Independent or frail?

What is the difference between frailty, disability, dependence and comorbidity (having multiple diseases at the same time)? That is not so very easy to say. The similarity is not difficult. These words are all used to describe the heath status of older people. But there is much discussion in the scientific community about the precise definitions and how to measure them.

Ok, let them discuss it, I was always inclined to say. After all, if you are old why bother whether you are frail or dependent? But there is more to that. If you want to provide the right care to old people, you need to know what their problems are. Hence, you first have to measure their health status. To be able to measure, you must know what to measure. And for this you need good definitions. So, the scientists are right in this case.

After this week in Geneva, I learnt a bit more about the definitions. First we had a visit to WHO by Prof. Linda Fried, a world authority on frailty and now dean at Colombia University. In 2000 she already identified a definition and way to measure frailty. She defined it (in my own shorter version) as a state of high vulnerability for adverse health outcomes that results from decreased physiological reserves. In other words, your life reserves come to an end and your are less able to cope with health threats. Note that it is probable but not absolutely necessary that you have (mutiple) diseases when frail.

She also proposed how to measure it, When you have 3 out of 5 following symptoms you are frail:

1. Unintentional weight loss
2. Self reported exhaustion
3. Weakness (measured by grip strength)
4. Slow walking speed
5. Low physical activity

Later in the week, we had a retreat with the whole department where we elaborated on the issue. That was very pleasant a we had our meeting somewhere in the Alps in a chalet owned by one of the team members. Many people in te team had prepared delicious dishes and cakes so I felt a bit frail when coming back. Especially as I had to postpone my flight back and am now flying at 6 in the morning, while typing this blog

But it was worth it. During our discussion it became clear that the definitions sometimes overlap. You can be disabled, have multiple diseases and be frail at the same time. But also be only disabled, only frail and only have few chronic diseases. Or any combination in between. That is important to know when organising a long term care system.

Then dependence. Instead of measuring the health status, you can also measure what people can still do. To do this we identify activities of daily living (for example eating and personal hygiene) and instrumental activities of daily living (for example shopping and housework). When people cannot perform these activities without help, they are dependent and need help or care. This is a more functional approach to ageing.

Of course dependency is a difficult concept and varies per individual, by country and over time. One old person will be dependent when not being able to do the groceries any more, whereas the other person is not and already solved it one way or another. And in 2030 people will probably be less dependent than in 1980 due to more assistive devices. There are even people who would like to redefine the whole definition of health so that it would focus on the ability to adept.

Anyhow, a very interesting week that made me a bit more frail, but also more independent in my thinking on the topic.