Frailty or pre-frailty, what is it, can we avoid it?

A lot of us don’t think about getting older, the same way we don’t think about retirement until it is right on the doorstep and then we wonder whether we have the resources to retire!  It might be similar for many people when they are first introduced to frailty. Frailty has several definitions, the Australian Frailty Network defines it as “a state of vulnerability characterised by a loss of reserve across multiple physiological systems. Put simply, someone who is frail is less able to “bounce back” after a stressful (health) event, be that something minor like a urine infection or a more significant event like a fractured hip” [1].

It might not sound very serious, but it can lead to impairments in physical function, mobility and mental health; which are so important to living independently. One in 6 (16.7%) older Australians are at risk of frailty [1], in the United Kingdom (UK) it is approximately 10-15% [2]. However, the big kicker is that 45% of older adults were shown to be pre-frail in a systematic review (i.e. lots of studies joined together) that included 25 studies from countries such as the USA, UK, several in Europe, China, Japan and Australia [3].

So how do you know if you are pre-frail or frail and can you reverse it?

There are a few tools that you can use to help classify different stages of frailty. One user-friendly tool that helps to classify frailty across three stages: 1) not frail, 2) pre-frail, 3) frail is the Fried Frailty Phenotype. The Fried Frailty Phenotype has five criteria, if you score 0 for these you are not frail, score 1-2 indicates pre-frail and score 3-5 means someone is frail. The good news is, particularly if you score in the pre-frailty stage, research shows 23.1% of people can transition back to no frailty (if they put action in, rather than just thoughts), 58.2% will stay in the pre-frailty stage (no action) and 18.2% will become frail (potentially doing even less or having an illness or injury occur). It is more challenging once in the frail stage to return to pre-frail, but not impossible.

The five criteria included in the Fried Frailty Phenotype are [4]:

• Unintentional weight loss: losing more then 4.5kg or 5% body weight in the past year, or having a low BMI (<18.5kg/m²). If you are losing weight without trying to, there is usually a problem. You can calculate your BMI here https://www.heartfoundation.org.au/bmi-calculator although please don’t take this as gospel for older adults, it is ok to have a higher BMI when older because this does assist if you have a stressful "health" event happens.

• Self-reported exhaustion: Feeling like everything is an effort or that you are really struggling to get moving in the last week.

• Low physical activity: low weekly energy expenditure (males: <383kcal/week; females: <270k/cal/week) calculated across a two-week period. You can easily calculate this using the TDEE calculator online https://tdeecalculator.net/

• Slowness: A slow walking speed measured over a short distance (e.g. 5 metre walk, those in the slowest 20% by gender and height). Although not included as part of the Fried Frailty Phenotype test, other clinical thresholds can include at or below 0.6 metres/second to 0.8 metres/second being a flag for functional risk, particularly a greater falls risk. It is easy to do, walk 5 metres and time yourself doing it (i.e. distance/time), then divide 5 by the time it took to walk the 5 metres.

• Weakness: this is measured by grip strength using a hand dynamometer, the results need to be adjusted for gender and body mass. Those with low grip strength are seen to have a weakness in this area. Unfortunately, most people don’t have a dynamometer at home so this test is harder for you to identify your score, unless your gym or GP has one in their clinic.

Have a think to yourself, if you scored yes on 1-2 of these criteria then you may be pre-frail, 3-5 is frail. All is not lost though, it is possible to get back to being “robust” as they call it (i.e. not frail), particularly if you, a family member or friend is in the pre-frailty stage. 

These are things you can do [5]:

1.      Health Promotion and Screening: it is important to have a lifelong approach to health promotion; and screening for frailty is important for people aged 65 and over

2.      Exercise: strength training 2-3 times a week is highly recommended (please read my May 2026 blog outlining what two days a week means). Strength training helps to improve muscle strength and increase walking speed. Balance training should also be included because it is essential to prevent falls. It is important that your exercise and activity continue to be progressive and you are being challenged. If you are frail, it is recommended to see a professional, such as an exercise physiologist for help.

3.      Nutrition: a balanced diet with lots of vegetables, fruit, whole grains, dairy, lean meats and plant-based protein sources. You should aim for 1.0-1.2g/kg/day of protein, for those in pre-frailty or frailty 1.2g/kg/day is ideal. The Mediterranean diet has the greatest evidence for healthy eating and ageing

4.      Social connection: being connected to people you like and enjoy spending time with is important. It could be one-to-one, in a group, be with family, or friends. Having that connection, particularly in person, face to face is important.

5.      Medications: it is very, very (I can’t state this enough) important to have your medications reviewed every year, particularly if you take several medications. Non-pharmacological strategies should also be included because there may be other options outside of medication that can assist you. Please get this advice from your GP, not from a non-medical practitioner. Evidence about supplements is limited.

For many of you reading this blog, frailty likely does not affect you. However, it could be something you, your family or friends are needing to think about in the future and this information will be here if you need it. It is essential to avoid frailty if you are wanting to live independently in your own home, which let’s face it is the goal of pretty much everyone. Now you know what you can do to help make this happen and avoid frailty into the future.

• If you scored zero on the Fried Frailty Phenotype, well done. Keep doing what you are doing, challenge yourself, stay strong, keep your weight stable, eat well, connect with others and make sure you review your medications each year

• If you did score on one or more, today is the time to act, it’s up to you now

• There are many fantastic Mediterranean diet recipes online or in cookbooks, see how many you can make for the rest of the year, they really are delicious. You might consider growing some of it in your garden, I have started growing specific herbs that we use a lot and Mum gave me some of her spinach seedlings which have kept us going for the last couple of months. The best thing is we know they are fully organic and you can save compared to getting small bunches of herbs or spinach from the shops each week

• Have you been thinking about joining a new club, it could be a walking group or something that builds connection with like-minded people (I only say this because it is usually more enjoyable than having to continually butt heads with someone you don’t have much in common with), look it up this week. Starting is the tough part, but the only way to make things happen

• If you’re in the northern hemisphere, your weather is still amazing, get out, be active and together with others. For those in winter with me, there are still plenty of ways to stay active and eat well. Find things you enjoy, you’re more likely to stick with them, but challenging yourself is important too

• Remember the goal for us all is to live independently for as long as we choose!

Live the good life!

References

[1] Australian Frailty Network, 2026, https://www.afn.org.au/what-is-frailty/

[2] Gale CR, Cooper C, Sayer AA. Prevalence of frailty and disability: Findings from the English Longitudinal Study of Ageing. Age and Ageing. 2015;44(1):162–5. doi:10.1093/ageing/afu148.

[3] Yu l, Tang X, Gong D, Man C, Fan Y. Prefrailty prevalence and all-cause mortality risk in older adults from the general population: A meta-analysis of prospective cohort studies. Geriatrics and Gerontology International. 2025; 25(9): 1167-1177. doi:10.1111/ggi.70133

[4] Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: Evidence for a phenotype. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences. 2001; 56(3):M146-56. doi: 10.1093/gerona/56.3.m146.

[5] Chopra, S., Tornvall, I., Reid, N., Whiting, E., Hilmer. S., Job, J., Villani, A., Maiorana, A., Morgan, M., Fox, S., Young, A., Gibson, C., Reidlinger, D., Burton, E., Gordon, E., Baker, J.R., Shafiee Hanjani, L., Kouladjian O'Donnell, L., Sim, M., Miller, M., Dampney, P., Levinger, P., King, S., Hubbard, R., on behalf of the Australian Frailty Network Working Group*. 2026. National consensus statement on the prevention and management of frailty among community-dwelling older adults. Medical Journal of Australia. 224:e70182. DOI: 10.5694/mja2.70182.