Preventing Frailty in Older Adults

Preventing Frailty in Older Adults

Joy Stepinski, MSN, RN-BC

November 1, 2025

Frailty is a prevalent and debilitating condition that affects many adults over the age of 65. Approximately 21% of older adults living in a house or apartment experience a physical or cognitive decline that limits their ability to carry out activities independently [1]. Consequently, those with frailty have a reduced quality of life and poorer health outcomes. Preventing frailty starts early in life, through measures that promote mobility, adequate nutrition, and strong social connections.

Frailty reflects a state of increased vulnerability affecting both cognition and physical abilities [2]. Risk factors for frailty include poor nutrition, decreased muscle mass, poor oral health, chronic diseases such as cardiovascular disease and diabetes, and polypharmacy [3]. Polypharmacy, defined as the use of three or more medications, can lead to a risk of adverse drug events, drug interactions, and drug toxicity. Frailty contributes to a multitude of problems, such as weakness, falls, the inability to care for oneself, difficulty swallowing, malnutrition, and increased mortality [1, 3].

One author, James Fries, discusses the importance of postponing the onset of chronic disease [4]. He relates that common chronic diseases, such as osteoarthritis and diabetes, are typically multifactorial, without being attributed to one single cause.  Although these diseases have certain risk factors, they frequently begin early in life and progress gradually over time, until clinical signs and symptoms appear. Observations of autopsies in young adults demonstrate this finding. By delaying the onset of illness, people will have longer potential to maintain independence and function, while experiencing better vitality as they age.

Delaying the onset of chronic disease is a key aspect of healthy aging. According to the Centers for Disease Control and Prevention [5], healthy aging refers to maintaining one’s overall well-being, including physical, emotional, and social health. Achieving good health later in life is not merely something to focus on in older years, but instead is a lifelong process to nurture throughout one’s lifespan.

Despite the pervasiveness of frailty, numerous measures prevent its occurrence.  Mobility is perhaps one of the most important factors for maintaining health and quality of life. Sarcopenia is a condition characterized by muscle wasting, impaired muscle repair, and decreased physical ability, commonly observed in frail individuals. Preserving muscle mass supports physical function and independence [6].  Regular physical activity provides numerous benefits [7], including sustaining a healthy weight, improving bone density, increasing muscle mass, reducing the risk of chronic disease, and enhancing emotional well-being. Among older adults, physical activity is associated with greater independence, mobility, flexibility, muscle strength, cognitive function, and mental health.

A Cochrane study [1] investigated the effect of mobility training on older adults in the community. The research included 12 randomized controlled trials with a total of 1,317 participants. The outcome showed that mobility training led to an 8% improvement in overall mobility, a 9% improvement in functional ability, and a 19% reduction in adverse outcomes.

Even when introducing exercise to frail older adults, there is still a benefit. One systematic review investigated the effect of exercise on frail adults in nursing homes [8]. Sixteen studies of 1,444 participants were included. The authors reported that “findings consistently demonstrated that exercise interventions produced significant improvements across multiple domains” [para. 3] The residents improved their quality of life, mobility, muscle grip, lower limb strength, cognition, and mood.

When an older adult lacks muscle strength, protein supplementation is often prescribed. A systematic review included eight randomized controlled trials in their study [6]. The authors concluded that there was no statistical significance of protein supplementation on lean body mass, and no meaningful effect on muscle strength or physical performance. Exercise is considered the superior treatment. Nutrition is another key factor influencing frailty. A prospective cohort study in community settings of China examined the relationship between diet and the risk of frailty among older adults [9]. Of 3,990 participants, 557 people were considered frail. The researchers found that consistent consumption of a plant-based diet was protective. Diets of fruits, vegetables, and whole grains are high in fiber and antioxidants, which reduce inflammation and support physical resilience. The authors state, “These findings stress that a plant-based diet, especially with a consistently high PDI [plant-based diet index] diet, should be recommended as a dietary strategy to prevent and reduce frailty in older adults” (Abstract section).

This finding was also supported by other studies, including research that examined older adults in community settings in Spain. The research demonstrated an inverse relationship between plant food and frailty risk [10].

Another association with frailty is the lack of social connections. A systematic review described social vulnerability as insufficient social support [11]. Factors included were loneliness, social isolation, and low social participation. The review showed that the lack of social connection does not cause frailty. However, both influence each other. For example, isolation may result from declining health, while low social support may hinder a person’s ability to participate in activities. A separate study showed an association between social isolation and cognitive frailty [12]. Cognitive frailty is characterized by mild cognitive impairment in people with physical frailty, of which social isolation is thought to increase the risk.

Frailty is a condition that can have a major impact on the quality of life of an older adult. Preventing frailty starts in younger years, including regular physical exercise, nutritious plant-filled meals, and maintaining social connections. Some interventions, such as mobility, can improve health outcomes in an individual already frail. By delaying the onset of chronic disease through lifestyle factors, an older adult can maintain independence and function as long as possible.

 References:

1.      Treacy, D., Hassett, L., Schurr, K., Fairhall, N. J., Cameron, I. D., & Sherrington, C. (2022). Mobility training for increasing mobility and functioning in older people with frailty. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD010494.pub2

2.      Dong, X., Chen, D., Peng, W., Li, B., He, M., Li, J., & Yang, Y. (2025). Meta-analysis of risk factors for oral frailty in older adults. Geriatric Nursing, 62, 7-12. https://doi.org/10.1016/j.gerinurse.2024.12.041

3.      Liu, J., Zhu, Y., Tan, J. K., Ismail, A. H., Ibrahim, R., & Hassan, N. H. (2024). Factors associated with frailty in older adults in community and nursing home settings: a systematic review with a meta-analysis. Journal of Clinical Medicine, 13(8), 2382. https://doi.org/10.3390/jcm13082382

4.      Fries, J. F. (1983). The compression of morbidity. The Milbank Memorial Fund Quarterly. Health and Society, 61(3). 397-419. https://pmc.ncbi.nlm.nih.gov/articles/PMC2690269/pdf/milq0083-0401.pdf

5.      Centers for Disease Control and Prevention. (2024). Healthy aging at any age. https://www.cdc.gov/healthy-aging/about/index.html

6.      Zhang, L., Liu, G., Huang, X., & He, F. (2025). Effects of protein supplementation on muscle mass, muscle strength, and physical performance in older adults with physical inactivity: a systematic review and meta-analysis. BMC Geriatrics, 25(1), 1-13. https://doi.org/10.1186/s12877-025-05885-x

Roychowdhury, D. (2020). Using physical activity to enhance health outcomes across the life span. Journal of Functional Morphology and Kinesiology, 5(1), 2. https://doi.org/10.3390/jfmk5010002

8.      Zhu, Y., Zhang, Y., Li, X., & Du, Z. (2025). Effects of exercise interventions on physical function, cognitive function and quality of life of frail older adults in nursing homes: a systematic review and meta-analysis. Frontiers in Psychology,  16, 1679734. https://doi.org/10.3389/fpsyg.2025.1679734

9.       Duan, Y., Qi, Q., Gao, T., Du, J., Zhang, M., & Liu, H. (2023). Plant-Based Diet and Risk of Frailty in Older Chinese Adults. The Journal of Nutrition, Health & Aging, 27(5), 371–377. https://doi.org/10.1007/s12603-023-1918-9

10.    Maroto-Rodríguez, J., Delgado-Velandia, M., Ortolá, R., Carballo-Casla, A., García-Esquinas, E., Rodríguez-Artalejo, F., & Sotos-Prieto, M. (2023). Plant-based diets and risk of frailty in community-dwelling older adults: the Seniors-ENRICA-1 cohort. Geroscience, 45(1), 221-232. https://doi.org/10.1007/s11357-022-00614-3  

11.   Hanlon, P., Wightman, H., Politis, M., Kirkpatrick, S., Jones, C., Andrew, M. K., Vetrano, D. L., Dent, E., & Hoogendijk, E. O. (2024). The relationship between frailty and social vulnerability: a systematic review. The Lancet. Healthy longevity, 5(3), e214–e226. https://doi.org/10.1016/S2666-7568(23)00263-5  

12.   Bai, Y., Chen, Y., Tian, M., Gao, J., Song, Y., Zhang, X., ... & Xu, G. (2024). The relationship between social isolation and cognitive frailty among community-dwelling older adults: the mediating role of depressive symptoms. Clinical Interventions in Aging, 1079-1089. https://doi.org/10.2147/CIA.S461288