How Frailty Can Increase the Risk of COVID-19 and 5 Ways to Reduce It

Preventing frailty

Weight-bearing exercise including yoga, tai chi and walking helps strengthen bones and muscles, which in turn can help avoid frailty. Photo: Johnny Greig/Getty Images

Early in the pandemic, older people were identified as more at risk from severe complications and even death from COVID-19, so nations locked down their most vulnerable first, advising them to stay inside and self-isolate.

But the biggest indicator for complications from the coronavirus — even more than age — is frailty, a general term used to describe a decline in mental and physical health. According to the Canadian Frailty Network, there are more than 1.5 million people in this country who fit the description.

“It’s really come to light that frailty is a much better indicator than age alone in making it through the other side of the COVID crisis,” says Amy Doyle, manager of strategic partnership development for the Canadian Frailty Network (CFN).

But it’s not always easy to determine who meets the criteria, since signs can be as subtle as needing help with day-to-day activities, like getting groceries. “I think the most important message is that you can actually appear perfectly healthy,” says Doyle. “Often frailty goes with underlying health conditions, but not always.”

Social isolation, taking multiple drugs, inactivity and poor nutrition can all contribute to frailty, which can hamper the ability to bounce back from minor illnesses like colds, not to mention the flu or, in the worst-case scenario, COVID-19.

Think of the dire consequences if a person with frailty breaks a hip, says Kelsey MacIntosh, health promotion co-ordinator for CFN.

“Something that you would have been able to recover from, now has catastrophic health outcomes. And I think that’s where it ties into COVID,” she explains. “It’s not necessarily just their chronological age, but if they’re frail they’re not able to bounce back from the virus like somebody that is in better health.”

Signs of Frailty

But how can you tell if you or a loved one is frail? Doyle says if you have three or more of the following symptoms, you must be extra cautious: unintentional weight loss of 10 or more pounds in the past year; muscle loss and weakness; fatigue; a slow walking speed; and low levels of physical activity.

She points out that frailty was used to triage, or prioritize, the care of COVID-19 patients in Italy (where 95 per cent of more than 30,000 people who died were 60 and older) and the U.K. (where people aged 65 and older account for nearly 90 per cent of the death toll, which has surpassed 35,000).

Although Canada has seen only about a fifth as many fatalities, the outbreak here has followed a similar arc, with 95 per cent of COVID-19-related deaths among people 60 and older.

Since age increases the risk of frailty and frailty increases the risk of severe outcomes from a coronavirus infection, your instinct may be to avoid contact with elders, but Doyle says that would be a mistake.

“You can’t just abandon them. You have to strike a balance, because [COVID-19] can become a really convenient excuse.”

Staying Connected

Providing tools, advocacy and support for people living with frailty and their caregivers is part of the network’s mandate. Since it anticipated that social distancing measures would increase social isolation, they developed tips for staying connected during lockdown.

I particularly like the low-tech idea of a genealogy project, where people with frailty are encouraged to work on a family tree by reaching out to relatives they may not have had contact with in years. All it takes is a telephone. But if the pandemic has taught us anything, where there’s a will, there is high-tech way. My partner’s family has taken to a weekly, cross-country, multigen trivia night via Zoom, with their nearly 90-year-old matriarch participating via her iPad.

Avoiding Frailty

The network has developed a five-point strategy, which encourages regular activity, vaccination, optimizing medication, eating healthily and — as mentioned — increasing social interaction.

Watch Frailty: Every Step You Take Matters!

Doyle also stresses prevention, and to take early signs of frailty seriously.

“So you can be pre-frail at 54. It’s little things like, I don’t walk as fast. People write it off to, ‘Oh well, it’s just old age,'” she says “No. It might just be lack of activity. Maybe you haven’t been physically active for the last 10 years and now you’re moving into frailty.”

Avoiding frailty has never have been quite so important. Here are five evidence-based tips:

  • Weight-bearing exercise such as brisk walking, yoga and tai chi, builds muscle and bone strength — and can safely be done solo
  • After age 50, vaccines for shingles, pneumonia and high-dose flu shots help protect from infections and illness as immune response wanes
  • Regularly review prescriptions, over-the-counter medications and even vitamin supplements you take with your doctor or pharmacist
  • Reach out if you are feeling lonely, people with strong social ties live longer and healthier
  • Protein, vitamin D and calcium are particularly important in our diet as we age as they help maintain bone and muscle health


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