AIMS Research Fellow David Zitner discusses the signs of frailty. As care rationing becomes a more prominent reality in the health system, patients will have to take on more knowledge and control over their own health care. He gives warning signs about frailty to help readers monitor their own function.


As government rationing of primary care increases, many Nova Scotians are taking more responsibility for their own health and health care.  About 100,000 Nova Scotians do not have a family doctor for ongoing advice.  Another example of rationing is the odd proposal from the Department of Health that telephone advice should be an insured service, but only for those over 65, not for younger folk.

The Nova Scotia health authority cannot or will not bother to provide an estimate of when the situation will improve. Dr. Lynne Harrigan, the Vice President of Medicine for the Nova Scotia Health Authority suggested that her solutions might make things worse in the short term; the proposed benefits might not be visible for 10 or more years.[1]  Clearly, Nova Scotians will benefit if they are able to stay healthy and participate in their own care.

Scientists are developing tools to help people understand their own health. Drs. Ken Rockwood and Arnold Mitniski are Nova Scotians who publish internationally acclaimed research on aging.  Their important work focuses on learning how personal characteristics contribute to predictions of longevity and future health.

Retailers like Amazon use information about you, personal characteristics, to identify products that will interest you and prompt you to buy them.  The techniques to identify who is likely to become sick are no different from the techniques retailers use to estimate what items you are most likely to purchase.

Many people would welcome worthwhile suggestions to maintain and improve health.  However, in Nova Scotia, primitive health information systems, administered by the Provincial government, do not automatically provide personal health information, prompts or suggestions to seek health advice.

Citizens, suffering from rationed primary health care, find it inconvenient and become reluctant to seek credible health advice.  Those who know some of the simple warnings of impending illness may be more likely to persist in the search for timely care and advice.

Most people can recognize the simple, and sometimes subtle, elements that predict illness and realize they should seek advice if they have specific discomfort or reduced function.  However, they might ignore some more subtle warnings.

Five subtle elements associated with frailty and future illness are[2]

  1. unintentional weight loss
  2. weakness: (i.e. reduced muscle strength measured by grip or walking upstairs)
  3. exhaustion: (i.e. a constant feeling of fatigue, difficulty walking short distances)
  4. slowness: (i.e. slow walking speed )
  5. low levels of physical activity

Activities that prevent or delay frailty[3] include

  1. Muscle strengthening and aerobic exercise
  2. Improving diet to include sufficient protein, calories and vitamins
  3. Caution and proper management for people who take several different medications
  4. Early detection of chronic disease (including persistence in seeking timely advice)

Experts recommend that physicians review older people and look for signs and symptoms that predict frailty.  People without a doctor but with early signs of frailty should persist and find credible professionals who can advise them what to do to prevent minor problems from becoming more than an inconvenience.

[1] Lynne Harrigan comment at Town Hall organized by CBC in Studio 60 and held on Thursday June 16 at 7:30 p.m.