A Perhaps Surprisingly Large Degree of Age-Related Frailty is Self-Inflicted

No-one can choose not to age, at least not until reliable, low-cost rejuvenation therapies are developed, but some aspects of aging can be accelerated through simple neglect - and one can therefore choose to avoid that burden. Frailty is one of these aspects: a condition of weakness and lack of resilience found in many older people. Losses of muscle mass and bone strength, immune system and organ function all play their part. There are various formal definitions of frailty as a medical condition, but there is no bright dividing line here: it is a continuum of decline. Frailty is an end state of aging, and everyone will get there eventually unless claimed by one of the common fatal age-related conditions first. Nonetheless, it is certainly possible to get there faster rather than more slowly, by making poor choices in health and lifestyle. The research materials linked below argue that the majority of people are not aware of the degree to which they are harming themselves, and that efforts should be taken to correct this state of affairs.

In our technological society of cheap calories, easy transportation, and replacements for physical labor, most people eat too much and exercise too little. That becomes ever more pronounced over the years, as older individuals tend to become wealthier and thus more able to enjoy all of these comforts. This has a cost when it comes to health, and there is a large body of research that seeks to put numbers to that cost, both for the average individual and for the population as a whole. Avoidable damage done to health over the long term is often referred to as secondary aging. It includes, for example, the consequences of chronic inflammation and other metabolic disruption produced by excess visceral fat, as well as accelerated loss of muscle resulting from lack of exercise. Near everyone in later life fails to exercise sufficiently, as demonstrated by study after study showing improvement in the muscle and health of even very old people following modest resistance exercise programs.

Ultimately, forms of applied biotechnology will eliminate the need for exercise and calorie counting, but this lies at least decades in the future, well past the immediate focus on first generation rejuvenation therapies that each only address one narrow fraction of the causes of aging. I suspect that the development of the full portfolio of therapies needed to turn back aging will itself stretch over decades, from the easiest such as senolytics to the hardest such as comprehensive stem cell replacement. There is still a role for taking care of your own health even in the midst of a revolution in medical biotechnology, because the trajectory of secondary aging you set for yourself today will be a sizable determinant of the degree to which you can benefit tomorrow from the first incremental advances in treating the causes of aging.

Preparing for longevity -- we don't need to become frail as we age

"Societies are not aware of frailty as an avoidable health problem and most people usually resign themselves to this condition. Fortunately, by proper lifestyle and adequate physical, mental, and social activities, one may prevent or delay the frailty state." Frailty encompasses a range of symptoms that many people assume are just an inescapable part of aging. These include fatigue, muscle weakness, slower movements, and unintentional weight loss. Frailty also manifests as psychological and cognitive symptoms such as isolation, depression, and trouble thinking as quickly and clearly as patients could in their younger years. These symptoms decrease patients' self-sufficiency and frail patients are more likely to suffer falls, disability, infections, and hospitalization, all of which can contribute to an earlier death.

There is ample evidence that the prevalence and impact of frailty can be reduced, at least in part, with a few straightforward measures. Unsurprisingly, age-appropriate exercise has been shown to be one of the most effective interventions for helping the elderly stay fit. Careful monitoring of body weight and diet are also key to ensuring that older patients are not suffering from malnutrition, which often contributes to frailty. "Social campaigns should inform societies about age related frailty and suggest proper lifestyles to avoid or delay these conditions. People should realize that they may change their unfavorable trajectories to senility and this change in mentality is critical to preparing communities for greater longevity."

Is It Time to Begin a Public Campaign Concerning Frailty and Pre-frailty?

Frailty is a geriatric syndrome caused by a multisystem decrease in reserve capability and is associated with a high risk for various adverse outcomes. Frailty is not synonymous with either comorbidity or disability, but comorbidity is a risk factor for frailty, and disability is an outcome of frailty. Pre-frailty is a condition predisposing and directly preceding frailty. The frailty state is associated with a variety of adverse consequences, such as falls, cognitive decline, infections, hospitalization, disability, institutionalization, and death. Frail patients present much worse prognoses than non-frail patients, particularly in cardiovascular diseases. Moreover, frailty impairs the effects of invasive treatments in these disorders, e.g., percutaneous coronary interventions, transcatheter aortic valve implantations or coronary artery bypass grafting. Frailty also imposes a significant financial burden on health systems, particularly because frailty appears to have an incremental effect on ambulatory health expenditures.

Awareness of these facts may afford us an opportunity to develop cost-effective care for this group of people, resulting in improvement in long-term care and its outcomes. However, despite numerous studies addressing this condition in recent years, frailty as an entity is not commonly recognized in the general population or even by some medical societies, and there are no consistent preventative and therapeutic strategies dedicated to this disorder. Because population aging is associated with a higher prevalence of frailty and pre-frailty, it is necessary to familiarize societies with these states. Moreover, if we want to improve the quality of life of elderly persons and reduce expenses for their care in the future, we should take preventative measures against frailty now. Therefore, it is time to begin treating frailty like other population-affecting diseases such as obesity, diabetes or hypertension. Appropriate prospective studies are needed to define which preventative lifestyle interventions should be implemented to ensure good physical and mental conditions in senility. Social campaigns could draw societies' attention to proper life habits that may be effective to avoid not only diabetes and cardiovascular diseases but also age-related frailty.


This comment seems to imply that maximizing your health-span is as easy as following some kind of 'good life' recipe and that proceeding with this recipe is simple, without compromise or conflict, and leads down a path that would still enable someone to live a socially-satisfying life of family, career, and personal fulfillment within the boundaries of today's first-world culture. But is it that easy? Is the author being a bit disingenuous by having expectations that are outside of commonly accepted norms.
Let me proceed as a medical/biological non-expert/ non-enthusiast at pointing out one possible conflict/ contradiction:
- calorie restriction vs regular exercise regime - it would appear one is about minimizing energy intake and the other would appear to require additional energy intake to facilitate muscle, cardio, and flexibility-type improvements (as compared to regular lifestyle, however one defines that) - can one (reasonably) live on less than 1500 calories per day (for example) and participate in 5+ hours per week of intense, directed physical - assuming simplistic milestones/rules-of-thumb?
Further to the larger point, can a person who would likely need to work 50+ hours per week for a middle class job, co-support a family of 4-5 in an average town, and maintain a reasonable social standing (by not undertaking ideological-type 'extreme' behaviours such as being vegan, alcohol-free, avoiding social eating (common restaurants), exercising 10+ hours a week, etc) actually expect to maximize health-span. The point is about 'selling' a maximized health-span to common people with common values and thus realizing the goal of public acceptance and possible public and private support of medical intervention to further health-span initiatives. Health-elitism is still elitism. It can never be about shaming one's way to success. Advocacy has to, at least some level, be 'relatable' to the common values if one wishes to re-define common values, especially in light of wanting support and widespread adoption.

Posted by: Jer at August 15th, 2017 7:20 PM

Jer: You should read Dan Buettner's Book Blue Zones, about 10 geographic areas through out the World where people commonly live to 100 or more. People in those areas just live a simple lifestyle, eat a nutrient rich diet (but don't overeat), stay active physically even at elderly ages, have a glass of wine at 5 PM, etc. Its the lifestyle they live, not a formula 1500 calories/day diet, jogging 3 miles/day, etc. that gets them to Centenarian status. My grandfather was a dairy farmer which kept him active a good 12 hours/day. He lived to be 97, raised a family of 12 children, but he was a smoker. His brother, also a farmer, lived to 100 was not a smoker. But they did not have any special formula for long life and didn't take any vitamins like we do today. With all the advances in aging research, I plan to live to 120. I am almost 77 already. I take vitamins and run 2 miles most days. Good luck with your longevity plan.

Posted by: Biotechy at August 16th, 2017 1:30 PM
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