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Prevention of Frailty

by James T. Pacala, MD, MS

Frailty is loss of physiologic reserve, which makes people susceptible to disability due to minor stresses. Common features of frailty include weakness, slowed motor function, weight loss, muscle wasting (sarcopenia), exercise intolerance, frequent falls, immobility, incontinence, and frequent exacerbations of chronic diseases.

Exercise (see Exercise in the Elderly) and a healthy diet (see Nutritional Recommendations for Prevention of Frailty) are recommended for preventing or reducing frailty. Elderly people who engage in regular aerobic exercise (eg, walking, swimming, running) increase their life expectancy and have less functional decline than those who are sedentary. Mood and possibly cognitive function may also be improved. Weight training can help increase bone mass and reduce risk of falls and fractures. A healthy diet may prevent or reduce risk of many diseases that contribute to frailty, including breast and colon cancers, osteoporosis, obesity, and undernutrition; morbidity and mortality may also be reduced.

Nutritional Recommendations for Prevention of Frailty

Measure

Description

Rationale

Low-fat diet

Fats limited to less than about 20 g/day, with 6–10 g polyunsaturated (with ω-3s and ω-6s in equal proportions), 2 g saturated fats, and the rest as monounsaturated fats

Some sources of healthful oils: Oily fish (eg, tuna, salmon, mackerel, herring), certain vegetable oils (flaxseed, canola, soybean), flax seed, and walnuts

Decreases risk of cardiovascular disease

Reduced Na diet

Optimal level of intake unknown but some evidence to support reducing intake to 2.3 g/day

Lowers BP in some people

High Ca diet and Ca supplements

For the elderly, 1200 mg/day (most American diets contain only 500–700 mg/day)

Helps maintain bone density and reduce risk of fractures

Adequate intake of vitamins and minerals

Largely by eating fruits and vegetables

Supplementation with vitamin D (at least 600 IU/day for patients ≤ 70, 800 IU/day for patients > 70) for people with average or low dietary Ca

For vitamin D, prevents bone loss, falls, and fractures

May prevent various chronic diseases

High-fiber diet

Best obtained by eating fruits, vegetables, and grains

May prevent colon cancer

Has a beneficial effect on serum lipids

Moderate alcohol intake

About 1 oz of alcohol/day (more can be harmful)

May decrease risk of cardiovascular disease

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