Can Frailty be Delayed?

Advances in healthcare have resulted in longer lives. But will living longer mean an extended period of weakness and frailty?  Can frailty be delayed?

The answer is YES. Without a doubt, it’s possible to delay frailty. "Blue Zones" refers to a concept developed by Dan Buettner and National Geographic. It identifies regions around the world where people live significantly longer, better lives. One such location is Loma Linda, California where life expectancy exceeds 90 years. People who live in Blue Zones live longer, higher quality, lives with a delayed onset of frailty.

Blue Zones describes 9 important lifelong lessons that are important to review in detail. Diet, exercise, and smoking habits play an undisputed role in life expectancy. Healthy lifestyle choices also help a person age well.

But in this post, I’d like to highlight 4 points about delaying frailty:

I. Protein Protein Protein

Older adults who eat more protein are healthier and stronger. Here’s why:

Protein is not stored in the body. In addition, conversion of protein into muscle is less efficient as we get older. 30 to 50 percent of muscle mass is lost between the age of 40 and 80. Seniors who consume more protein have better preservation of muscle mass and strength. Inadequate amounts of protein result in more muscle loss.

More protein is needed whenever a body needs to repair itself. This applies to seniors. Older adults are more likely to have chronic disease. Any acute illness, surgery, or wound repair will result in increased need for protein. If there isn’t enough protein in the diet, the body will pull protein out of the body resulting in loss of muscle.

How much protein is enough? The healthiest seniors consume approximately 0.5 grams of protein per pound. For a 150-pound person this means approximately 75 grams of protein daily. This is not a small amount. For perspective, that is the amount of protein in a dozen eggs.

Is there a harm in too much protein?

Diets that are high in protein can be harmful in people with significant kidney disease. In this situation, protein restriction is often recommended.  Careful discussion with a healthcare provider is vital.

High protein/low carb “ketogenic” diets have been advocated for weight control and health. These diets are often very high in protein and low in carbohydrates and fats. They can result in weight loss over a short period of time. However, they can also result in inadequate fiber, nutrients, and fat-soluble vitamins. Carbohydrates are normally the body's primary source of energy. A ketogenic diet can be exceptionally low in carbohydrates. This results in dietary protein being used for energy production, not muscle tissue.

High protein diets that are high in salt, sugar or fat content are not recommended.

What about protein supplements?

Supplements are made by extracting protein from real food. They are “supplements”, not substitutes for food. They should only be used when daily intake of protein is otherwise not enough. Protein supplements may be particularly important when people are sick and eating poorly. During these times, the body needs extra protein.

II. A steady diet of hamburgers without exercise = Obesity

Protein intake without exercise often leads to obesity and does not improve strength. The protein ends up mostly excreted or converted into fat tissue. A “couch potato” lifestyle, or an extended time of illness with bedrest, leads to rapid loss of muscle mass. Protein is important but must be combined with strengthening exercises to build muscle. Balance and flexibility exercises are also important. Tai Chi is excellent for coordination and has been proven to decrease the risk of falls.

At least 20 minutes of exercise per day is recommended for seniors. Think of the acronym FIT: Frequency, Intensity, Time. All 3 are needed to impact frailty. Even people who are frail can become less frail. However, it requires a consistent guided exercise program. Frail people need both more time for exercise and more time for rest to restore muscle mass.

Step by Step Strengthening

I always recommend that older adults take the stairs if they can do so safely. Stair climbing is excellent for building strength, endurance, and balance.

III. Love, Love, Love

Make sure you have loving relationships. One role I had as a geriatrician was supervision of a Medicare Wellness Program. It was an eye-opening way of seeing whether people were aging well. Many patients complained of loneliness. The reasons varied including widowhood, divorce, family disputes, and lack of companionship. It’s not mentioned often but loneliness is a major risk factor for frailty. People who are lonely need more love in their lives. There are no studies that prove having love decreases the risk of frailty. But I have no doubt that it does. It eases the pain of traumatic life events we all have. People who love you will support and help you through life’s ups and downs. When you love people and when you love life, you have more of a reason to live and to try hard. There is no question that having love in life is more challenging for some people than others. But love is powerful. It gives you the strength to live well.

IV. There’s no Fountain of Youth…Yet

Treatment of infectious diseases, cancer, and heart disease have dominated the 20th Century. The result is longer life expectancy. Cellular aging is the next huge frontier. Aging cells produce less energy, accumulate waste, and become damaged. The body becomes frail as cells age. There are many advances in understanding how to promote cellular longevity. Antioxidants, antibiotics, anti-inflammatories, supplements, and herbs are studied to determine anti-aging properties. Stem cells may regenerate and repair damaged tissues. The anti-aging product market is now in the billions of dollars. These products, though promising, remain unproven in humans. But we’re getting closer.

Hormone replacement therapy, including growth hormone, is also a major area of study. Testosterone supplements increase muscle mass and strength in older men. But testosterone increases the risk of cardiovascular disease in men with chronic illness.


Some thoughts about delaying frailty at different stages in life:


WHY? Obesity increases the risk of frailty. Conversely, caloric restriction appears to delay aging.

The Mediterranean diet is heart healthy and promotes healthy aging.

Lifelong stress accelerates aging.

Senior Years

  • Extra Protein AND Exercise
  • Build and restore relationships

WHY? Close to half of older adults do not have enough protein in their diets. This is especially true among women. Even fewer seniors optimize protein intake. It is best to have protein with every meal. Lean meats contain all nine essential amino acids. Non meat sources of protein include nuts, beans, dairy products and eggs.

As a senior, you never know when you’ll need loving support and connection.

Pre-Frail Years

  • Make exercise and rest a big part of your day.
  • Ask for and accept help.

WHY? Pre-frailty is a period in which extra effort is needed to avoid falling into frailty. It requires time, determination, and a supportive team.


Warmest Aloha,

[email protected]

PS: Send me a note if you’d like scientific references for this post.


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  2. Dr. Warren,
    I enjoyed very much reading this article about can Frailty be delayed? Absolutely, you have dropped a fruit for thoughts. Diet plays a vital role in longevity especially a balanced diet. There is a still debate whether all protein are created equal, The animal based protein versus plant based protein continues be a vital role. Which one is better? I was listening to podcast talking about how protein played a vital role in ageing especially in patient with early stage of dementia etc this is due to the fact that vital organs such as brains was getting the adequate proteins. Exercise is important as well because when you stop working the 9-5; you need find hobby – whether it is walking, cycling, swimming pickle ball, even meditation to get the mind in positive. Oh ❤️ Love is the greatest gift of mankind, it is important to surround yourself with love and let go of those people that are toxic to be quite frank. I hope people are listening to this gem you are dropping… Thank you for your service.

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