Ageing is Inevitable but Frailty is Not – How to Shift the Frailty Threshold

I’ve got frailty on my mind.

In about 6 months, I’ll turn 40. I’ve always lived by the philosophy, ‘age ain’t nothing but a number’. That is until I read this study on physical activity and ageing.

According to the authors of the study, it’s around the age of 40 when age-related deterioration of the body becomes detectable. So, I can soon look forward to:

  • Declining cognition — affecting memory and learning
  • Weakening muscles — affecting physical function
  • Decreasing bone density — increasing risks of fracture

Ok, I had some idea before reading the study that I would lose my physical prowess as I aged. Since 1981 — the year I was born — the ‘Elderly People Crossing’ sign has been used in the UK as a warning to motorists. For nearly 4 decades, its depiction of older people has been quietly insisting on how I’m supposed to look in my golden years — hunched, frail, and in need of assistance.

Cultural representations of fit older people are the exception rather than the rule in today’s society.

Luckily for us all, while ageing is inevitable, frailty is not. Research shows that by increasing the amount of physical activity we do, we can stave off some of the most debilitating effects of ageing. This will allow us to live healthier lives for longer.

The Frailty Threshold

If you make it to 80, you’ve got a 50% chance of suffering from frailty. Frailty is a clinical set of symptoms occurring in old age. It’s characterised by ‘multiple deficits to body systems’.

A clinically frail person experiences severe impairments to their physical and mental function. This limits their ability to perform basic activities of daily living — such as getting dressed, walking, or taking care of personal hygiene. A frail person is likely to be dependant on family or carers to assist with basic tasks, or they may live in an assisted living facility such as a care home.

The frailty threshold is the point in a person’s life where they’ve become so impaired that they cannot carry out the tasks necessary for safe and dignified independent living.

We’re Living Longer But Less Well

Graph depicting ageing population in UK | Frailty & Ageing | Vee Uye

Image Source: ONS. Image licensed under the Open Government Licence 3.0.

Improvements in medicine have seen the average life expectancy in the UK steadily increase. More people are reaching the age of 90 than ever before. Unfortunately, the length of time that people spend in good health before frailty occurs has actually decreased.

  • 31% of people over 75 report long-standing heart and circulatory problems
  • 30% report a chronic musculoskeletal condition.
  • 50% of people over 80 experience a fall at least once a year, putting them at high risk of fragility fractures.

Patterns of Ageing

‘The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty’

Old age in itself is not the cause of frailty and loss of function. The way we live our lives today has a direct consequence on the way we will live in our later years. Specifically, the amount of physical activity we do as younger adults determines how physically active we will be when elderly.

Graph Depicting Patterns of Ageing | Ageing & Frailty Threshold | Vee Uye

Image modified from McPhee, et al. Licensed under Creative Commons Attribution 4.0 International License.

The dashed line in the graph above represents the frailty threshold — the point where a person becomes unable to perform basic activities of daily living. For illustration — and in line with the research already discussed — the theoretical age for crossing the frailty threshold for normal ageing occurs around 80 years old.

In accelerated ageing, the frailty threshold has shifted closer, occurring at around 60. For a person experiencing an accelerated decline in physical and mental function, loss of independence happens nearly 20 years earlier than in normal ageing. That’s 20 years of poor function and dependence for basic activities of daily living.

In healthy ageing, the frailty threshold has shifted further away, closer to 100 years of age. That gives almost 40 extra years of physical function to someone ageing healthily than to a person experiencing accelerated ageing.

The Frailty Threshold and Episodes of Illness or Injury

Graph depicting impact of illness or injury on frailty threshold | Vee Uye

Image by the author.

The chances of experiencing an episode of illness or injury — such as a fall or an infection — are much higher for elderly people because of the physical and cognitive declines an ageing body undergoes.

However, the chance that such an episode will knock them below the frailty threshold is much lower if that person has remained physically active. The green line in the image above represents the fit older person’s physical response to and recovery from a debilitating episode. At no point does the episode knock them below the frailty threshold.

The red line, on the other hand, shows that for an unfit elderly person, a debilitating episode could knock them below the frailty threshold and prevent their full recovery. In this case, the chance of another debilitating episode is made much more likely and the effects will compound.

Benefits of Physical Activity

We have a powerful tool at our disposal to help us kick the frailty threshold as far down the road as possible — regular physical activity. While ageing brings inevitable declines in physical and mental function, the benefits of physical activity can limit the severity.

Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent’

Regular physical activity reduces the risk of:

  • Cardiovascular disease
  • Metabolic disease
  • Obesity
  • Falls
  • Osteoporosis
  • Cognitive impairment
  • Muscular weakness
  • Balance and coordination deficits

By becoming more physically active, we can give ourselves the best chance of shifting the frailty threshold in our favour. Conversely, becoming more sedentary in our behaviour will shift the frailty threshold against us.

 

It’s Never Too Late

Being physically active throughout our lives helps prevent us from falling below the frailty threshold. But what if you haven’t moved much until now? What if you’re already pushing 40, like me?

The good news is that if you take up physical activity at any stage — even in later years — it will still have a positive effect on shifting the position of the frailty threshold. It is never too late to benefit from increased physical activity, even after a relatively sedentary life.

What Kind of Physical Activity is the Best?

As it’s clear that physical activity is the key to combating the debilitating effects of ageing, I can look forward to my 40th birthday with slightly less trepidation. But physical activity is a broad term. Exactly what sort of physical activity should I be doing and for how long?

Researchers have found that you don’t need to go from couch potato to marathon runner to improve the quality of your life. Some physical activity is better than none at all. In fact, for the most unfit and sedentary of us, even very light activities like walking will produce reductions in the risks of death and disease.

The World Health Organisation recommends that adults between the age of 18–64 should do:

  • At least 150–300 mins of continuous moderate-intensity exercise a week
  • Or 75–150 mins of vigorous-intensity exercise a week
  • And muscle strengthening activities involving the whole body on 2 days a week

The key takeaway is that ‘an inactive lifestyle is not safe’.

If you already move, move more. If you’re not moving much at all, now is the time to start.

Whether you’re new to physical activity or you’ve just taken a break, you’ll want to ease into it. Read this article on how I used an evidence-based approach to ease back into running following the birth of my daughter – it may give you a place to start.

In Summary

  • Ageing is inevitable. More people than ever before are reaching very old age, but the proportion of time that we can expect to spend in good health — our healthy lifespan — is decreasing.
  • The frailty threshold marks the point at which an older person becomes unable to perform basic activities of daily living.
  • All frail people are old but not all old people have to be frail. By becoming regularly physically active, we can push the frailty threshold away and extend our healthy lifespan.
  • Some physical activity is better than none at all, and it is never too late to benefit from taking up regular physical activity.

There’s no guarantee that any of us will make it into old age. But if we do, we want to have given ourselves the best opportunity to live healthily and independently. The evidence shows that we can do that by introducing more quality movement more frequently into our daily lives.

Why not start now? After you’ve finished this article, log off and take a stroll around the block.

You’ve got nothing to lose. But you might ensure your golden years are truly golden.

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