Don't Let Frailty Steal Your Later Life

Imagine yourself at age 100. If you live that long, will you be able to lift your great grand children? Carry a bag of groceries? Will you be able to walk a mile? Bathe without help? Get up from a chair? How much will you weigh?

Because of heart failure, stroke, arthritis or other chronic medical conditions, many older people become disabled and unable to handle routine daily functions, even in their 60s and 70s. Frailty, on the other hand, is not a disease but a condition that develops gradually over many years and eventually seems to define what it is to be old. About half of Americans over age 80 are frail, and many end up in nursing homes as a result.

If you live long enough - to 100 or beyond - are you destined to become frail? It is now believed that frailty is not inevitable and that it is possible to take some measures to at least delay or minimize its effect on your independence and quality of life.

Apart from the effects of co-existing physical illness, frailty is basically a combination of osteoporosis (loss of bone density) and sarcopenia (loss of muscle mass and strength).

Osteoporosis is commonly associated with declining levels of estrogen in postmenopausal women. Males can also lose bone density, and the condition becomes increasingly common - and frequently overlooked - with advancing age.

Signs of osteoporosis include rounded shoulders, loss of height and, eventually, an increased vulnerability to fractures. Hormone replacement is sometimes recommended as treatment, but less commonly today following studies showing the elevated risk of heart disease among women taking hormones. Increased dietary calcium and regular weight-bearing exercise are safer preventive measures.

Loss of Muscle Mass

Even more common is loss of muscle mass and strength, known as sarcopenia. This loss begins at about age 45, but it's gradual enough that it usually does not become noticed until after 60, at which time it may become more difficult to climb stairs, do chores or even get up out of a chair. This loss occurs even in older athletes, but it may be less noticeable in those who have more muscle to begin with.

Because women generally have about one third less muscle mass than men after adolescence, sarcopenia tends to affect them sooner and more dramatically. Women live longer than men, and they are also more likely to spend their final years in a nursing home.

The process of sarcopenia is believed to involve:

•·        a loss of nerve cells and chemical connections linking the brain and muscle cells;

•·        a weakening of the immune system, leading to accumulation of substances harmful to muscle cells;

•·        lower levels of hormones such as testosterone, estrogen and human growth hormone; and

•·        disuse.

The latter can be particularly devastating because it accelerates the process. If it feels uncomfortable to use your muscles, you tend not to use them, and they quickly get weaker and less able to do formerly routine activities.

One obvious solution is to keep moving. Persons who continue to walk, run, bike or swim keep blood and nutrients flowing to their muscles, improving their cardiovascular fitness and bone density as well as their muscle tone. There's no question that regular aerobic exercise of at least moderate intensity improves health and quality of life.

But even high-level masters athletes suffer from loss of muscle mass if they don't add resistance training to their routine. A Danish study found that highly trained runners and swimmers in their late 60s had signs of developing sarcopenia while older weight lifters had muscle mass similar to those of younger lifters (even though their performance may have declined with aging).

These lifters had done strength training most of their lives, but even men and women who start late in life can delay or reverse muscle loss. One study of persons in their 80s and 90s documented muscle strength gains averaging 125 percent plus improvements in walking speed and ability to climb stairs following a 10-week program of high-intensity strength training.

Another study found that elderly nursing home patients increased their knee and hip strength by 189 percent and 87 percent respectively through resistance training. By comparison, subjects assigned to recreational therapy showed minimal gains. And nutritional supplements had no effect on either group.

Weight lifting is effective only when it's at a high enough intensity that it causes microscopic muscle tears that the body is forced to heal. Adequate protein is then needed to re-build the cells, making them stronger than they were before.

Protein is also necessary for routine muscle maintenance, and a certain amount is lost every day through the skin, nails, hair, sweat and body fluids. When adequate protein replacement is not provided through diet, the body turns to muscle as a resource. With a protein deficiency, an older person is more likely than a younger one to suffer loss of muscle mass and function as well as a decline in immune response.

The recommended daily allowance is .36 grams of protein per pound of body weight, or 54 grams for a 150 pound person. It's believed that more than 30 percent of Americans over age 60 get less than that amount. And studies suggest that seniors should have an even higher daily requirement - 0.45 grams per pound or 68 grams for a 150 pound person, according to one Tufts University study.

Major sources of protein are meat, fish and poultry (7 grams per ounce); milk or yogurt (8 grams per cup); cheese (7 grams per ounce); eggs (6 grams) and peanuts (7 grams per ounce).

Most of these items are also good sources of calcium and vitamin B12-two other nutrients important for healthy aging. Vitamin D, important for maintaining muscle function, can be obtained through sun exposure, fatty fish (salmon, tuna, mackerel) and milk.

For many Americans, frailty is a cycle involving a poor diet, waning energy, a sedentary lifestyle and declining strength. Unless there is a serious illness or disability involved, this cycle can be reversed with good nutrition and a balanced exercise program that includes two to three days a week of strength training.

Dr. Vincent Murphy is a physician with Southeast Texas Medical Associates and SelectCare of Texas/Texan Plus