Frailty, or weakness, means the body cannot handle problems as well as it should. Frail people cannot fight off infections very well. When they have accidents, their injuries may be worse than in stronger people. When they work or exercise, they tire easily. They slow down and are limited in what they can do.
WHY DO OLDER ADULTS WITH HIV HAVE FRAILTY?
Some people with HIV become physically weaker. This might be caused by HIV’s effects on the body, or by other unknown factors some of which are part of the aging process.
WHAT HAPPENS WHEN YOU ARE FRAIL?
Frail people are weak and cannot get around very well, making it harder to work, exercise, do housework, go to the store, or do what they enjoy.
They are more likely to fall, more likely to be injured seriously if they do, and more likely to be hospitalized because of injury. When they have surgery, they often need more time to heal. They also have a greater risk of death.
HOW DO I KNOW IF I AM FRAIL?
There are many tests for frailty, but researchers don’t agree on the best ones. Different doctors may use different tests. In general, you might be frail if you are weak, slow, easily tired, or losing weight.
What you can do with your doctor
TELL YOUR DOCTOR IF YOU ARE LOSING WEIGHT
Losing weight can worsen frailty. Find out why you are losing weight. If the cause can be identified, treatment can often help. Ask if a nutritionist can help.
TELL YOUR DOCTOR IF YOU ARE WEAK
Your doctor may send you to an exercise trainer for older adults or physical therapist who can teach you how to exercise to get your strength back. Don’t be embarrassed to use a cane or walker if you’re advised to do so– these tools can literally save your life. If you are given a cane or walker, ask for clear instructions on how to use it properly.
TALK TO YOUR DOCTOR BEFORE HAVING SURGERY
Frail people are more likely to have problems after surgery. Ask your doctor if the procedure is worth the extra risks caused by frailty.
If you need the procedure, ask what can be done to avoid a long hospital stay or other problems. Your doctor might send you to a nutritionist or physical therapist to work on your weight and your strength before the surgery. Follow-up physical therapy is important to anyone who has had surgery, and more important if the person is frail.
EAT A HEALTHY DIET
Eating healthy foods helps the body fight infection, gain energy, and stay strong. If you’re not sure what food is best for you, ask a nutritionist for help. This is especially important if you have other conditions, such as diabetes or kidney disease, that have their own dietary restrictions.
What you can do yourself
TAKE YOUR MEDS CORRECTLY
Take your medication as prescribed Use a pillbox, set an alarm, or ask someone to remind you. Taking pills correctly helps prevent and control illnesses and allows the body to become stronger.
BACKGROUND
The concept of frailty has been used for years by clinicians to describe older adults who are seen as vulnerable to more disease and disabilities. Frailty carries an increased risk for poor health outcomes including falls, incident disability, hospitalization, and mortality. People with frailty are unable to fully recover from injuries or illness. The frequency of frailty was found to be from 5-30% in certain populations with HIV.
CAUSES
The reasons for frailty in older adults with HIV vary by the individual being evaluated. Also, they cannot be totally explained. Besides HIV itself, indirect predictors of frailty include older age, low CD4 count, presence of multiple comorbidities, especially depression, cognitive impairment, diabetes, and low body mass index. HIV, even if well treated, has a negative effect on the body due primarily to persistent inflammation. This results in the elevation of various chemical markers that cause damage. Separate from the inflammation, HIV can have other negative effects with an impact on cell energy production. and the way the body handles the stress from excess oxygen from body metabolism. All of these problems may combine or lead to frailty in older adults with HIV.
DIAGNOSIS
There are four approaches that have been used to make a diagnosis of frailty. First, an experienced clinician, especially one trained in geriatrics, will conduct a history and physical examination. Second, symptoms of frailty may include unexplained weight loss, loss of energy, slow walking speed, low physical activity, and weakness. Weakness is measured by grip strength. The third approach is to add up the total number of diseases and conditions that an individual might have and provide a score. The higher the score, the more likely that frailty is present. Finally, there is an indirect measure of frailty called the VACS (Veterans Aging Cohort Study) Index. The index includes a number of variables such as age, race, CD4 count, viral load, hepatitis C infection, liver problems, anemia, and kidney function. This index can predict a number of serious outcomes from frailty, including hospitalization and death. Interestingly, studies done over time with the same individuals have found that the measurements of frailty can change, suggesting that individual behavior can affect the diagnosis of frailty.
TREATMENT
The approach to therapy will need to be customized to your personal health. If you have a viral load and/or your CD4 levels are low, then your healthcare provider may need to adjust your HIV treatment. If weight loss is unexplained, a dietician can help you identify dietary changes that may be needed. If weak and deteriorating muscles (sarcopenia) are issues, you may need the assistance of a physical therapist. Balance exercises may help in reducing falls and the potential for fractures. More exercise may also be recommended starting with walking and then increasing the activity levels. You and your healthcare provider may also work together to better manage comorbidities paired with possible pill use reduction. Finally, frailty may also have psychological aspects that need to be addressed. The most common condition is likely to be depression. In addition, loneliness may play a role in the depression. The presence of loneliness and depression while treating frailty will need the coordinated efforts of the managing team, social worker, psychologist, and psychiatrist. With all of these efforts, some improvement in frailty should be possible.