April 23--It was 8 a.m., and 86-year-old Allan Ford had delayed his breakfast to
help researchers at the Hospital of the University of Pennsylvania figure out
whether a hormone called ghrelin can combat frailty -- a combination of muscle
loss and fatigue -- in the elderly by making them eat more.
Clinical trials have been something of an avocation for Ford, a former marketing
and advertising man from Wynnewood, since the mid 1990s. With no chronic
illnesses, he was always in the healthy control groups. But this time, even
though he looks young for his age and is mentally sharp, he was weak and
physically slow enough to qualify for the treatment.
While many U.S. researchers want to block ghrelin in the obese, Anne Cappola, an
endocrinologist who is leading the Penn study, hopes the appetite stimulant will
counteract the weight loss and weakness that often accompany aging. Many older
people complain that they're just not hungry.
That recent morning, Ford got a shot of the hormone under the skin of his belly,
then waited half an hour before eating a hearty breakfast of eggs, bacon,
cereal, and toast from two trays. An earlier arm of the study had proven he ate
more after the shot. This part was to find out whether he could learn to give
the daily shot himself. (He could.)
Next, Cappola's team will test what happens when the drug is combined with
Many people still believe that the words old and frail naturally go together,
but aging experts increasingly view frailty as a separate syndrome that often
can be prevented and treated.
"While death is inevitable, this kind of long, slow decline into frailty and . .
. disability is not really inevitable," said William Evans, an expert on aging,
exercise, and nutrition who heads GlaxoSmithKline's muscle metabolism discovery
performance unit in North Carolina. His group is studying drugs that may help
build muscle or improve its quality. There may be human trials next year.
If doctors can figure out how to keep people stronger, that could lead to
longer, more independent lives for the elderly and lower health costs for
The issue is gaining importance as baby boomers enter their final decades. Many
will be prime candidates for frailty because of unhealthy lifestyle habits.
"It's going to be an enormous problem in the next 10 to 20 years," said Evans,
who taught at Penn State in the 1990s. "The societal cost of nursing homes and
institutionalization is enormous."
In a paper to be published in June, a consensus group representing six
international geriatrics groups will recommend that both primary care doctors
and specialists screen all patients older than 70 for frailty. Early
identification, the group says, will help the elderly achieve one of their
highest priorities -- aging at home -- and reduce costs.
Because cancer and its treatments seem to accelerate frailty, the National
Cancer Institute has made research on frailty one of its funding priorities this
year, said Catherine Alfano, deputy director of the office of cancer
What exactly is frailty? For years, doctors agreed they knew it when they saw
it, but had no definition. We all can picture the shrunken, old lady who needs
help with her grocery bags and walks at a snail's pace. Linda Fried, then an
aging expert at Johns Hopkins University, came up with the first definition for
the syndrome about 10 years ago.
People with three of these five symptoms are considered frail: slow walking
speed, weakness as measured by hand grip, physical inactivity, exhaustion, and
unintentional weight loss of more than 10 pounds in a year.
Others have somewhat different definitions, and doctors now realize that obese
patients also are often frail. The bottom line is that frail people are weak and
at high risk of death and disability. They don't bounce back well from injury or
While frailty can occur in people like Ford with no chronic health problems, it
is also common in people with cancer, heart failure, and chronic obstructive
Cappola said 7 percent of people 65 and older and 15 percent of those in their
80s are frail. A much higher percentage are "pre-frail," a group experts want to
target for help.
Researchers are focusing on the physiological underpinnings of the syndrome,
which Fried says involve poorer coordination between bodily systems.
Inflammation is one possible culprit; genetics is another. Vitamin D has
potential to help.
Evans also has developed a urine test -- not yet FDA approved -- that will for
the first time help doctors measure how much muscle patients have.
As all that is sorted out, the advice is the same as for so many health
problems: exercise more and eat better. People naturally lose muscle mass and
quality as they age, but many are declining too fast due to the way they live.
"We're an aging population, and we're aging faster than we need to," said
Kathryn Schmitz, an exercise physiologist at Penn who has studied exercise in
breast cancer survivors and will soon work with Cappola's study subjects.
Many elderly people complain they've lost their appetite -- hence the ghrelin
trial. They may need to focus on eating more, especially more protein, which is
needed for muscle building. Eating less saturated fat may improve muscle
quality, Evans said.
Moving more is key. "It's the single most important thing you can do for healthy
aging," Alfano said. "Everyone's looking for the magic pill. We have it. It's
Aging experts strongly recommend exercising all through life, but studies have
shown that aerobic activity and weight lifting can help even very old, very weak
Getting older people to exercise can be challenging. "The real problem often is
attitude," Evans said. "Older people think that frailty and weakness are
It often helps when a family member exercises too. Many a daughter has told him,
, "This has been the most important thing I've ever done with my mother."
Fried, who is now dean of Columbia University's Mailman School of Public Health,
said society needs to make keeping citizens strong a priority.
"This is one of the things we need to invest in . . . as we become a society of
longer lives," she said.
Once 6 feet, Ford said he is now 5-foot-9 and 150 pounds. He looks good, but his
arms and legs are thin. He likes to hold onto things as he walks and admits that
he gets "more mental exercise than physical exercise."
A reporter wasn't allowed to watch Ford eat for fear it would affect the study
results, but he reported a robust meal. "I ate the whole first tray and. . .
practically the whole second tray. I was hungry."
Contact Stacey Burling at 215-854-4944 or firstname.lastname@example.org.
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