Fragility. Down syndrome

Everyone knows elderly people who, despite being the same age, have very different functional states. Older people who are 82 years old are perfectly functional and look agile and strong, they are opposed to dependent individuals, with a weak appearance and, ultimately, fragile.

This weakness, which if evoked provides a very clear mental image and of which multiple examples can be offered, is very difficult to define and synthesize.

Frailty and, in an extreme way, the syndrome of decay or decline, is a set of symptoms and clinical signs that are characterized by the decrease in the reserve capacity of organs and systems, which causes large functional losses in the individual before small changes. When frailty is accentuated, the syndrome of decline arises, marked by involuntary weight loss, increased general weakness and dependence on basic life activities; this process has a very low probability of recovery and high mortality.

Frail elderly are more likely to develop dependence (but not all dependents are frail, nor are all frail dependent), with an increased risk of falls, hospitalization and death.

In this problem several factors can be differentiated:

The pathophysiological mechanisms are believed to involve multiple body systems. The most important are the loss of muscle mass, the poor adjustment of the different hormones and their control mechanisms (increase in own cortisone, decrease in growth hormone and the sex hormones testosterone and estrogens) and decrease in immune function (for dysfunction of humoral immunity, messengers and mediators of this immunity). Likewise, there are various environmental factors, such as toxic or inappropriate dietary habits, especially very restrictive diets.

The effects of these alterations can be long-term, not very visible, and come to light in the face of various triggers, which can be, for example:

Although most people, and especially doctors who are regularly in contact with the elderly, are able to correctly point to a frail older person, it is relatively difficult to establish a phenotype, a robot portrait of frailty. Some studies have been able to establish the following points:

It seems that there is a relationship between low levels of cholesterol and albumin in the blood and the frailty of the elderly, so that at lower levels, greater frailty.

To prevent this problem, various studies comment on the importance of an adequate and balanced intake of nutrients and energy, and above all maintaining and increasing physical activity to preserve muscle mass in the best possible state.

• Decreased level of activity and mobility, with deterioration of physical functional capacity, balance and gait disorders.
• Decreased mental functions, although it does not necessarily have to reach a level of dementia. On many occasions there are mood disturbances, such as depression.
• Social isolation.
  • Hidden diseases: infections such as tuberculosis, malignant tumors, alcoholism, etc.
  • Diseases that cause new functional losses: cerebrovascular accidents, heart, respiratory or liver failure, severe sensory disturbances such as blindness, etc.
  • Mental illnesses: depression, cognitive impairment, etc.
  • Social changes: widowhood, social isolation, poverty, overload of caregivers, etc.
• Involuntary weight loss of more than 4.5 kg or a decrease greater than or equal to 5% of the usual weight.
• 20% decrease in hand grip strength.
• Decreased general endurance, feeling of exhaustion.
• Walking speed 5m greater than or equal to 7 seconds.
• Low physical activity, both in physical exercise and recreational activities.
What's more