Prevention Of Frailty In Old People – A Public Health Need
Prevention Of Frailty In Old People – A Public Health Need By Dr. Harshavardhan Kale his is part of the HELP Talk series at HELP,Health Education Library for People, the worlds largest free patient education library www.healthlibrary.com. For info log on to www.healthlibrary.com.
Published on: Mar 4, 2016
Transcripts - Prevention Of Frailty In Old People – A Public Health Need
Prevention of Frailty in Old People- An Public Health Need
• 22% of world population will be over 60 years of age by 2050 (approx. 2 billion)
• 81 million people in India are over 60 – Largest in the world
• India 75% of older people live in rural areas , in contrast to Argentina the majority live in
• Old age is a significant issue in India
• 66 % old people in India are vulnerable as far as food, clothing and shelter is considered
• There is no national health scheme in India, making the old people depend upon family
• Better integrated care systems have healthier old people, and India severely lacks behind
• This gives rise to frailty in old people
• Frailty is a condition of being weak and debilitated
• There are several causes for being frail including lack of exercise and food
• Though it is considered to be a part of getting old, yet it is preventable
• With frailty comes major health hazards including falls, morbidity, depression and disabilities
• Body ability to produce energy, utilize it and repair body declines considerably causing Frailty
• The saddest part of frailty is old people loose their independence
• Government is not prepared for the speedily growing old population, thus capacity building is essential in
• It causes financial loss
• Models used in various countries to tackle Frailty:
• Japan: Comprehensive Community Care (CCC) model
• Dominic Republic: Old person centric approach catering to all his needs
• France: Several Government plans to improve old peoples health
• Czech Republic: Specific care plans developed by Gerontology centres
• UK: Integrated health and social care centres developed with GP and Primary care
What is frailty?
• General weakness and inability to comprehend well that arise out of old age could be termed as frailty in
old people (Lally and Crome, 2007)
• Although there is no common consensus on the definition of frailty; however there is agreement that the
condition arises from altered psychological state that affects the ability of an individual to withstand stress.
• Daniels et al (2008) mentions various interventions including nutritional interventions on disability and
physical interventions which have two components including program on lower extremity strengthening and
6 multi-component programs addressing a variety of physical parameters
• Waltson and Espinoza (2013) suggests exercise, hormonal or anti-inflammatory interventions,
Comprehensive geriatric assessment and treatment, All-inclusive care for the elderly and The Acute Care for
Elders model for preventing frailty in elderly people
• Daniels et al (2008) however argues that no evidence was found in support to effectiveness of nutritional
interventions and lower extremity strengthening.
• He also found that the 6 multi-component programs addressing a variety of physical parameters which
focused on endurance, flexibility, balance and strength was more effective and beneficial
• The Swedish National Institute of Public Health (2007) mentions; that health promotion is an effective
way to decrease frailty in old people
• It mentions that Health promotion is defined in the Ottawa Charter (4) as “the process of enabling
people to increase their level of control over, and to improve, their health”.
• The Swedish National institute of Public Health (2007) has introduced “Healthy Ageing Project” which
has a holistic approach and incorporates various determinants of health
• Lally and Crome (2007) argue that exercise has beneficial effect on old people with comparatively lower
values of IL6 and CRP in physically active people.
• Lally and Crome (2007) also argue that having a positive psychological state has beneficial effect and
• Fairhall et al (2012) argues that multifactorial, interdisciplinary intervention which consolidates
physiotherapy, diet management and community exercise programs results in decreased disability thus
resulting in lower frailty
• The intervention enabled the old people to achieve better mobility which resulted in increased frequency of
them going out of home and getting involved in community thus improving their psychological needs
• Rydwik et al (2008) mentions that the randomized controlled trail have shown the beneficial effect of lower
extremity strengthening exercises and balance training on decreasing frailty and also mentions that
nutrition has no effect in reducing the frailty
• Chan et al (2012) argues that the old people subjected to thrice a week exercise program had beneficial
effect on them in the form of increased bone density and improved vitamin D levels
• Daniel K (2012) mentions that randomized control trial of “progressive functional rehabilitation” confirmed
its effectiveness and lead to positive outcomes in the form of better physical fitness and improved
confidence in balancing.
• It can be concluded from above information that the interventions that can be successfully applied to
reduce frailty in older people can be categorized into physical and psychological interventions or a
combination of the both
• The effective interventions include multifactorial, interdisciplinary intervention, lower extremity
strengthening exercises and balance training, to thrice a week exercise program and progressive functional
• The effective intervention not only takes care of the physical needs of the frail old people but also takes
care of the psychological needs.
Limitations of interventions
• Beswick et al (2008) argues that though the multidimensional complex interventions can be applied
successfully; however they do need individually modified approach to achieve better results as the individual
• It is also important to address the psychological needs of the old people in order to achieve better success.
Possible limitation of the intervention could be that they address only the physical needs and miss out on
• Only taking in account the nutritional aspect of the elderly frail individuals does not reduce the frailty.
Various physical ailments may pose as limitation in successfully applying physical intervention
• Fairhall et al (2012) argues that medical conditions including musculoskeletal conditions presented as a
limitation as the participants experienced pain while undertaking physical exercises
• A successful intervention needs to address nutrition, physical needs and psychological needs as well.
• Indian system needs to take into account the rising problem of frailty
• Government of India should have a national scheme for old people suffering from frailty
• Preventive aspect far better than actually treating frailty