Nutrition and frailty

Nutritional status is a key contributor to frailty.  Poor nutrition is frequently associated with frailty and in turn this can lead to falls, particularly if muscles are wasted or weak. Appetite loss affects up to one in five older people living in the community. Many people perceive low body weight and unplanned weight loss (malnutrition) to be a normal part of ageing – but these may be due to poor dietary intake instead.

In combination with exercise, older people need to eat enough protein foods to help prevent muscle loss (sarcopenia). If poor nutrition is suspected, a referral to local dietetic services should be considered. Many GP surgeries now have a dietician aligned to their practice; it is useful to know about local availability. 

Higher consumption of fruit and vegetables and lower consumption of highly processed foods are both associated with lower frailty risk. 

Vitamin D deficiency has been associated with osteopenia (thin bones) and with muscle weakness, poor neuromuscular co-ordination and falls. People are at risk of vitamin D deficiency if they are aged over 65 years, or are not exposed to much sunlight, usually because they are confined indoors for long periods or because they wear clothes that cover the whole body. 

For a person with adequate calcium intake (700mg/day) but who is not exposed to much sunlight, 10mcg/400 international units of oral vitamin D daily (without calcium) is recommended. If calcium intake is inadequate the same dose of vitamin D with at least 1,000mg of calcium daily is recommended. For elderly people who are housebound or living in a nursing home, 10mcg/400 international units of vitamin D with at least 1,000mg of calcium daily throughout the year is recommended. This dose has been shown in some studies to reduce falls and fractures although the evidence is of low quality.

Safety at home

When visiting patients to deliver medicines or help with medicines-taking, there are things pharmacy team members can notice and provide advice on, or refer for support from social services or other voluntary organisations. These are based on analysing how falls have happened and could include questions in a simple printed leaflet, such as:

• Do you have good lighting, especially on the stairs?
• Are stairs and steps clutter free?
• Do you have handrails on both sides of the stairs?
• Do you have slippers that provide good support for your feet?
• When you go out, do you wear shoes that provide good support for your feet?
• Do you have a night light in the bedroom or a torch by the bed in case you need to get up in the night?
• Are your floors clear of trailing wires, wrinkled or fraying carpets, or anything else that you might trip or slip on?
• Do you have a handrail in the bath/shower and a non-slip bath mat?
• If you need to reach something from a high place, what do you do? Do you have a grabber or a secure step ladder? Never stand on a chair to reach something
• Do you keep your garden paths clear and free from moss?
• Does your pet wear a collar with a bell? It is important to be aware of where they are when moving about to avoid tripping over them.

Minimising risk during winter

• Consider fitting a grab rail if there are steps at the front or back door
• If going outside is essential, making sure to wear boots or shoes with good grip on the soles
• Have some food supplies at home in case it is not possible to go out for a few days; ask neighbours/friends to help with basic food supplies when they are doing their own shopping
• Order repeat prescriptions in plenty of time, particularly if bad weather is forecast. Consider getting them delivered during the winter months.