Frailty – and the naming of parts

Today we have naming of parts. Yesterday,
We had daily cleaning. And tomorrow …….
Henry Reed 2017

Frailty

I have not quite finished with frailty – my regular trawl of recent medical publications is always rewarded with yet more facts and opinions about this great threat to the health of the nation.

Does frailty need a new name?

A recent article in the British Medical Journal (BMJ) queried whether “frailty” is a suitable term to describe the condition of weakness and debility in later life – it sounds like an attempt at “re-branding” which is so prevalent in many areas of life and commerce today. However some people do regard  the term “frailty” as pejorative – as a negative stereotyping of debilitated older people.

The Oxford English Dictionary cites several definitions, the first being what most of us would regard as being our take:

“The quality of being physically weak or fragile, or vulnerable to damage. In later use chiefly in reference to physical weakness or infirmity as a result of old age“.

However alternatives include:

* “A moral failing, a particular weakness or character flaw”
* “Moral weakness: sinfulness; propensity to give in to temptation, especially of a sexual nature“!

There is no doubt of the importance of recognising the condition – about 40% of older patients with unplanned hospital admissions are living with moderate or severe frailty. Knowing this should allow better planning of patient care, service design and preventive measures.

The downside

Many older people who regard the term “Frailty” as derogatory deny the possibility of being frail and lose out on the need for action to delay progression or reverse the condition. Worse individual health and increased hospital admissions have been shown to result.

A new term which distinguishes “biomedical frailty” from personal weakness might be helpful. A biomedical explanation of their condition should help older people to face up to it and take steps to manage it.

How to find a new term?

The BMJ takes the  term “neurodiversity” as a relatively recent example of a new term to describe a common condition with a variety of presentations. It is acceptable to all involved, does not have negative connotations, refers to a spectrum and  to something which can be modified but which can improve or deteriorate.

The journal does not come up with  a solution to a suitable new term to replace “frailty” but recommends that “Greater collaboration with older people is needed to develop ways of talking about frailty and any new term.”

Any ideas out there? Your responses would be very welcome.

Body Mass Index – BMI

This has long been the measure which best describes categories of weight by numbers. But could it also be replaced – by BRI – Body Roundness Index?

In this case, there is more than stigmatising to consider. It is well recognised that BMI is a far from perfect measure of the risk associated with obesity. BMI fails to distinguish between different fat distributions and cannot take into account the proportions of muscle, bone and fat which all have different densities. BMI remains popular because it is easy to measure and, like democracy, is better than all the alternatives.

What is BRI?

BRI is calculated from waist circumference, hip circumference and height and describes body shape. Weight is not involved. The figures are fed into one of the online formula calculations to give a number between 1 and 20. Levels below 3.41 indicate leanness – about 20% of the population – and above 6.91 indicate fatness – also about 20% of the population.

The strengths of BRI vs BMI

1. BRI considers waist circumference, a key indicator of abdominal fat
2. It is more sensitive to changes in body shape and fat distribution
3. Recent research suggests that it is better at predicting cardiovascular health risks
4. It provides a more accurate assessment for people with high muscle mass. Very muscular people have misleadingly high BMIs despite low fat levels.
5. Body Roundness Index is nicely descriptive!

The future of BRI

Don’t rush to measure your BRI – we are a long way off having the evidence to establish this as a clinically useful tool. And there may be better measures in the pipeline.

For the time being, BRI just gives a number to what you see in the mirror.