One major feature of physical frailty is the lack of ‘energy’ often described fatigue by frail older adults. Early hypotheses of the underlying causes of physical frailty included the proposal that mitochondrial dysfunction led to low levels of energy production and ultimately to clinical features such as fatigue and low energy/activity levels (Wallace, 2011; Loeb et al., 2005; Wallace, 2010; Wallace 2005; Wallace, 2001). Over the past several years, studies into the biology of frailty have indeed identified features of mitochondrial decline that may ultimately contribute to physical frailty. Mitochondria are the cell’s power houses, generating energy in a highly charged process, called oxidative phosphorylation, which transfers electrons from oxygen to make ATP. ATP is an energy source that is utilized for almost all cellular activities. The process of making ATP creates reactive oxygen species (ROS), which can damage cellular structures if not quickly neutralized (Conley et al., 2007). Continue Reading

New Clinical Topic

Introduction: Cancer and Frailty

Cancer is a disease of older adults. About 60% of cancers occur in people 65 years of age or older. Furthermore, about 70% of the deaths caused by cancers occur in this stage (White et al., 2019). Frailty - whether defined by comprehensive geriatric assessment (CGA), deficit accumulation indices (DAI) or the physical frailty phenotype criteria (PFP) - is prevalent among those with cancer. In a 2015 meta-analysis of nearly 3000 participants, prefrailty and frailty were diagnosed in half of older adults with cancer, while only roughly a third were classified as fit by a CGA (Handforth et al., 2015). Continue Reading

New Blogs

What Can Digital Health do for Geriatric Oncology? – advancing equity and meaningful use

Nabiel Mir, MD
Geriatric Oncology Fellow
University of Chicago Medicine

Frailty in older adults with cancer is associated with poor outcomes such as mortality (Augustin et al., 2016; Soubeyran et al., 2012), functional decline (Hoppe et al., 2013) and toxicity from chemotherapy (Hurria et al., 2011). Major organizations like the American Society of Clinical Oncology recommend using a comprehensive geriatric assessment (CGA) to identify vulnerabilities such as functional impairment, comorbidities, and cognition as well as institute CGA-driven interventions like exercise or nutritional rehabilitation (Mohile et al., 2018) that have been shown to significantly reduce the risk of high-grade toxicity without compromising survival in vulnerable cohorts with geriatric impairments (Mohile et al., 2020). Continue Reading

New supplemental award examines mitochondrial function and frailty development among people with and without HIV

The Johns Hopkins Older Americans Independence Center (OAIC), a long-running NIH funded research program focused on frailty research, was recently awarded a supplemental grant to investigate the intersecting biological pathways that drive early onset of physical frailty in a subset of individuals living with and without HIV through the study of mitochondrial decline. Continue Reading

New Podcast

Frailty and Diabetes in Older Adults, with Dr. Rita R. Kalyani

Rita Rastogi Kalyani, MD, MHS
Associate Professor of Medicine, Division of Endocrinology, Diabetes, & Metabolism
Johns Hopkins University School of Medicine

For the tenth episode of the Fighting Frailty Podcast, our host Ramana Kolady speaks with Dr. Rita R. Kalyani about diabetes in older adults and associations between diabetes, frailty and functional status, and geriatric symptoms. Dr. Kalyani also shares her insights on sarcopenia (age-related muscle loss), and future opportunities to improve the health and care of older persons living with diabetes and frailty. The Fighting Frailty Podcast is developed and sponsored by FrailtyScience.org. Listen now

The Latest Updates from Frailty Science

New Research Topic

Mitochondrial Dysfunction and Frailty