Frailty

As a society, we don't understand frailty very well. Even the medical community - other than gerontologists - has a difficult time grasping the concept of frailty. Frailty is this process of getting older, and though we do not want to think of it, closer to death. Frailty is a loss of physiologic reserve, a decrease in the backup life force than someone has. I feel funny using such fuzzy words, but it's because we don't think of it enough and consequently don't have the right words to describe it. Frailty is not a disease or illness; rather, it's a state of being, an inevitability. As someone ages, even if she is perfectly healthy, she will become frail. Although heart disease, cancer, smoking, and chronic disability can lead to frailty, frailty will happen regardless. It is like death; there is no avoiding it or pushing it back or staving it off.

And our society needs to understand that. Even if we cure our grandparents' heart disease with stents, put their cancer in remission, convince them to quit smoking, replace their joints, stave off their dementia, vaccinate against the flu, they will still be frail. They will still someday pass away. They won't be able to walk as far as they used to, live as independently, weather respiratory tracts as quickly. They will, by virtue of age, have a change in their quality of life. Doctors cannot fix that. We have to accept aging as a process that finds every single person. At some point, we have to start talking about quality of life, about whether it makes sense to start chemotherapy or let that cancer smolder, about whether that surgery will provide enough benefit long term to justify the short-term risks. We have to think about whether someone would prefer comfort, function, meaningfulness, and living at home to chasing every disease trying to achieve immortality. We need to hear these patients' stories, their lives, their wishes, their fears, and their hopes. Perhaps not all their dreams will revolve around living forever. How do we live with frailty? How do we die with dignity? Aging, disability, and death are taboo topics in our society, but it is time to put them out in the open and talk about them.