The concept of frailty and successful ageing

Age-related disability is characterized by generalized weakness, impaired mobility, impaired balance and poor endurance. This state is also called 'frailty' and is defined as a syndrome of multi-system reduction in physiological capacity as a result of which an older person's function may be severely compromised by minor environmental challenges, giving rise to the condition 'unstable disability' (Campbell & Buchner 1997). The increase in heterogeneity with age makes research findings more difficult to generalize, therefore it might be better for certain research to focus on the least frail and 'non-diseased', which implies the successfully aged. Older persons with minimal physiological loss, or none at all, when compared to the average of their younger counterparts, can be regarded in physiological terms as having aged more broadly successfully (Rowe & Kahn 1987). The concept of frailty focuses mainly on the physical or physiological aspects of ageing, while the concept of successful ageing comprises a broader range of aspects. Both concepts are not easy to define in a single measure.

Although definitions of successful ageing in gerontology are numerous, there is still no generally accepted definition. Rowe and colleagues defined it as including three main components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life (Rowe & Kahn 1997). Fries, amongst others, defined successful ageing as optimizing life expectancy while simultaneously minimizing physical, psychological and social morbidity (Fries 1988). Vaillant argued that in addition to physical health, there are three further dimensions, or outcomes, of successful ageing: mental health, psychosocial efficiency and life satisfaction (Vaillant & Vaillant 1990).

Since many of the predictors of the physical functional status appear to be potentially modifiable, research must be done to refine diagnostic criteria and elucidate practical methods of measurement of key physiological capacities in order to identify proper targets for interventions with 'normal' elderly and thus to enhance the proportion of the older population that ages successfully.

In a research we performed among 403 independently living elderly men (aged 73-94 years) from a blue-collar suburb of Rotterdam, The Netherlands, we have measured several physical characteristics. We assessed subjective and objective functional ability using the modified health assessment questionnaire and a physical performance test, respectively. Furthermore, we measured bone mineral density, body composition, muscle strength and cognition. Muscle strength was independently, positively related to lean body mass, bone mineral density and physical performance, and inversely related to the number of problems in activities of daily living. Muscle strength and functional ability can be considered the key characteristics of physical functional status in independently living elderly men. These findings confirm previous studies in which it was demonstrated that loss of muscle strength is a strong predictor of physical functional problems (Fiatarone et al 1994, Guralnik et al 1994). The clinical correlates of sarcopenia, the age-related loss in skeletal muscle, include falls, fractures, loss of mobility, and development of independence in basic activities of daily living.

Successful ageing also encompasses terms like psychological well-being, quality of life (QoL) and life satisfaction, which are all used interchangeably. QoL is measured by subjective indicators only, while successful ageing can be measured by both objective and subjective indicators. There are numerous general and nonspecific QoL questionnaires. In our study among elderly men, we used a QoL questionnaire recently developed by Henrich and Herschbach, which includes a weighting for the relative importance of each dimension for the individual concerned (Herschbach 1995, Huber et al 1988).

Part of the ageing process affecting body composition (loss of muscle size and strength, loss of bone, and increase in fat mass) might well be related to changes in the endocrine system (Korenman et al 1990, Rudman et al 1990).

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