Frailty syndrome

Woman with a walker showing why it's important to prevent frailty syndrome.Prevent frailty

Frailty syndrome is highly prevalent in the elderly; it means there is a much greater risk of falls, hospitalization, loss of independence and death; disability is considered an outcome of frailty, and not a cause.

I have my doubts about that, but it's not good form to argue with the scientists. Having admitted that, should a disabling hip or knee condition impede your walking speed, in my humble opinion it would contribute to an increased risk of the development of frailty. Perhaps it's not treatable, but if it is... get it sorted. Have you tried a daily set of exercises, done in a disciplined fashion every single day?

The number of frail persons is expected to increase four times by 2050, largely due to our less physically active lifestyles and highly refined diet, deficient in vitamins, minerals and phytochemicals.

By Bernard Preston

  1. Bernard Preston
  2. Healthy choice foods
  3. Frailty syndrome

Fried's definition of frailty

Every doctor, including chiropractors, has patients whom one intuitively realise are becoming frail. How does one define this more precisely, and is there anything that can be done to prevent the insidious course of the condition?

Fried's definition of frailty is when and if you qualify for three or more of these five criteria[1]:

  1. Low grip strength
  2. Low energy
  3. Slowed walking speed
  4. Low physical activity
  5. Unintentional weight loss

Even if you have only one or two of these criteria then there's still a higher risk of progressing to frailty syndrome.

Low grip strength

Your grip strength can be accurately defined using a dynamometer; it is one of the important criteria of impending frailty syndrome, and improving your strength now will help prevent the progression of this nasty condition.

Here are some suggestions if you have a sense that your hands are becoming weak:

  • Use a pair of secateurs regularly to pick flowers and prune your plants.
  • Scissors for cutting material
  • Weeding in the garden
  • Carry your groceries to the car
  • Squeeze a tennis ball.
  • For men, regularly use a hammer, pliers and push a lawn mower.


When everything becomes an effort and you have a sense that you cannot get going, that you have unusually low energy levels and feel weak and tired, then there are concerns about progression to frailty syndrome, should this state of exhaustion continue.

This is the time to have a medical checkup to test for conditions like anaemia and diabetes, and a visit to a dietician to examine your your meal planning; tea and toast does not constitute breakfast! Ask for a special focus on the four vitamins that, if deficient in your diet, will cause rapid progression of frailty syndrome. Researchers found that it is far more effective to get them from your food than in pill form.

Low physical activity

Low physical activity can be accurately defined but it's an expensive test, and generally one has an innate sense that that one is becoming inactive.

Here are some suggestions:

  • Take several short walks every day; use a stick if necessary.
  • Park the car further from the entrance to shops so that you must walk.
  • Use the stairs rather than the elevator, using the hand rail to prevent falls.
  • Walk to nearby friends, shops, churches and so on, rather than take the car.
  • Join a swim group.
  • If appropriate, use a bicycle.


Slowed walking speed is defined as taking more than 6 or 7 seconds to walk 15 feet (4.6m) at your normal walking speed; it's one of the strong indicators of progression to frailty syndrome.

Using a piece of chalk and a tape measure, mark out 15 feet; ask a friend to time how long it takes for you to walk that distance.

Suggestions to increase your walking speed:

  • Use a stick so that you can step it out more confidently during your short walks; wear at hat, but short sleeves; aim at least 15-30 minutes exposure to sunshine for adequate vitamin D.
  • Have that painful ankle or foot treated, if it's the impediment; knee, hip?
  • Ask your chiropractor for specific exercises for those joints that are ailing and slowing you down.
  • If extra pounds is what is slowing you down, make a serious effort to reduce, or if need be cut out altogether the refined carbohydrate in your diet; they and not fat are the most common cause of obesity.

Unintentional weight loss

Unintentional weight loss contributing to frailty syndrome is defined as ten pounds (4.5kg) in the last year. It's definitely time to consult your doctor for a checkup.

Report in particular any change of bowel habits.

The regular onset of diarrhoea contributes to malabsorption syndromes, which then cause malnutrition with concerns about anaemia, and the poor absorption of these four most important vitamins, and minerals too.

Lower down we will discuss in some detail the four vitamins that have been found to have a vital function in the prevention of frailty syndrome.

Understanding the meaning of gluten may be important should you be intolerant to bread.

Medically the condition is known as sarcopenia, or gradual loss of muscle mass and strength. It's thought to be caused by 'oxidative stress', the build up of dangerous reactive oxygen ions in the tissues.

Thus antioxidants like vitamin E and many photochemicals from the diet are an important part of the solution.

Frailty syndrome

Frailty syndrome can be prevented by timeously starting a simple exercise program, and ensuring that your diet includes adequate levels of these four vitamins.

If ever there was a case for prevention rather than a cure, it pertains to this insidious condition that causes such pain and disability. Soon dependency on others to care for you follows.

The four vitamins

Researchers have found that four vitamins in particular are very important in preventing frailty syndrome; we look at measures you can take to make sure you have adequate stores in your body.

Most of the time it can be taken care of by indulging in a walk in the sun most days, and ensuring that you get your eight to ten coloured foods daily. Then not only the vitamins are covered, but the host of micronutrients that we neither could nor should monitor; that would make us hopelessly neurotic.

Vitamin B6

A diet deficient in vitamin B6, known as pyridoxine, is strongly associated with the development of frailty syndrome.

Because it causes a form of anaemia, different to an iron deficiency, exhaustion is common, and of course chronically tired people, young or old, are not likely to go out walking; nor do they have the inclination to prepare proper nutritious meals.

Tea and toast may fill the spaces but it doesn't provide the vitamin B6.

Vitamin B6 foods include, top of the pops, chickpeas. We get a good dollop of pyridoxine every day from this authentic hummus recipe with a green salad.

Of equal importance, researchers have found that low levels of vitamin B6 is strongly associated with chronic inflammation in the body in diseases such as rheumatoid arthritis and inflammatory bowel disease [1].

A divine green saladDivine green salad

Vitamin C

When the world's sailors were dying like flies from a mystery disease known as scurvy, the British Limey's escaped the scourge thanks to a very smart doctor who recognised that enjoying freshly squeezed citrus was the solution; limes were his remedy.

The first symptom not surprisingly of a deficiency of vitamin C is known as malaise; exhaustion and chronic tiredness. That leads directly to folk who are unlikely to have the energy to go out walking; frailty syndrome lies waiting, ready to strike.

Folic acid (vitamin B9)

Folate is usually associated predominantly with prevention of birth defects and anaemia. However, because of its importance in the degradation of toxic homocysteine in the body, it is also important in protecting the integrity of the inner lining of the blood vessels.

Homocysteine cardiovascular tells all; decreased blood supply affects the whole body and certainly explains why a deficiency of folic acid contributes to exhaustion and low physical activity, two of the hallmarks of frailty syndrome.

For more about the foods rich in vitamin B9, read the benefits of folate page.

Vitamin E

Vitamin E is a potent antioxidant, mopping up free radicals that are formed in the body during normal tissue metabolism[3].

It is these free radicals, known in the research literature as 'reactive oxygen species' that are thought to cause the gradual loss of muscle mass in the elderly, and unintentional weight loss.

The quadriceps muscle in the thigh is often targeted, making it difficult to stand up from a chair; the walker and wheelchair soon follow.

Current research indicates that vitamin E not only prevents atrophy but also promotes muscle regeneration.

Read here for more about vitamin E and in which foods you can find it.

Take home

The take home from all this is to enjoy a walk every day, and enjoy a diet rich in many coloured foods and unrefined carbohydrate.


Because chronically raised blood sugar affects the nerve supply to muscles, they tend to waste away; sarcopenia. This is particularly true of the quadriceps in the thigh, leading to falls.

Diabetics are prone to all five of the criteria of frailty syndrome.

Interesting research quoted in Diabetes Care showed that not one of a group of prediabetics went on to get the full blown disease if they took the active ingredient, curcumin, in turmeric daily, compared to 16% in the placebo group4.

4. Curcumin Extract for Prevention of Type 2 Diabetes

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