Frailty Prevention and Management Protocol
Primary Stack
Core supplements with strongest evidenceEssential for muscle maintenance; higher requirements in elderly; prevents sarcopenia
Supporting Studies (1)
Deficiency extremely common in frail elderly; affects muscle function, falls, bone health
Supporting Studies (1)
Supporting Stack
Additional supplements for enhanced resultsSupports muscle strength and function; may enhance benefits of resistance training in elderly
Supporting Studies (1)
Anti-inflammatory; may help preserve muscle mass and reduce inflammation associated with frailty
Supporting Studies (1)
Leucine metabolite; may help preserve muscle mass in elderly; reduces muscle breakdown
Supporting Studies (1)
Deficiency common in elderly; affects neurological function and energy
Supporting Studies (1)
Often deficient in elderly; supports immune function and wound healing
Supporting Studies (1)
Supports cellular energy production; levels decline with age; may improve fatigue
Supporting Studies (1)
How This Protocol Works
Simple Explanation
Frailty is a clinical syndrome characterized by decreased resilience and increased vulnerability to stressors. It's distinct from normal aging and represents a state where minor events (like an infection or medication change) can trigger major functional decline.
FRAILTY PHENOTYPE (Fried Criteria):
3 or more of:
STAGES:
RISK FACTORS:
CONSEQUENCES:
MOST IMPORTANT INTERVENTIONS:
1. Exercise - especially resistance/strength training
2. Nutrition - adequate protein and calories
3. Medication review - reduce polypharmacy
4. Comprehensive geriatric assessment
* Protein (1.2-1.5g/kg/day) is essential - elderly need MORE protein, not less.
* Vitamin D deficiency is extremely common and affects muscle function.
* Creatine + resistance training may have synergistic benefits.
* Exercise is the MOST effective intervention - even in very frail individuals.
Expected timeline: Frailty can be reversed, especially from pre-frail state. Improvements may be seen in weeks to months with consistent exercise and nutrition.
Clinical Perspective
Frailty: Syndrome of decreased physiological reserve and increased vulnerability. Pathophysiology: sarcopenia, inflammation, hormonal changes, immune dysfunction. Assessment: Fried frailty phenotype (research standard) or FRAIL scale (clinical); Clinical Frailty Scale; gait speed; grip strength. Prevalence: ~10% community-dwelling 65+, >50% in institutional care.
CRITICAL: Exercise is cornerstone intervention - multicomponent including resistance, balance, aerobic. Even very frail can benefit. Nutrition optimization essential - higher protein needs (1.2-1.5g/kg). Comprehensive geriatric assessment identifies modifiable factors. Deprescribing to reduce polypharmacy. Address social isolation, depression. Supplements supportive but secondary to exercise and nutrition.
* Protein (A-grade): Muscle maintenance. Systematic review: (PMID: 28332116). 1.2-1.5g/kg/day. Leucine-rich (20-40g at main meals).
* Vitamin D (A-grade): Muscle function; falls. Meta-analysis: (PMID: 28750270). 1000-4000 IU daily.
* Creatine (B-grade): Muscle strength. Systematic review: (PMID: 12679790). 3-5g daily. Enhanced with resistance training.
* Omega-3 (B-grade): Anti-inflammatory. Review: (PMID: 27840029). 2-3g EPA+DHA daily.
* HMB (B-grade): Muscle preservation. Meta-analysis: (PMID: 28177710). 3g daily.
* Vitamin B12 (B-grade): Common deficiency. Systematic review: (PMID: 28660890). 500-1000mcg daily.
* Zinc (C-grade): Immune support. Review: (PMID: 26845419). 15-30mg daily.
* CoQ10 (C-grade): Energy. Review: (PMID: 24268541). 100-200mg daily.
Assessment targets: Gait speed, grip strength, SPPB (Short Physical Performance Battery), weight, nutritional status, functional independence.
Protocol notes: Exercise prescription: multicomponent (resistance + balance + aerobic); supervised initially; progressive; 2-3x/week minimum; can be effective even in 90s. Protein: distribute throughout day; 20-40g per meal with leucine; supplement if intake inadequate. Vitamin D: test and replete; aim 30-50 ng/mL. Polypharmacy: review all medications; deprescribe cautiously. Falls: comprehensive assessment; home safety; vision check; footwear. Social: address isolation; daycare; support services. Cognitive: screen for cognitive impairment; can coexist. Depression: common and treatable; SSRIs generally safe. Dental: poor dentition affects nutrition; address. Palliative: discuss goals of care in advanced frailty. Prevention: pre-frail is ideal intervention point; can reverse. Hospitalization: major setback for frail; avoid if possible; mobilize early if admitted.