are vulnerable. In between there are people who are pre-frail, meeting one or two criteria described below. This group includes those who may be developing unhelpful habits which may contribute to a further decline in both physical and mental health. Either way both groups can benefit from further assessment and advice; many more can benefit from learning how to become habitually more active.

Test yourself. You can do it:

Below are the 5 simple questions which are designed to identify early warning signs of pre-frailty so that the process of muscle weakness, functional decline or an earlier demise can be prevented.

Score one point for a positive response to each question. Zero for a negative response.

	Yes	No
Q 1. Are you fatigued? or In the last month have you had too little energy to do the things you wanted to?
Q 2. Do you have difficulty walking up a flight of stairs? or Because of health problems do you have difficulty climbing a flight of stairs without resting?
Q 3. Are you unable to walk one block? or Are you unable to walk a distance of about 800 yards (about 730 metres) without aids?
Q 4. Do you have more than 5 illnesses? Include any illness that causes symptoms and/or for which you need to take regular medications.
Q 5. Have you lost more than 5% of your weight in the last 6 months? or Have you unintentionally lost weight and/or appetite in the last 3 months or more?
Score

Total: I or 2 suggests pre-frailty. 3 or more is compatible with being frail.

What to do about the positive responses:

Fatigue?

Exhaustion, overwhelming fatigue or ‘tiredness all the time’ may be due to a number of causes. It is a common feature of some viral illnesses, depression, stroke and heart disease and even taking multiple medications. It may also be due to poor nutrition.

If this is of recent onset, has no obvious precipitating factor and persists for longer than a month, my recommendation is to seek medical advice.

Unable to walk one flight of stairs without resting?

Assuming this is a long term problem and not just due to poor nutrition secondary to unintentional weight loss or exhaustion, then a possible explanation is ‘deconditioning’. This occurs with any prolonged inactivity or sedentary lifestyle. In other words if you haven’t used it you may have lost it. At least temporarily!

Whilst this may be due to a chronic problem such as arthritis, stroke or heart disease, and it may be easier, safer or more comfortable not to be active or do things for yourself, the consequence of continuing with this strategy will be a further decline in both physical and mental well-being.

Recent research has shown that for all the conditions mentioned above, exercise can be more effective than drugs at achieving good outcomes. Indeed practicing going up and down stairs is one way of building your stamina and fitness.

Unable to walk one block?

This is a test of aerobic fitness and an inability to meet this criterion may be associated with both muscular wasting and weakness.

This may be secondary to chronic illness and associated de-conditioning. See comments under the previous heading.

Multiple illnesses?

Just because you have 5 or more illnesses doesn’t necessarily mean that you must rest more and avoid exercise. If being on multiple medications is contributing to your lack of energy then a medical review is recommended.

Even for people who are sedentary because of lower limb arthritis, research has shown that exercise rather than rest can be beneficial. Exercise can not only improve and/or maintain fitness but somewhat surprisingly it can also help to reduce the pain.

Unintentional weight loss?

In the original research this was measured by subtracting your present weight from a weight of 12 months ago: if the difference was 10lbs (4.5Kgs.) or more the score is one. An alternative measure for people who had no previous weight records was finding a BMI (Body Mass Index) of less than 18.5 Kg/m2.

The practical issues were either of being able to produce a comparative weight and/or the equipment and skills to measure both weight and height accurately.

An acceptable substitute measure is the answer to the question: “In the last 3 months what has your appetite been like”? Or: “Have you been eating more or less than usual?” If the answer to the first question is a negative one (e.g. “Poor”) or the answer to the second is “Less”, then score one.

Of all the components of these screening tests, the finding of unintentional weight loss requires further assessment from a qualified health professional. Whatever the cause of the weight loss turns out to be, if persistent then every other measure of frailty may be affected by malnutrition. Dietary supplements including Vitamin D may help, particularly if housebound, but are no substitute for proper assessment.

Key messages

Even in our 50s many of us do not tap into our own potential for healing, health and well-being.
We develop an increasingly sedentary lifestyle.
Both muscle strength and muscle mass decline with age.
Combined aerobic and resistance exercise can prevent decline.
Adding balance and flexibility exercises has also been shown to reduce the risk of falls and injury.
The evidence is that the fitter we are before we reach older age, the more likely we can postpone the risk of becoming frail.
Becoming more active is just a habit like any other.