News and Highlights

February 2015

Understanding the Syndrome of Frailty in the Elderly

On Wednesday, February 18, Dr. Linda P. Fried, MD, MPH, Dean and DeLamar Professor of the Mailman School of Public Health at Columbia University and the 13th annual Lorraine and Ralph Lubin Distinguished Visiting Professor of Healthcare Policy, presented the keynote lecture during the David Rogers Health Policy Colloquium at Weill Cornell Medical College. Her talk was titled, “Towards Understanding Loss of Resilience with Aging: the Syndrome of Frailty Informs Health System Change.”

Dr. Linda Fried; Dr. Madelon Finkel

Dr. Fried focused her talk on exploring frailty, a clinical syndrome in a subset of the elderly, to lay the groundwork for the design of health systems to help people who are losing resiliency and to prevent the cascade of decline that is the hallmark of the syndrome.

“Complex interactions in societal, community-level, familial, individual, physiological, and cellular factors contribute across the life course to resilience, or the lack thereof, in older adults,” she said.

“Frailty has a distinct physiologic nature,” she continued. “It is a chronic progressive syndrome defined by a loss of resilience and reserves and a high vulnerability to bad outcomes.” A study led by Dr. Fried in 2001 identified about 7 percent of adults over 65 years of age as frail, with the rate increasing by age.

Frailty involves a vicious cycle of dysregulated energetics: less energy leads to less activity and decreased motor performance, which leads to decreased muscle mass and other bad outcomes. In comparison to older adults who are not frail, frail people have higher levels of inflammation, blood abnormalities, nutritional deficiencies, abnormal hormonal levels (including elevated cortisol levels), abnormal glucose tolerance and insulin levels, and other pathophysiology. “There appears to be a critical mass of symptoms that push people over the edge into a frail state,” said Dr. Fried. “What emerges is a dysregulated complex system that is greater than the sum of the parts.”

Frail people are at high risk for death, disability, falls, hospitalization, burns, and slow or incomplete recovery from illness, surgery, and trauma.

“What we have learned about frailty has a number of implications for the improvement of health system design,” she said. “Among the factors that should be considered are that early prevention is likely to be most successful and that screening and early diagnosis of frailty could change treatment. Being aware of moments of risk (such as the potential for falls) can prevent adverse outcomes, and it is important to be aware that recovery from illness, injury and surgery can be slow. For people who are already frail, prevention of further illness or injury (as can occur with falls), palliative care and extrinsic compensation (such as the use of walkers and grab bars) are also essential.”

“A major aspect of frailty prevention should focus on helping older adults to be physically active as well as engaged with their communities, as lack of activity and engagement are associated with adverse health outcomes for older adults, including frailty,” said Dr. Fried. “Programs such as those that connect older adults with children in school and other settings, are a huge benefit to both the senior volunteers and to the children.”

About Dr. Fried
Dr. Linda P. Fried, MD, MPH, is a leader in the fields of epidemiology and geriatrics who has dedicated her career to the science of healthy aging and creating the basis for a transition to a world where greater longevity benefits people of all ages. An internationally renowned scientist, she has done seminal work in defining frailty as a medical condition, illuminating its causes and the potential for prevention as keys to optimizing health for older adults.

Dr. Fried is also the designer and co-founder of Experience Corps, a scientifically designed community-based program in 19 cities that puts senior volunteers to work in public schools. Before coming to Columbia in 2008 as Dean of the Mailman School, she founded the Johns Hopkins Center on Aging and Health, directed the Program in the Epidemiology and Biostatistics of Aging and the Division of Geriatric Medicine and Gerontology, and held joint appointments in the schools of medicine, nursing and public health.

About the Lorraine and Ralph Lubin Distinguished Visiting Professorship
The Lorraine and Ralph Lubin Distinguished Visiting Professorship in Healthcare Policy was established with a gift in memory of her parents from Dr. Madelon Lubin Finkel, Professor of Clinical Healthcare Policy and Research and Director of the Office of Global Health Education at Weill Cornell. The Lubins strongly believed in the value of education as a means to making a difference in the lives of others. Each recipient of the annual award has achieved the highest recognition in either the field of epidemiology or health care policy and is regarded as an excellent role model for students. In addition to presenting the keynote address at the Rogers Colloquium, the visiting professor meets during the day with medical students, faculty and members of the administration.


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