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Defining physical function and frailty

This is an excerpt from Exercise and Physical Activity for Older Adults by Danielle R. Bouchard.

By Danielle R. Bouchard and Andrea Mayo

Over the last few decades, the issue of physical functioning has become more prominent in the public eye and the aging community. With this increase in awareness, the terminology around physical function has expanded. In this chapter, we use the term physical function; however, other terms such as physical capacity, functional independence, and physical disability all describe the ability to perform activities of daily living in order to live independently. These activities, identified by Lawton and Brody (1969), include the following:

• Getting in and out of a chair
• Going up a set of stairs
• Bathing oneself

The ability to perform more than these basic activities increases the quality of life, affecting older adults' enjoyment levels and giving them a sense of independence. These tasks include being able to cook their own food, clean their own house, or do their own shopping. In other words, older adults with greater physical function can live independently in their community and the comforts of their own home while being able to take care of themselves.

Compared to physical function, frailty is more complex. There is no set definition for frailty; however, many variables are considered to make a diagnosis:

• Disability (Rockwood et al., 2004)
• Comorbidity (Winograd et al., 1991)
• Falls (Fried et al., 2001)
• Hospitalization (Fried et al., 2001)
• Advanced age (Winograd, 1991)

Frailty is a distinctive health state related to the aging process in which multiple body systems gradually lose their built-in reserves (British Geriatrics Society, 2017). Older people living with frailty are at risk of adverse outcomes after an apparently minor event that challenges their health, such as an infection or new medication. The limitations that frailty introduces often lead to the decision for an older adult to leave their home and independent lifestyle and move into an assisted living home (Gill & Morgan, 2011). An older adult can have declined physical function but remain in their home. Falls, mobility issues, delirium, and incontinence are often present in the case of frailty (Roedl, Wilson, & Fine, 2016). Other symptoms suggesting a state of frailty include the following (Johnson, Barion, Rademaker, Rehkemper, & Weintraub, 2004):

• Unintentional weight loss
• Reduced muscle strength
• Reduced gait speed
• Self-reported exhaustion
• Low energy expenditure

Nonetheless, the strongest risk factor is age. Prevalence of frailty rises with age and is generally higher in women (Jette et al., 1986).

A diagnosis of frailty is not static; this condition can improve or decline. Creating personal interventions to decrease the severity of frailty is recommended; for example, the patient may follow a nutrition plan to help with weight or participate in exercises to maintain or improve strength and balance. Distinguishing the difference between a loss of function and frailty is important because frail individuals are more unstable and are at a greater risk for adverse events with greater consequences (Wade & Collin, 1988).

Functional Fitness Checkup: Exercises to Help Maintain IADL and ADL Abilities

An older adult is often deemed physically functional and able to be independent if they are able to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). ADLs are basic activities that are necessary for a person to live independently in their home, including personal hygiene, dressing, eating, maintaining continence, and mobility. IADLs are activities that are important for an older adult to remain independent, but not crucial. Common IADLs are activities such as communication skills, meal preparation, shopping, and housework.

Exercises to maintain ADLs

• Washing hair: Shoulder press
• Putting on pants: Romanian deadlifts
• Getting out of bed: Squats
• Eating: Biceps curls

Exercises to maintain IADLs

• Shopping: Biceps curls
• Getting up to answer the telephone: Squats
• Walking independently: Balance and walking techniques
• Mowing the lawn: Bent over single arm rows

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