New York, NY - A front-page story in the New York Times linking preexisting cardiovascular disease to increased frailty in the elderly also asks the question of whether social stereotypes of seniors may also serve to make older men and women weaker, slower, and less able to care for themselves [1]. Doctors' attitudes toward aging and the elderly are compounding the problem, Times journalist Gina Kolata writes.

"Undetected cardiovascular disease . . . is often a major reason people become frail," Kolata observes. "They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys, or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace."

Frailty, she notes, is defined as exhaustion, weakness, weight loss, and a loss of muscle mass and strength.

Examining research into why different people seem to have vastly different strength and vigor going into their 80s and 90s, Kolata points to a May 2006 study published in the Journal of the American Medical Association by Dr Anne Newman (University of Pittsburgh, PA) and colleagues—and reported by heartwire—that found that apparently healthy people in their 70s who were unable to walk a quarter mile within five minutes were at increased risk of MI [2]. For each additional minute they took to do the walk test, risk of dying within four years increased by one third and risk of MI rose by 20%. People who took more than six minutes faced the same MI or mortality risk as people who could not walk the quarter-mile distance at all, independent of age.

At the time her study was first published, Newman commented to heartwire, "[It's] not to say that everybody who is older needs to be superfit, but for two people who otherwise have the same medical history and health problems, the one who tries to keep up his fitness is going to benefit."

In separate research, writes Kolata, Newman et al looked at participants in the Cardiovascular Health Study and found that people with congestive heart failure, previous MI, or stroke were more likely to be frail. Similarly, asymptomatic participants with signs of atherosclerotic disease were almost three times more likely to be frail and were more likely to become disabled five years earlier than people with no evidence of cardiovascular disease at the study outset.

While other factors, such as osteoporosis, arthritis, and cancer, may play a role, heart disease stood out. "In explaining frailty among seemingly healthy people, the findings on cardiovascular disease made sense," Kolata writes. However, she adds, "Investigators say that there is a ray of hope in the finding—if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition."

But a second factor that plays a role in determining who becomes frail and who doesn't is less tangible and relates to individual perceptions of health and aging. "Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path," Kolata writes.

Physicians may be partly to blame when they use pejorative or at least stereotyping terms like "biddy" or "crock" to refer to elderly patients, the article notes.

"It is hard to avoid seeing or hearing demeaning depictions of the elderly," Kolata notes. "There are greeting cards that make old people the butt of jokes. There are phrases like 'senior moment' to describe a memory lapse. Then there are the ways older people are treated. For example, researchers find that people use 'elderspeak,' speaking louder and using simpler words and sentences when talking to old people."

Other research has shown that people exposed to stereotypes about poor memory and age-related decline did worse on memory tests than they did if exposed to positive feedback about aging.