In pairs figure skating, a move in which the male skater pulls the female skater into a circle around him while she skates on one foot with her body almost horizontal to the ice, her head almost brushing the ice.

That point in a person's life when one moves from elderly and vigorous to elderly and vulnerable. While difficult to pinpoint, doctors say they know it when they see it. A person in this medically fragile state is threatened even by a small cold.

For many years, there wasn't any particular way to identify it.

Doctors knew it when they saw it, but it probably meant something slightly different to every clinician. Unchecked, it could send a patient into a death spiral.

"The term is frailty," says Dr. George Kuchel, director of the University of Connecticut Center on Aging in Farmington.

It's the kind of frailty that makes older people vulnerable -- so vulnerable that almost any illness might send them into a spiral toward death.

"It's a very hot area" of study, says Kuchel. "These are people who are managing OK, but if they become exposed to a challenge -- for instance, pneumonia or anesthesia -- it could set up a chain of events, a spiral."

The answer is "no" to all those fraidy-cat, middle-aged people who fear the death spiral starts in their 40s, 50s or even 60s. It doesn't, or doesn't have to, if you look after yourself. Sure, you may head downhill during those years, but it's a gentle decline.

"It's a fallacy that declines with aging begins the minute you turn 65," says Kuchel. "There are declines that begin much earlier, but when you talk about a sudden turn where one thing leads to another, it's older adults."

The classic example is the older woman who breaks her hip, says Kuchel.

"We know that an older woman has one chance in three of dying within a year of the fracture," says Kuchel, "and only one in three of getting back to living where she was living before."

Spiraling also often starts with illness.

"The first thing that happens when they get sick is they stop walking and stay in bed," says Kuchel. Within a couple of days, they begin to lose muscle strength, eat less and may be given medications that have serious side effects. They may then enter the hospital and become disoriented.

Kuchel says doctors have begun to develop tests to assess a person's frailty and vulnerability to a downward spiral.

"If we can identify people who are frail and understand why they are frail," then doctors can develop interventions to help restore strength and reduce vulnerability, he says.

"We can begin adding life to years, rather than just adding years to life."

But it's difficult to determine who is frail and who isn't. There isn't a blood test or a special X-ray.

Kuchel says two of the most important factors are mobility and muscle strength. Research has shown that good predictors of how long people will remain independent are the distance they can walk and the strength of their hand squeeze, he says.

"Physical activity is very important," says Kuchel. "Older adults who remain physically active prevent frailty."

He says one of the best tests for strength is to start subjects sitting in a chair, ask them to get up, walk 10 meters, turn around and return to sitting in the chair. Young people and vigorous elderly people do this in under 10 seconds. A frail person may take 20 to 30 seconds or longer.

Kuchel says research has not yet been done to show that exercise can turn around frailty. But it appears exercise is associated with increased mobility, strength and better mental functioning, he says.

Kuchel says the future in anti-aging activities really has to do with prevention.

"You could make the argument that prevention begins with childhood," he says. "This is why physical activity in schools is so important. We need to teach people good life habits long before they become old."

If you're a senior citizen interested in exercise, the University of Connecticut Health Center in Farmington offers a program called "Powerful Aging." For more information, call 860-679-2846. The program is also offered in West Hartford. Call 860-523-3772.

Kathleen Megan can be reached at

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