Helen Dennis: Exercise may help frail older adults

Question: My mother is 86 years old. She has always been vibrant and positive seeing all that is good in life.

This in itself is amazing since she is a Holocaust survivor and left Germany on a Kindertransport in the late '30s at the age of 14, never to see her family again.

Now something has changed.

Despite a hearing aid, she does not hear well, walks tentatively, has little strength and energy and is losing weight.

She also is suffering from depression and is seeing a psychiatrist who has recently given her an antidepressant.

What alarms me is that I think my mother is becoming frail and suddenly seems old. I fear she will never return to her old self.

Is my fear a reality?

- S.C.

Dear S.C.:

Your concern is warranted. The good news is that your mother is being treated for her depression.

Let's talk about frailty. According to Dr. Walter M. Bortz, noted Stanford University geriatrician and author of "The Roadmap to 100" (Palgrave Macmillan, 2010), frailty sums up all the adverse effects of aging. He writes, "It affects the entire body, particularly the muscles, skeleton and neural and endocrine systems."

Furthermore, he notes, frailty is particularly "pernicious," or damaging, because it means a person loses his or her functioning. And that means a loss of independence.

The subject continues to be a topic of interest. In a New York Times (June 26, 2012) article, journalist Karen Pennar writes that the definition of frailty has been elusive.

She quotes John Rowe, professor of health policy and management at the Mailman School of Public Health at Columbia University, as saying, "For years, frailty was like pornography, it's hard to define, but you knew it when you saw it."

Frailty used to describe anyone who was very old. That has changed.

Chronological age is not the determining factor. Research by Dr. Linda Fried has shed some light on the subject. She recognized signs of frailty after observing and working with older patients and developed a definition. An individual age 65 or older is considered frail if he or she has three or more of the following:

• Unintentional weight loss of 10 pounds or more in the past year.

• Weakness as measured by grip strength.

• Self-reported exhaustion.

• Slow walking speed.

• Low physical activity.

Identifying these signs is good news. Health care professionals now can be aware of who is at risk and suggest either preventions or interventions.

They can learn who is at risk for falls. Homes can be redesigned and supportive devices such as a cane or walker can be used.

Hospitalization is another area where such information is useful. Physicians and nurses can help determine who might have difficulty after surgery and be more vigilant in patient care both before and after.

So what to do? No amount of physical activity can stop the biological aging process. However, there is evidence that regular exercise can minimize the physiological effects of a sedentary lifestyle. Today, there are exercises for frail older adults that can build muscle mass and thereby increase strength and balance.

C.S., consider consulting your mother's physician to determine if she is in a position to engage in physical activities.

Kathy Ganter, a physical therapist at Torrance Memorial Medical Center, tells us there are programs to address what she calls "deconditioning." A doctor's order is required. Then the individual is evaluated by a physical therapist and a program is designed to meet his or her needs.

For more information, call Torrance Memorial's Rehabilitation Services at 310-517-4735.

A bit of enlightening trivia: Bortz writes that leg strength seems to be a key indicator of frailty. Leg power, not age or disease state, is considered the best single predictor of the need for nursing home placement.

In a conversation with Bortz, he said the biggest predictor of nursing home admission is if an individual cannot get up from a chair. That, in part, is an indication of leg strength. He writes that healthy legs improve the health of all other organs and are the greatest source of energy production.

Bortz is 82; he ran his 41st marathon last year.

Your question: Will my mother get back to her old self?

No one knows that answer. What we do know is there is much we can do to postpone frailty, and implement interventions to regain strength and a more positive outlook on life. With that, there's a good chance that your mother as you knew her can return.

Regarding your mother's hearing, you might check that she is receiving the best hearing device possible for her condition.

S.C., thank you for your good question and continue your positive influence.
