What is frailty?

Frailty is when you experience at least three of the following five signs: 

  • Shrinkage: Unintentional weight loss
  • Strength loss: Physical weakness
  • Slowness: Sluggishness with physical tasks
  • Sedentariness: Reduced daily activities
  • Sleepiness: Feeling easily tired

When you are frail, you may lose some physical, mental, psychological, and social well-being, making you more vulnerable to negative health outcomes from medical conditions. 

Frailty can be prevented, reversed, or delayed in the early stages and managed in the later stages, through early detection and interventions to optimise functional ability, activity participation and quality of life. 

Both low physical activity and inadequate dietary intake play a significant role in the onset and progression of frailty, particularly through decline or deterioration in bone and muscle health. It has been proven that a combination of nutrition support and physical exercise yielded a more positive outcome on frailty status. 

How to prevent and manage frailty with nutrition and physical activity?

Adequate nutrition is important in the prevention and management of frailty. It helps to maintain muscle strength and preserve bone mass, hence reducing the risk of falls and fractures. 

1. Ensure a balanced and healthy diet

a. Enjoy a variety of food.

b. Consume food in the recommended amount as suggested in My Healthy Plate. It is important to obtain sufficient amount of food from all the food groups to prevent unnecessary weight loss and muscle loss.

Balance and Healthy diet.png

c. If appetite is poor (i.e., declining food intake consistently in the past 2 weeks), consider small and frequent meals to optimise nutrient intake. Meals and snacks should be high in calorie and high in protein.  It is recommended to increase the nutritional content of meals and snacks without increasing their total volume. Oral nutritional supplement can also be considered in consultation with doctor and/or dietitian. 

Here are some examples of how to increase the nutritional content of meals or snacks. 

Base foodAdd these into base food 
Rice, porridge, noodle

- sweet potatoes and braised peanut into porridge

- drizzle sesame oil or healthy cooking oil into porridge

- egg and/or fish into rice, porridge or noodle

Oats 

- unsweetened high-calcium soy milk, milk, milk powder, or nuts

- fruits, for example banana

- honey*

Bread 

-peanut butter, kaya*, fruit jam*, or margarine spreads

-cheese, canned tuna, or avocado

Pancakes

-fruit jam*, kaya*, honey*, margarine, or peanut butter spreads

-cheese, scramble egg, or avocado

Mashed potatoes-cheese, milk, margarine, or sour cream
Cream soup or clear soup

-cheese or milk or high-calcium soymilk into cream soup

-egg, fish into clear soup

-drizzle healthy cooking oil or sesame oil onto clear soup

Hot beverages-milk powder, milk or unsweetened high-calcium soy milk

*these foods contain sugar, to limit or avoid intake for people with diabetes

2. Consume adequate amount of protein-rich food 

a. A diet low in protein is linked to frailty and muscle loss. Hence, adequate protein is important to minimise muscle loss.

b. Refer to the table below for food sources of protein and its recommended serving size. Aim for 3 servings of dietary protein a day, of which one serving is from dairy foods or calcium-rich foods sources.

1 serving of protein is:

1 serving of protein.png

Incorporate a VARIETY of protein sources into your daily diet. 

c. It is recommended to distribute protein intake evenly throughout the day to enhance muscle building. Protein-rich food must be included in each of the three main meals. 

An example of how a VARIETY of protein sources can be incorporated into our meals to achieve 3 servings of protein food a day

3 servings of protein food.png

 

3. Bone up on dietary calcium and vitamin D 

a. Calcium and vitamin D help to keep the bones strong. Aim for 1,000mg of dietary calcium a day. This can be achieved by consuming 2 servings of milk or unsweetened high-calcium soy milk and 2 servings of green leafy vegetable a day. 

b. Vitamin D is important for calcium absorption. Include vitamin D-rich food sources such as oily fish (e.g., salmon, mackerel), eggs, fortified cereals, fortified low-fat dairy, and fortified unsweetened high-calcium soy milk in your daily diet. 

c. Enjoy a daily 15- 30minutes of direct sunlight exposure to help with vitamin D production. 

4. Maintain a healthy weight 

a. It is important to maintain a healthy weight to retain muscle mass. Older adults are encouraged to weigh themselves regularly to monitor for any weight loss.

b. A weight loss of ≥ 5% over 3 month or ≥ 10% over 6 months puts a person at risk of malnutrition, hence requiring medical and dietetic assessment. 

5. Stay active 

a. If you have any pre-existing medical conditions, consult a doctor and/or physiotherapist for a pre-exercise assessment.

b. Aim for at least 150 minutes of moderate- intensity activity each week

c. Engage in muscle-strengthening activities at least 2 days a week, at moderate intensity to keep muscles, bones, and joints strong. You can incorporate exercises like resistance band training while watching your favourite shows. 

d. Include multi-component physical activity that focus on strength and functional balance, such as yoga, jogging, or tai chi, at least 3 days of the week at a moderate intensity. 

Acknowledgements

Community Dietetics and Nutrition Workgroup (Feb 2022 – Dec 2024) – Dietitians from Public Healthcare Institutions, College of Family Physicians Singapore, Nurses from Polyclinics and Community Care Sector.

References

  1. National Frailty Strategy Policy Report. Weblink: https://www.moh.gov.sg/resources-statistics/reports/frailty-strategy-policy-report
  2. Singapore physical activity guidelines for older adults (65 years and above). Weblink: https://www.healthhub.sg/programmes/moveit/moveit-singapore-physical-activity-guidelines#older-adults