AGING AND FRAILTY

LECTURE

● The aging process does not occur in parallel in different tissues, our body's cells and tissues
don't age and regenerate at the same rates

Multiple definitions of aging

1. Chronological age: age according to the body
2. Apparent/visible age: "do I look my age?"
3. Psychological age: "young at heart"
4. Social age: how we present ourselves

General characteristics of aging

● Universal process in all organisms
● Inevitable
● Varies by individual
● Influenced by genetic and environmental factors
● Normal (physiological) process! (healthy aging)
● Yields decreased adaptability to internal/external stressors
● Increased vulnerability to frailty, diseases, and mortality

The hallmarks/common denominators of aging

● Altered intercellular communication
● Genomic instability
● Telomere attrition (ends of chromosomes become shorter, degradation of cell survival
● Epigenetic alterations (chemical modifications to chromosomes and DNA, leading to different
gene expression)
● Loss of proteostasis (proteins that normally function properly may not form properly, may
become damaged and lead to diseases)
● Deregulated nutrient sensing
● Mitochondrial dysfunction (not enough energy)
● Cellular senescence (cellular processes slow down prior to death)
● Stem cell exhaustion (new cell production slowed or stopped completely)

Changes in life expectancy throughout history

● Changes in environment, nutrition, and medical care have extended the expected/average
survival age
● This increase in age is also letting us see new diseases related to aging (Parkinson's, Alzheimer's,
etc.)
● More elderly expected in the future
 Frailty
● A condition where an individual is less able to tolerate a stressor event (e.g. a minor illness),
increasing the likelihood of an even more negative outcome, such as a fall
● A clinical recognizable state of increased vulnerability to adverse health outcomes (e.g. falls,
hospitalizations, disease)
● Results from aging-associated decline in multiple physiological systems
○ Mainly those involved in energy metabolism and neuromuscular function
○ Reduce capacity to react to stressors (eg. Trauma, illness, etc.)
● “A state of increased risk, compared with others of the same age”
● Aging and frailty are not synonymous - can be frail without being old, can be old without being
frail
● Frailty remains and evolving concept lacking both a unique definition and diagnostic criteria
● When you're not frail, you can recover from a stressor with ease, but when frail each injury
results in a functional decline which does not recover to prior levels
● As we age, the rate of decline in these physiological systems differs among individuals due to
both genetic and environmental factors

Frailty - Domains and impairments

● Physical: Low grip strength, low physical activity – sarcopenia (loss of muscle mass and strength)
● Nutritional: Low energy, unintentional weight loss – dysregulated energetics (e.g. decreased
energy production or increased utilization)
● Sensory: Reflexes, gait, and/or balance deficits
● Cognitive/Mental: Attention deficits and other deficits

Ways of assessing frailty

● Frailty Phenotype
○ Frail: Presence of three (3) or more of the following : weight loss/shrinking, weakness,
poor endurance and energy, slowness and low physical activity level
■ Presence of one or two deficits = pre-frail
■ Absence of deficit = not frail
● Frailty Index
○ Expressed as a ratio of deficits present to the total number of deficits considered
(usually includes 40 variables or more)
○ For example, if there are a total of 10 defined deficits, and a person has 5, they would
have a FI of 0.5
● The Frailty Phenotype and Frailty Index measures complement each other

Why is it important to study frailty?

● 25-50% of people older than 85 years are estimated to be frail (the largest users of health care
services)
● From a societal perspective: it identifies groups of people in need of extra medical attention and
at risk of high dependency
● From the financial/health care planning perspective: it allows to better select management and
prevention programs
● Some studies suggest that the frailty status might be reversible with the implementation of
specific exercises programs and nutritional supplementation à identifying frail people is key
● Some researchers also suggest that the aging process might be medically reversible à identifying
biological mechanisms of aging is key

Tests used to assess frailty

1. Short Performance Physical Battery Test: To simulate the physical symptoms of frailty
2. Mini-mental state exam (MMSE): To simulate the neurological symptoms of frailty