How to avoid the ‘little old lady’ syndrome
By Deborah Jeanne Sergeant
Beyond the idea of skewing the stereotype, not becoming a “little old lady” is important for aging well.
Losing muscle and bone in older age and becoming frail can raise risk for earlier death. Frailty isn’t just “getting older.”
Carol Sames, Ph.D., associate professor of physical therapy education at Upstate Medical University, said that frailty can be viewed as a syndrome with a distinct presentation and also as a state of vulnerability.
As a syndrome, frailty can be tested.
“You can see if they’re frail if they have three of the following: unintentional weight loss of more than 5% of bodyweight in the last year; muscle loss; exhaustion that’s self-reported; decreased grip strength; slow walking speed and low physical activity,” Sames said. “Then you start to get into why this is happening.”
That ties more into the state of vulnerability. It’s a mindset that looks at aging as a slippery slope where aging people lose their ability to perform high-energy fun activities like skiing. Then they can no longer do arduous tasks like lawn work. Towards the end, they cannot do the most basic, low-energy activities of daily living like getting dressed, walking at a comfortable pace or performing housework.
“Instead of looking at getting older as a straight downward slope, people who are active change the slope of that line and in fact continue to do activities that are fun and functional into their 80s and 90s,” Sames said.
Why some lose their ability to function has to do with a loss of reserves. Younger people have more reserves to help protect against stressors to their bodily systems. In part, aging whittles away reserves. The onset of frailty includes chronic health conditions, hormonal changes, isolation and little social support. Letting chronic disease go unmanaged can increase risk of frailty.
“Diabetes, hypertension chronic obstructive pulmonary disease, coronary artery disease, arthritis: all decrease physical and functional abilities which can lead to frailty,” said Maria Enecilla, a geriatrician at Rochester Regional Health. “Osteoporosis increases risk of fracture which leads to physical decline.”
Taking unnecessary prescriptions also makes a difference in falling.
“A lot of people have a long list of medications that can interact with each other and the body and lead to side effects that lead to frailty, like fatigue, dizziness and confusion,” Enecilla said.
Oftentimes, falls begin a downward spiral in health if the woman breaks a hip and becomes further deconditioned. Thirty percent of adults experiencing a hip fracture die within a year, according to the American Family Physician Journal.
To fight the risk factors associated with frailty, Enecilla encourages women to stay physically active. One means is through strength training. This can include bodyweight exercise, lifting free weights, using a weight machine or stretching exercise bands. All of these can help address age-related muscle and bone loss.
“The lack of estrogen in menopause affects our bones and our muscle mass,” said Maureen Slattery, OBGYN and certified menopause practitioner with Rochester Regional Health. She encourages women to improve their resistance training, including core strength and balance.
Incorporate activity that improves balance such as tai chi, yoga or dance to reduce the risk of falls.
Try aerobic exercise like brisk walking, cycling and swimming, which have a low risk of injury yet provide a means to keep the heart healthy and build muscle.
Enecilla added that diet should support building muscle.
“Adequate protein intake is crucial for muscle mass,” she said. “One study shows higher protein intake is associated with lower levels of frailty.”
Many women benefit from supplementing with calcium and vitamin D. Ask your care provider if these would help you.
Managing chronic conditions like autoimmune diseases and diabetes and following up with a primary care provider and any appropriate specialists can help reduce risk of frailty. Don’t let maintenance medications run out or necessary lab work fall by the wayside.
Keeping the mind busy and healthy can also contribute to avoiding frailty. Enecilla said that poor mental health can increase risk for frailty.
“Make sure you stay engaged and manage things like depression and anxiety,” she added.
Overall, avoiding frailty is about remaining engaged with life.
“Aging doesn’t equate frailty,” Enecilla said. “Some seniors lead robust, active lives. Target factors that lead to frailty and look at possible causes already present. It enhances quality of life and reduces risk of severe health consequences and leads to a more active lifestyle.
“I see 80- and 90-year-olds at the Y doing Silver Sneakers,” she said. “Aging doesn’t always mean decline.”