Researchers in Germany have discovered that having lower cortisol levels in the morning—and higher cortisol levels in the evening—is linked to frailty in older individuals. Cortisol levels are typically supposed to be highest in the morning and lowest in the evening.

"Cortisol typically follows a distinct daily pattern with the highest level in the morning and the lowest basal level at night," said Karl-Heinz Ladwig, PhD, MD, of Helmholtz Zentrum München and a co-author of the study. "Our findings showed dysregulated cortisol secretion, as featured by a smaller morning to evening cortisol level ratio, was significantly associated with frailty status."

The new study titled, “Blunted Diurnal Cortisol Pattern is Associated with Frailty: A Cross-Sectional Study of 745 Participants Aged 65 to 90 Years” will appear in the March 2014 issue of the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

The Cortisol Awakening Response 

The cortisol awakening response (CAR) is represented by a typical 50 percent increase of cortisol levels that occur 20 to 30 minutes after waking up in the morning. Researchers believe that this morning burst of cortisol may be part of a hormonal carpe diem kind of "seize the day" kick-start.

Researchers speculate that the anticipation of the upcoming demands of the day are part of regulating the cortisol awakening response. On workdays—when people have to motivate to get up and get to work—CAR is more active. CAR is typically less active on days off and weekends resulting in lower morning cortisol levels. One reason that people ages 65-90 may have lower cortisol levels in the morning might be linked to someone being retired or not feeling a need to seize the day.

On the flip side, if a person is under constant stress to achieve and in a neverending state of ‘fight or flight’ cortisol levels can remain constantly elevated which can lead to a wide range of health problems. Ideally, cortisol levels should ebb and flow throughout the day. For 5 easy ways to help stabilize cortisol levels check out my Psychology Today blog post: “Cortisol: Why "The Stress Hormone” Is Public Enemy No. 1.”

In their new study, Dr. Ladwig and colleagues conducted a cross-sectional analysis of 745 participants between the ages of 65 and 90 years. Cortisol levels were measured using saliva samples at three points: awakening, 30 minutes after awakening, and evening. The researchers then compared the cortisol levels to a person's 'frailty status.'

Participants were classified as “frail” if they met 3 (or more) of the following 5 criteria:

  1. Exhaustion
  2. Physical inactivity
  3. Low walking speed
  4. Weakness (measured by grip strength)
  5. Weight loss (loss of more than 11 pounds in the past six months)

"Our results suggest a link between disrupted cortisol regulation and loss of muscle mass and strength, as the underlying pathophysiology of frailty," said Hamimatunnisa Johar, a PhD student at Helmholtz Zentrum München and co-author of the study. "In a clinical setting assessment of frailty can be time-consuming, and our findings show measurements of cortisol may offer a feasible alternative."

Conclusion: What is causing the changes in cortisol levels that are linked to frailty?

The researchers make a clear correlation between higher evening cortisol and lower morning cortisol being linked to frailty. They also conclude that frailty increases the odds of an older person needing assisted living and having a shorter lifespan.

However, the 'chicken or the egg' question remains: What comes first? Are daily habits that lead to frailty triggering disruptions in cortisol levels, or are the changes in cortisol levels actually creating frailty? Clearly there is a link between the timing of someone's daily ebb and flow of cortisol and frailty, but more research is needed.

There is a possibility that frailty in older people could be improved by taking a two-pronged approach aimed at simultaneously getting normal cortisol patterns back on track while also increasing resilience, strength, and joie de vivre through lifestyle changes.

If someone over 65 can adopt daily habits that increase activity, muscular strength, and walking speed—while finding reasons to spring out of bed to seize the day—it might be possible to kick-start cortisol secretion in the morning, and lower it by evening which could improve frailty status.

If you’d like to read more on this topic, check out my Psychology Today blog posts:

Follow me on Twitter @ckbergland for updates on The Athlete’s Way blog posts.

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