This is part 2 of the two-part post on frailty. In the first part, we discussed the definition of frailty, how it affects us as we age and the very important symptom of muscle mass loss.

In this part, we’ll talk more about muscle mass, what to look for, and how to reverse its loss. We will also discuss how doctors measure frailty.

What I’m Doing Now

The primary treatment for loss of muscle mass is exercise, mostly resistance training or strength training. That’s why I joined a gym and bought weights to use at home. If I fail to make it to the gym, I try to lift weights at home in the evening.

I also try to increase muscle strength and endurance by other means, such as carrying bags of groceries instead of using a cart. I unloaded them myself instead of asking for help. I tried to pick up my own bags of fertilizer, straw bales, etc. when gardening.

The other night, I moved my own furniture like I used to do. I compete with my husband to handle my own luggage, though he’s always worried I’ll hurt my back. I try to take the stairs, and ride my bike twice a week on the hills of Tallahassee.

At the next appointment, Dr. Emhof noticed an increase in muscle mass in my arms and chest, but I was still lacking from the waist down.

I had to do all this and do at least four exercises just for my hips and thighs. Finally, my legs responded. Dr. Emhoff is now pleased, and I don’t have to go see him every three months anymore.

But Frailty Is More Than Muscle Loss

Our 50s trigger lots of problems. When we get to our 50s, the risk of heart disease increases, along with problems such as cholesterol, high blood pressure and diabetes. If you are a smoker, this is when it really catches up with you, holding your body back from repairing itself as it did in the past.

Degrees of Frailty

In Part 1 we discussed how frailty increases about the time we get to be 75. That downward spiral accelerates if we don’t begin to work on our muscle mass and our heart by our 50s.

Doctors Use an Index to Determine How Frail We Are

Frailty is when we have many things wrong with us. When your doctor notices this, a geriatric assessment is conducted, where the doctor counts the number of things we have wrong, or the number of deficits we exhibit.

This examination shows how fit or frail we are. There is a frailty index to help physicians determine to what extent a person is frail.

The medical community measures frailty several ways, but two stand out.

The Journals of Gerontology in “Frailty in Older Adults: Evidence for a Phenotype” defines frailty as an imbalance of the “physiologic triad” of sarcopenia, immune and neuroendocrine regulation.

The latter is a big word, but our nervous system and our endocrine system work together to regulate the physiological processes of our body, otherwise known as homeostasis. It regulates reproduction, energy utilization, blood pressure, our metabolism and much more.

Using this index, patients are considered frail if they have three or more of the following:

  • Reduced activity; maybe even a slower gait.
  • Slowing of mobility.
  • Weight loss, such as an unintentional loss of ten pounds or more during the past year.
  • Diminished handgrip strength.
  • Exhaustion.

Someone who has only one or two of these items is said to be ‘pre-frail.’ Someone with none is said to be ‘robust.’ I don’t know about you, but I don’t plan to get anywhere near my doctor when I’m having a bad back day. The assessment takes about 15 minutes.

The Frailty Index

Another way to measure frailty is The Frailty Index which is based on the concept that frailty is a consequence of interacting physical, psychological and social factors. It was developed by Dr. Kenneth Rockwood and Dr. Arnold Mitnitski at Dalhousie University in Halifax, Nova Scotia, Canada.

It measures health deficits like diseases, signs, symptoms, laboratory abnormalities, cognitive impairments and disabilities in activities of daily living.

As these deficits accumulate, people become more vulnerable to unfavourable outcomes. In short, this frailty index is based on a comprehensive geriatric assessment. It includes functional dependencies as deficits, such as needing help to dress.

So as you can see – and as I learned – the word frail means so much more. It is important to realize that the whole person is in a process of aging, and it is a very dynamic process. Some of us will be helped by knowing and will try to keep ourselves from going farther down the index.

For all the rest of us, it is good to remember what one doctor said – that there seems to be a natural order of life. When we are well, we walk around a lot. And when we get sick, we move around less.

What healthy lifestyle habits are you adopting to avoid being frail as you get older? Have you noticed getting weaker in certain functional/physical areas? Please share your thoughts and observations below.

Cindy Roe LittlejohnNative Floridian Cindy Roe Littlejohn blogs at the Old Age Is Not For Sissies, where life is good and every day is an adventure. At 62 she is healthy, married, a mother to three, and grandmother of six. She is an author and writer, a tree farmer, and a retired lobbyist. She loves to travel on old trails, garden, do genealogy, spend time in the outdoors, and spend time with her family. You can reach her at

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