This transcript has been edited for clarity.

Hello and welcome. I'm Dr George Lundberg and this is At Large at Medscape.

Time marches on. Famed Duke professor of medicine, Eugene Stead (1908-2005), said that there are three causes of illness (personal communication, circa 1966):

  • Made wrong

  • Wore out

  • Bad luck

But if you make it past that juggernaut—and as an American, you have a really good chance—you graduate into what is called elderly, aka older than 65 years. More than 80% of Americans are on Medicare when they die.[1] There are the "young old," ages 65-75 years; the "old," 75-85; and the "old old," 85-plus.[2]

Retirement planners declare ages 65-75 "the go-go years," 75-85 "the slow-go years," and 85-95 "the no-go years."[3] They recommend that you allocate retirement planning and spending with that in mind.

Thus, in the 21st century, becoming elderly is to be expected, and it's a good, normal thing. But what about the "frail elderly"? Not a good thing.

The definition of "frail elderly" requires age above 65 years (often above 80 years), and includes at least three of these clinical features: loss of strength, weight loss, low levels of activity, poor endurance or fatigue, and slowed performance.[4]

Frailty may be secondary, in which case the patient also has a recognized and diagnosed serious disease, such as cancer, stroke, COPD, heart failure, liver failure, psychosis, or dementia. Or frailty may be primary, in which none of these or other recognized diseases is present but the patient is "frail" nonetheless.

In either event, it is a serious situation. But let's confine our remarks today to "primary frailty," since discussion of "secondary frailty" entails a diverse consideration of many other known entities.

As the reader may understand, there has not been a great deal of high-quality research about how to prevent primary frailty published in the medical literature. One comprehensive discussion paper, based on "deliberations of a 2014 Canadian expert consultation meeting and scoping review," was published in the Canadian Geriatrics Journal in 2017.[5]

I found another well-done 2017 scoping review article, from nurses and geriatricians in Toronto, Halifax, Hamilton, Vancouver, and Montreal, Canada.[6] This study included 12 randomized controlled trials and two cohort studies (mean number of participants, 260 [range, 51-610]). The authors rated the quality of the studies as moderate to good. The interventions studied included:

  • Physical activity;

  • Physical activity combined with nutrition;

  • Physical activity plus nutrition plus memory training;

  • Home modifications;

  • Prehabilitation (physical therapy plus exercise plus home modifications); and

  • Comprehensive geriatric assessment.

The interventions that significantly reduced the number of frailty markers present, or the prevalence of frailty, included all types of physical activity and other tested elements in combination, and prehabilitation. The exercise sessions ranged in frequency from once per week to five times per week. Most included strength, balance, coordination, flexibility, and aerobic exercises supervised by exercise professionals and were progressively increased based on the individuals' competency and performance.

The studies that examined a nutritional arm included:

  • Milk fat supplementation;

  • Supplementation using a multifiber formula enriched with iron, folate, vitamins B6, B12, D, and calcium; and

  • Education and cooking classes with healthy nutrition focused on the strengthening of muscles through protein and vitamin D–rich ingredients, in addition to supplementation of vitamin D.

Nine of the 14 studies reported that the interventions reduced the level of frailty.

So, as of April 2019, off to my fitness center I will continue to go, 3 days per week, for 1 hour each time, with resistance training (continuing until failure), balance and coordination (including hand-eye) exercises, flexibility stretching, and aerobics (aiming at an average of 7000 steps—many backwards—per day). Obviously, while maintaining a steady weight by climbing on the scale at the same time every day and not permitting that number to go either up or down significantly. Can't last forever; nothing does. But why not keep on keeping on?

That's my opinion. I'm Dr George Lundberg, at large at Medscape.

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