Old Age and Frailty

Key Concept

Even though we are healthier than ever before – these are “old age” years and eventually we will become frail – so how do we deal with that?


This series of modules provides a guiding hand to support you as you enter old age (whenever that may be) and you start to become frail.

Becoming old and frail

150 years ago there were people who lived into their 90s. Now, there are still people who live into their 90s - it's just that there are a great deal more of them.

Modern medicine has given us a 2 edged sword; an increased likelihood of 20 additional years of life, but, they are old-age years and with them come all the complications of old age.

Where in the past, we would have died of disease or catastrophic injury, modern medicine is giving us a second (and third) chance to grow old and frail.

How we use that chance becomes the first question. If a disease was brought on by our poor lifestyle; high cholesterol, obesity, high blood pressure or lack of exercise, we have an opportunity to change and to live into healthy old age.

If we choose not to change our lifestyle, modern medicine will continue to "rescue" us but we will live into an increasingly miserable old age - where one disease is compounded by two, three or four other life threatening conditions.

The second question is why. Why have we developed the ability to keep people alive into frailty? Perhaps, in this busy, busy world, we are losing touch with our spirit. It’s hard to find the time to “be” – to sit quietly and contemplate our lives.

Consider this interesting definition. The process of physical decline that is linked to the growth in spiritual development is called frailty. So perhaps, the spiritual task of aging is to transcend the disabilities, the losses, the dependencies and to move beyond the self.

Elizabeth MacKinlay (Canberra University) in her Doctorial thesis The Spiritual Dimensions of Caring identified 6 Spiritual Tasks of Aging.

• To become aware of, and acknowledge, the ultimate meaning of life
• To develop a response to that meaning
• To accept dependency and vulnerability
• To develop wisdom
• To maintain relationships
• To maintain hope

At the same time, we need to consider what value our dependencies bring to others? When we were babies we were unconsciously dependent and our dependence brought great pleasure and a sense of fulfilment to our parents and carers. Now, in our frailty we have the opportunity to give that same pleasure and fulfillment – but this time we are consciously dependent.

But if we are miserable and wracked with multiple diseases we won’t be bringing pleasure and fulfillment – we will be a burden and we will suffer.

We have been able to decide how we want to live - now we have an opportunity to decide how we want to grow old and frail.

Helping you and others to help you

This module serves 2 purposes – to provide you with information about frailty and to give whoever is caring for you some guidelines on how they can best support you.

Normal aging brings about inevitable and irreversible changes. These normal aging changes are partially responsible for the increased risk of developing health-related problems within the elderly population.

The SPICES acronym

S   is for Sleep Disorders

P   is for Problems with Eating or Feeding

I   is for Incontinence

C   is for Confusion

E   is for Evidence of Falls

S   is for Skin Breakdown


Learn more about this.

The Aging Process

It is said that medical students suffer every disease and condition they read about in their text books – so it is with great trepidation that we include information on the Aging Process – it is not intended as a guide to hypochondria. But it is useful to have some idea of what is happening to you as you get older.

The Aging Process


Well-being in Old Age

What follows is a collection of research projects that point to the needs of the elderly and the frail.

Older People Well Being and Participation

Can it be measured? Does it mean the same to everyone? And what produces well-being? Researchers have come up with different definitions and ‘indicators’ to be used in measuring well-being and these sometimes produce rather different results. Some research and policy appears to assume that well-being is a quality of individuals and can be produced through individual effort.

Others have argued that an emphasis on the individual does not sufficiently take into account the importance of relationships between people and that, rather than measuring individual well-being, we should focus more on how to generate caring relationships that can enhance well-being.

It is now understood that well-being is profoundly affected by the nature and quality of different types of relationship, rather than an individual characteristic or quality. It recognises that human beings need others in order to survive and flourish.

Summary Report on Shaping our Age

Click here to read a summary

Well-being was described by participants as feeling healthy and free from pain; being happy, contented, satisfied, fulfilled, ‘loving life’, having peace of mind, comfort, enjoyment, self-worth, self-confidence, safety, dignity, security, a sense of belonging, being needed and having a sense of achievement.

It also included good physical and mental health; achieving and accomplishing personal goals and objectives; leading an independent life; living in a comfortable, safe home and community; having sufficient personal finances and the comforts arising from faith, belief and spirituality.

In addition, the importance of keeping active: getting out; having a range of interests, hobbies and activities whether in the home or in the community; keeping busy and keeping fit. Many of these activities involved being with other people.

Relationships and social contacts with family, friends and within communities were highlighted as essential to well-being. As well as offering practical support, these connections bring a sense of belonging and feeling valued to older people. They also offer the well-being benefits gained from fun, good conversation and laughter.

While the quality of relationships is extremely important, there are a number of tests and exercises you can conduct (or ask a friend or Carer to conduct) that point to your state of physical and mental well-being.

Katz Index of Independence in Activities of Daily Living


  • INDEPENDENCE    (1 POINT)        No supervision, direction or personal assistance
  • DEPENDENCE:        (0 POINTS)     With supervision, direction, personal assistance or total care


  • (1 POINT) Bathes self completely or needs help in bathing only a single part of the body such as the back, genital area or disabled extremity.
  • (0 POINTS) Needs help with bathing more than one part of the body, getting in or out of the tub or shower. Requires total bathing.


  • (1 POINT) Gets clothes from closets and drawers and puts on clothes and outer garments complete with fasteners. May have help tying shoes.
  • (0 POINTS) Needs help with dressing self or needs to be completely dressed.


  • (1 POINT) Goes to toilet, gets on and off, arranges clothes, cleans genital area without help.
  • (0 POINTS) Needs help transferring to the toilet, cleaning self or uses bedpan or commode.


  • (1 POINT) Moves in and out of bed or chair unassisted. Mechanical transferring aides acceptable.
  • (0 POINTS) Needs help in moving from bed to chair or requires a complete transfer.


  • (1 POINT) Exercises complete self control over urination and defecation.
  • (0 POINTS) Is partially or totally incontinent of bowel or bladder.


  • (1 POINT) Gets food from plate into mouth without help. Preparation of food may be done by another person.
  • (0 POINTS) Needs partial or total help with feeding or requires parenteral feeding.


TOTAL POINTS     6 = High (patient independent)        0 = Low (patient very dependent)

Slightly adapted from Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970) Progress in the development of the index of AD

The Hendrich II Fall Risk Model

Click here to read more.

A significant problem in Old Age is falling. The information below provides some guidelines in assessing the risk. The assessment would normally be done by a Care Worker, but it can also be done by family members and in some cases, by the old person him/herself. The presence of each and any of these symptoms increases the risk of a fall.

Confusion, disorientation, impulsivity

  • impulsive or unpredictable behaviour
  • hallucinations
  • agitation
  • changes in attention, cognition, psychomotor activity, consciousness, or sleep-wake cycles
  • unrealistic, inappropriate, or unusual behaviour
  • disorientation to person, place, or time
  • inability to follow directions or retain instructions in self-care or activities of daily living

Symptomatic depression

  • prolonged feelings of helplessness, hopelessness, or being overwhelmed
  • tearfulness
  • flat affect or lack of interest
  • loss of interest in life events
  • melancholic mood
  • withdrawal
  • the patient's statement of depression

Altered elimination

  • urinary or faecal incontinence
  • urgency or stress incontinence
  • diarrhoea
  • frequent urination
  • nocturia (bed wetting)

Dizziness, vertigo

  • "The room is spinning" or "I feel like I'm spinning."
  • observe for swaying when the patient stands
  • swaying in a small circle when standing still?
  • poor gait and balance.


Being a Man

  • men are more likely than women to take risks, "go it alone," and ignore instructions.

A quick and easy test

"Get-Up-and-Go" test - rising from a seated position with hands resting flat on thighs.

  • able to rise in a single movement without using her or his hands scores a 0
  • pushes up with the hands and rises in one attempt scores a 1.
  • pushes up multiple times but ultimately is able to rise scores a 3.
  • unable to get up without assistance receives a score of 4.

Mental Status Assessment of Older Adults: The Mini-Cog(TM)

The Mini-Cog(TM) is a simple screening tool and takes only 3 minutes to administer. This tool can be used to detect cognitive impairment quickly.


1. Listen carefully to and remember 3 unrelated words and then to repeat the words. The same 3 words may be repeated up to 3 times to register all 3 words.

2. Draw the face of a clock, either on a blank sheet of paper or on a sheet with the clock circle already drawn on the page. Put the numbers on the clock face, then draw the hands of the clock to read a specific time. Eg. 10:30, 1:45 (11:10 is  difficult).

3. repeat the 3 previously stated words.


Scoring: (Out of total of 5 points)

Give 1 point for each recalled word after the Clock Drawing Test. Recall is scored 0-3.

The Clock Drawing Test is scored 2 if normal and 0 if abnormal.

(Note: The CDT is considered normal if all numbers are present in the correct sequence and position, and the hands readably display the requested time. Length of hands is not considered in the score.)


Interpretation of Results:

0-2: Positive screen for dementia

3-5: Negative screen for dementia

The Geriatric Depression Scale (GDS)

Source: http://www.stanford.edu/~yesavage/GDS.html

Depression is not a natural part of aging. Depression is often reversible with prompt recognition and appropriate treatment. However, if left untreated, depression may result in the onset of physical, cognitive, functional, and social impairment, as well as decreased quality of life, delayed recovery from medical illness and surgery, increased health care utilization, and suicide.


Geriatric Depression Scale: Short Form

Choose the best answer for how you have felt over the past week:

1. Are you basically satisfied with your life?


2. Have you dropped many of your activities and interests?


3. Do you feel that your life is empty?


4. Do you often get bored?


5. Are you in good spirits most of the time?


6. Are you afraid that something bad is going to happen to you?


7. Do you feel happy most of the time?


8. Do you often feel helpless?


9. Do you prefer to stay at home, rather than going out and doing new things?


10. Do you feel you have more problems with memory than most?


11. Do you think it is wonderful to be alive now?


12. Do you feel pretty worthless the way you are now?


13. Do you feel full of energy?


14. Do you feel that your situation is hopeless?


15. Do you think that most people are better off than you are?



Answers in bold blue indicate depression. Score 1 point for each blue answer.

  • A score > 5 points is suggestive of depression.
  • A score ≥ 10 points is almost always indicative of depression.
  • A score > 5 points should warrant a follow-up comprehensive assessment.

Discussion Forum – Old Age and Frailty

How do you rate your well-being? Describe what for you, are the important measures of well-being. Share these insights with friends and family who will be supporting you in your old age. 

Discussion Forum

Next module : Death and Bereavement

It is essential that you prepare for your death – if only to relieve friends and family of the burden of having to settle your affairs and arrange your funeral.

Next Module