Frailty and prediction of recurrent falls over 10 years in a community cohort of 75-year-old women

Abstract

Background: Frailty captures the age-related declines in health leading to increased vulnerability, including falls which are commonplace in older women. The relationship between frailty and falls is complex, with one leading to the other in a vicious cycle.

Aims: This study addresses the gap in understanding how patterns of frailty and falls propensity interact, particularly in those who have not yet entered the falls-frailty cycle.

Methods: The Osteoporosis Risk Assessment cohort consists of 1044 community-dwelling women aged 75, with 10 years of follow-up. Investigations were performed and a frailty index constructed at baseline, 5 and 10 years. Falls were self-reported for each previous 12 months. Analysis was two-directional, firstly based on frailty status and second, based on falls status. Recurrent falls was the primary outcome.

Results: Baseline frailty was a significant predictor of recurrent falls after 5 and 10 years [(OR 2.55 (1.62-3.99); 3.04 (1.63-5.67)]. Among women who had no history of falls at age 75, frailty was a stronger predictor of falls at 5 years [OR 3.06 (1.59-5.89)] than among women who had previously fallen.

Discussion: Frailty is significantly associated with recurrent falls and most pronounced in those who are frail but have not yet fallen.

Conclusions: This suggests that frailty should be an integral part of falls-risk assessment to improve identification of those at risk of becoming fallers.

Keywords: Community-dwelling; Falls; Frailty; Women.

Fig. 1

Proportion of women attending each visit who reported none, one or multiple falls in the previous 12 months. This figure shows how, with advancing age the proportion of women falling increases. At each visit (ages 75, 80 and 85) the proportion of women reporting haven fallen once or more in the previous 12 months increases from 28.4 to 31% to 44.7%. The green area represents non-fallers and shrinks as the proportion of women reporting falls increases. The fallers are represented with deepening shades of red to illustrate the multiple fallers; these increase over time as the proportion falling increases. Missing falls data: 75 y (n = 130); 80 y (n = 82)

Fig. 2

Proportion of non-frail and frail women women reporting recurrent falls at all visits based on frailty status at age 75. Women are defined as frail (≥ 0.25) or non-frail (< 0.25) at baseline and we show the proportion at each visit who reported recurrent falls in the previous 12 months. Among FRAIL women, proportionally more reported recurrent falls, compared to non-frail (32.6 vs. 8.9 at 75 y; 30.8 vs. 14.9 at 80 y; 47.9 vs. 23.2 at 85 y). Width of the frail segments narrows with successive visits, reflecting the proportionally higher loss-to-death and non-attendance in the most frail