People are living longer today than ever before, and it is estimated that 25-40 percent of those over age 85 are frail. But what is frailty? A frail person is weak and may be more vulnerable to falls and breaking bones, which aptly describes my elderly mom right now. She’s in rehab after breaking a hip and arm for the second time (opposite sides). As a nutrition professional but especially as a daughter, I found myself frantically searching for ways to improve or at least stabilize the processes contributing to mom’s steep slide into frailty. Here’s what I pulled from my expertise as a registered dietitian combined with sound nutrition and health research to help my mom:
- Sarcopenia, age-related loss of skeletal muscle and function, is a key component of frailty. But frailty is more than loss of muscle. Both sarcopenia and osteopenia/osteoporosis, loss of muscle and bone mass with age, are common among older adults and contribute to loss of physical function. Physical frailty is recognized as an important medical syndrome, but was not officially defined until a 2012 consensus conference. Diagnostic criteria for frailty includes unintentional weight loss, self-reported exhaustion, weak grip strength, slow walking speed and low physical activity.
- Physical frailty is a manageable condition. Experts attending the 2012 conference on frailty agreed that though physical frailty has a number of potential causes, there is some evidence that it could be improved by providing sufficient calories, protein, vitamin D, exercise and reducing inappropriate medications. Plus, previous research supports a high quality diet for the frail elderly. A study in older men showed that adhering to a high-quality meal pattern is associated with lower risk of frailty. Most recently, a large prospective study among community dwelling adults age 60 and older in Spain found that higher consumption of low-fat milk and yogurt was associated with lower risk of frailty – specifically due to lower risk of slow walking speed and weight loss.
As all of you who are working with frail elderly clients know, each has a unique set of medical conditions, nutritional needs and food preferences. So you may need to look for creative ways to provide sufficient amounts of calcium, vitamin D and protein to help meet nutrient needs.
Thankfully, mom has a good appetite, though it only takes small portions of food to maintain her 95-pound frame. Every calorie has to count nutritionally, which includes getting enough calcium and vitamin D from food and supplements as needed. However, many also will need more high-quality protein, like my mom did, to help reduce the risk of complications after fracture and minimize loss of muscle that occurs with bedrest. Meat, eggs and dairy foods like milk, yogurt and cottage cheese are good sources of high-quality protein to include in meals and snacks. In my mom’s case, I worked with the rehab dietitian to ensure she was getting enough protein, and we considered adding a high-protein meal replacement. However, mom didn’t really care for the taste, and we didn’t want to kill her appetite for meals.
My mom was already ordering milk at each meal, so I suggested substituting fairlife ultra-filtered milk at mealtime. Milk is already a good source of protein and an excellent source of calcium, and Fairlife whole, reduced fat or fat-free milk has more protein and calcium than traditional milk – concentrating some of the nutrients mom needed most.
It takes resolve and arduous effort for a person to overcome frailty, and the frail elderly need our expertise and compassionate support. I hope this has helped you see how you may be of assistance to elderly patients, family members and friends.
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