Frailty and falls in people living with multiple sclerosis

Arch Phys Med Rehabil. 2021 Nov 24;S0003-9993(21)01576-8. doi: 10.1016/j.apmr.2021.10.025. Online ahead of print.


Objective: To explore the association between frailty and history of falls in people living with multiple sclerosis (MS).

Design: Secondary analysis.

Setting: University research laboratories in the United States and Israel.

Participants: 118 people with relapsing-remitting MS [age=48.9 years (SD=10.0); 74.6% female; expanded disability status scale (EDSS) range=1.0-6.0] were studied in this cross-sectional analysis.

Intervention: Not applicable.

Main outcomes: A frailty index was calculated from 40 health deficits by following standard validated procedures. The number of falls (12-month history) was recorded.

Results: Overall, 33.9%, 29.7%, and 36.4% of participants were classified as non-frail, moderately frail, and severely frail, respectively. The frailty index was significantly correlated (ρ=0.37, p<0.001) with higher scores on the EDSS. In univariable negative binomial regression analysis, the frailty index was associated with a higher number of falls (IRR=3.33, 95%CI[1.85-5.99], p<0.001). After adjustment for age, gender and EDSS, frailty remained strongly associated with history of falls (IRR=2.78, 95%CI[1.51-5.10], p=0.001).

Conclusion: The current study identifies a significant relationship between frailty and history of falls in MS, independent of age, gender, and disease severity. These findings support the notion that frailty is a syndrome related to, but independent of, disability in MS.

Keywords: Multiple sclerosis; accidental falls; aging; disability; frailty.