White-haired at 85, Pope Benedict XVI looks a bit hunched in photos. He has had a pacemaker for years, the Vatican recently confirmed for the first time — an indicator of long-standing heart problems. His older brother has said that age is taking its toll.
Observers have noticed the pope’s reduced energy. The Times has reported that he was ferried to the altar at St. Peter’s for Midnight Mass Christmas Eve on a “wheeled platform,” then appeared to doze off during the service.
Visiting Mexico last year, he awoke at night and couldn’t locate a light switch in his room, then fell — such a familiar scenario for caregivers of old people — and bloodied his head when he hit the bathroom sink.
Beyond these few facts, we know very little about the health problems that have led Benedict to announce his retirement after his final audience on Wednesday. We don’t even really know if his flagging stamina — “the certainty that my strengths, due to an advanced age, are no longer suited to an adequate exercise” of leading the church, as he put it — was the true reason behind his resignation. But people have been describing him as tired and increasingly frail.
In geriatrics, “frailty” has a specific meaning: It’s a syndrome, a collection of physiological symptoms that drain people’s reserves, leaving them less able to withstand stressors — like a long trek through St. Peter’s Basilica or around a foreign country.
Geriatricians diagnose frailty when a patient meets three of five criteria: Unintentional weight loss of more than 10 pounds in the past year. Weakness, as measured by a test of handgrip strength. Self-reported exhaustion. Slowness, calculated by how long it takes to walk 15 feet. Low physical activity.
“You feel a sense of vulnerability,” said Linda Fried, dean of the Mailman School of Public Health at Columbia University and a leading frailty researcher for 20 years. With significantly lower energy, “It’s harder to push the envelope.”
Frailty’s prevalence increases with age, “from a tiny proportion of people in their 60s, about three percent, to up to a quarter or a third of people 85 and older,” Dr. Fried said. Doctors have learned to pay attention because of the unhappy consequences. “It’s strongly associated with higher mortality, as well as loss of mobility, falls and other kinds of disability,” she said.
Is Benedict frail? Certainly he is reporting that he is exhausted, but does he fit the other criteria? “The pope has probably never done a grip strength test,” said Ken Covinsky, a geriatrician at the University of California, San Francisco.
But the odds are high that he has health problems, even if they’re unacknowledged by Vatican spokesmen. In the United States, at least, nearly half of those over 65 have two or more chronic diseases, like diabetes, hypertension and emphysema. “It would be a rare 85-year-old with only one thing wrong with him,” Dr. Covinsky said.
And frailty is one of those conditions that indicate all is not well.
People often recognize frailty, even without data on walking speed. “I’ve tested it out myself over the years” when speaking to groups, Dr. Fried reported. “I ask people what they’re seeing, and there’s great consistency between the things they picture and what science has measured.”
Frail elders, people tell her, are thin (although overweight people can also be frail), weak, slow, fragile-looking. “The term people use is, they look like they could be knocked over by a feather,” she said.
So if observers in Vatican City say Benedict looks frail, well, maybe he is.
But I’m pursuing this subject not to ask experts to diagnose the pope from afar, but to point out that paying attention to frailty makes sense for the rest of us and our elders. It’s one of the conditions people can do something about.
In frailty’s early stages, “there’s great potential to reverse it or slow it,” Dr. Fried said. The key is exercise. “You have to walk and move, maintain strength and muscle mass,” she said. “We don’t have a drug to prescribe, but even if we did, there’s no question in my mind that exercise will always be the foundation.”
The pope has said that he plans to move into the Mater Ecclesiae convent within the Vatican once it’s renovated for him. We have to assume the nuns, and perhaps a couple of physical therapists, will provide excellent care there.
“Often, people with frailty can live a pretty good life with good home care and social support, and almost every country does better at that than the United States,” Dr. Covinsky said. Our lack of a workable, affordable system of long-term care for the elderly and disabled poses a national crisis.
This is where being a former pope — something that is so rare that it shocked the world — may be a good way to live out one’s days.
“In the U.S., he could get M.R.I.’s and all kinds of expensive tests,” Dr. Covinsky noted. “But Medicare won’t pay for a home health aide four hours a day.” Luckily, the Vatican probably will provide it.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
