Exploring the Relationship Between MS and Frailty

Frailty is an understudied phenomenon in relation to multiple sclerosis (MS) yet its prevalence in MS is high and the condition can lead to major adverse effects, according to a study in Multiple Sclerosis and Related Disorders.¹ 

Frailty becomes more prevalent in aging populations; however, those affected by MS may exhibit more severe signs of frailty in earlier periods of their life compared to aging groups without MS | image credit: HoursStudio - stock.adobe.com

“Frailty is an age-related condition of decreased physiological function that makes people more vulnerable to adverse health outcomes. This condition is common in people with multiple sclerosis (MS), and they tend to experience it earlier than those without MS. For instance, middle-aged people with MS are more likely to exhibit signs of frailty than older adults without the condition,” co-author Tobia Zanotto, PhD, University of Kansas Medical Center, told The American Journal of Managed Care^® (AJMC^®).

The mean age of patients included in the study ranged from 41 to 59 years. The strongest correlation between frailty and MS were those patients who ranked high for disability, had MS the longest, and who had progressive MS subtypes.

Frailty is linked to worse quality of life, fall risks, and other well-known MS-related symptoms, the study found. Existing research has identified strong connections between frailty, inhibited walking, worse quality of life and sleep, fatigue, visits to primary care, mortality, and more.

“Higher disability, longer disease duration, and more severe forms of MS are frequently associated with frailty in people with MS. In addition, our research strongly suggests that, while frailty and disability share some similarities, they should be considered distinct concepts in MS. Studies have also shown that frailty is closely associated with common MS symptoms like walking and sleeping issues, fatigue, poor quality of life, falls, more doctor visits, and higher mortality,” Zanotto commented to AJMC.

Observational data were collected between 2000 and 2024 from 10 original articles and 1 conference paper on PubMed, Scopus, Embase, Ovid MEDLINE, CINAHL, CENTRAL, Web of Science, PEDRO, and clinicaltrials.gov. Two studies were prospective and the remaining 9 had retrospective, cross-sectional designs. The studies were conducted in the US, Canada, Italy and the UK.

The authors believe their literature review is the first to focus on frailty and MS.

MS diagnoses typically occur between the ages of 20 and 30 years. The disease is the top non-traumatic disabling condition affecting young adults, and MS rates have been increasing over the past decade. Worldwide, nearly 3 million people have MS, which leads to sensory, motor, and cognitive difficulties, fatigue and depression.

“The aging of [patients with MS] will inevitably pose new challenges for their healthcare and the MS community,” the authors write. “One of these challenges will be to ensure that age-related syndromes, such as frailty, are timely recognized and effectively managed in [patients with MS].”

Researchers defined “frail” as a patient who meets 3 of the following 5 criteria: reduced walking speed, weaker handgrip, infrequent physical activity, self-reported fatigue or unintended weight loss.

People with MS are 15 times more likely to be frail than a person without MS of the same age, and MS tops the list of chronic conditions most associated with frailty.² The others include chronic fatigue syndrome, chronic obstructive pulmonary disease, connective tissue disease and diabetes.

Roughly three-quarters of patients with MS are female.¹ Frailty index scores are higher in female patients with MS compared with male patients with MS, which echoes the literature on geriatric populations that theorize higher frailty in women occurs because of higher life expectancies coupled with complex biological, social, environmental, lifestyle and nutritional factors.

“In summary, frailty in MS represents an area in need of further research. Specifically, there is an emerging need to identify strategies to minimize or potentially even reverse frailty in the MS community,” Zanotto stated.

References

1. Al Worikat N, Molaei F, Zanotto A, et al. Frailty in multiple sclerosis: a scoping review. Mult. Scler. J. 2024. doi:10.1016/j.msard.2024.106157
2. Hanlon P, Nicholl BI, Jani BD, Lee D, McQueenie R, Mair FS. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants. Lancet Public Health. 2018; 3:e323-e332. doi:10.1016/S2468-2667(18)30091-4