PUMPING IRONY: Formulas for Frailty

I’m not the most sociable guy you’ll ever meet. My favorite weekend activity, in fact, is canceling plans My Lovely Wife and I had made for the weekend. She’s in charge of finding events to attend; I’m in charge of not mentioning them until we both tacitly agree that we’re not attending. There was an art opening a couple of weekends ago, for instance, featuring the work of a local artist we know. She put it on her calendar, I put it on mine, nobody talked about it, and we ended up happily homebound.

So, I was slightly alarmed the other day to learn that my mild aversion to socializing may undermine the anti-frailty benefits of my strength-training regimen. This may require some explanation.

It’s been pretty well established among the gerontology set that frailty is a condition we want to delay as long as possible. Frail seniors are more likely to injure themselves in a fall, suffer from limited mobility, and struggle to handle everyday tasks. But recent research also suggests this lack of muscular functionality will make us lonely — and that loneliness may make us frail.

This circular correlation emerged from a study published last week in the journal Age and Ageing. Fereshteh Mehrabi, PhD, and her team at Montreal’s Concordia University reviewed health data on some 2,300 Dutch seniors who participated in the Longitudinal Aging Study Amsterdam between 1995 and 2016. Tracking changes in the participants’ physical and mental health at three-year intervals, the researchers found that those seniors who described themselves as frail — as defined by various functional limitations — were more likely than their less frail counterparts to also report feeling lonely or socially isolated.

Those physical difficulties, Mehrabi explains, can make it difficult to socialize: “There may be a cumulative effect of frailty on social isolation and loneliness as older adults with pre-frailty or frailty tend to have multiple diseases, reduced physical activity, or difficulties in performing activities of daily living, which may limit their social interactions, increasing the risk of social isolation.”

And lonely, isolated seniors tend to engage in more unhealthy behaviors — smoking, immoderate alcohol use, sedentary habits, poor diet and sleep quality — which then contribute to frailty. The frailty-leads-to-loneliness connection was not as strong as the loneliness-leads-to-frailty equation, Mehrabi acknowledges, but there was sufficient evidence at certain points in her analysis to make the case. “In our study, frailty had a stronger influence on social isolation and loneliness than the reverse direction,” she writes. “However, we found reciprocal and contemporaneous relationships between social isolation, loneliness, and frailty, suggesting these conditions mutually reinforce each other in older age.”

It’s not completely clear from Mehrabi’s study whether my relative lack of social contact is negating the physical activity I’ve been led to believe will contribute to a delay in the onset of frailty, which affects as many as 12 percent of American seniors. As Brandon Verdoorn, MD, at the Mayo Clinic recommends in a recent podcast, seniors should focus on strength training to maintain muscle mass and delay frailty’s onset. “I’m . . . not saying here that walking isn’t a good thing,” he notes. “Walking is good for your health for lots of reasons, but probably just walking is less powerful than forms of exercise that include some strength training.”

But does my relative aversion to social situations negate all the heavy lifting I’m doing to keep frailty at bay? Mehrabi’s conclusions regarding that association are, well, not exactly conclusive. She calls loneliness “a potential antecedent of physical frailty” but only when participants reached an advanced age. And this typically occurs when aging recluses lose the sort of support they need to maintain their physical functionality.

Besides, the definition of loneliness she’s using — a scale partly based on a participant’s expressed emotional need for “really close friends” — probably doesn’t apply to me. Despite my general aversion to socializing, I still can claim a few good pals. In fact, three of them were planning to gather at my place last Saturday, but something came up and we had to reschedule.

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