Older age does not look the same for everyone. Two people may both be 75, for example, but have a much different risk of dying in the near future. Decades ago, when scientists went looking for an answer to why, they uncovered a pattern. The people more likely to die sooner moved more slowly, had weaker hand-grip strength, and showed a cluster of other red flags for a condition now called frailty.
Frailty is “a long-term condition in the same sense that diabetes or Alzheimer’s disease is,” the British Geriatrics Society says on its website.
And it’s projected to become more prevalent in the near future, says Dr. Kenneth Rockwood, a professor of medicine at Dalhousie University in Canada who developed one of the scales for diagnosing frailty. “It's the demographic imperative,” he says. “In 2021 the leading edge of the baby boom generation turned 75 years old, and 75 is the age at which most of the diseases of aging take off. So now frailty is not some mystical, mythical far-off thing.”
However, frailty is not inevitable—and to some extent, it's possible to undo some of the damage. Here’s what to know.
How can you tell if you’re frail?
One of the best ways to identify frailty is a comprehensive geriatric assessment, in which a team of health care professionals look at many different aspects of an aging person’s health to get a sense of the bigger picture. But some potential tell-tale signs doctors might check for, and that you might notice on your own, include walking slowly—less than approximately 2.6 ft. (or 0.8 meters) a second, one study suggests—and taking more than 10 seconds in what’s called a “timed up and go test,” in which a person is timed getting up from a chair, walking for almost 10 ft. (3 meters), turning around, walking back, and sitting down. With frailty, “you can't tell at a glance, but it doesn't take that long [to detect] if you know what questions to ask…if you can see the person move,” says Rockwood.
Why is it important to know if you’re frail?
Frailty can be mild, moderate, or severe, and once clinicians have flagged it, it can help them make treatment decisions. An older person who is not frail might quickly recover from something like a little tumble, a cold, or an elective surgery, but that same event can cause sudden decline in a frail person—a pattern Dr. Sara Espinoza, a geriatrician at Cedars-Mount Sinai in Los Angeles who researches the condition, noticed early on in her career.
“Some patients would do really well. They would come into the hospital for whatever their issue was, and we would treat them, and they would be fine. They would go back out as if almost nothing happened,” she says. “But others were just very vulnerable. It was like the hospitalization was a tipping point for a bunch of other things to happen,” including complications and mobility issues.
Research has shown that frail people are at a higher risk for complications after planned surgeries. Knowing whether a patient is frail or not can change a clinician’s sense of whether to act swiftly on what seems like a small problem or to reexamine whether an elective surgery is a good idea, for instance.
Is frailty reversible?
“It looks like large elements of frailty are reversible, up to a certain period,” says Rockwood. Research suggests that starting a program of high-intensity resistance exercise can help people grow less frail, if continued over at least a few months. “Exercise is important,” concurs Espinoza.
A 2023 clinical trial found that a twenty-minute daily exercise routine designed to strengthen arms and legs and improve balance and coordination, paired with eating a bit more than a gram of protein per kilogram (around half a gram per pound) of body weight daily, was linked to significant improvements in frailty. People who followed the advice over three months improved their grip strength, increased their bone mass, and were more active than controls, suggesting that frailty can be improved with lifestyle interventions.