Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomised controlled trial

Lifelong LUTS: Understanding the bladder's role and implications across transition phases, a comprehensive review

INTRODUCTION

Lower urinary tract symptoms (LUTSs) are a diverse array of urinary and pelvic dysfunctions that can emerge from childhood, extend through adulthood, and persist into older age. This narrative review aims to provide a comprehensive perspective on the continuum of LUTS and shed light on the underlying mechanisms and clinical implications that span across the lower urinary tract.

METHODS

A panel of five experts from Belgium, the Netherlands, India, Denmark, and the United States participated in an intensive research to explore and pinpoint existing insights into the lifelong concept of LUTS, particularly at the pelvic level. The experts reviewed the existing literature and held a webinar to discuss their findings.

RESULTS

Childhood LUTS can persist, resolve, or progress into bladder underactivity, dysfunctional voiding, or pain syndromes. The Lifelong character can be explained by pelvic organ cross-talk facilitated through complex neurological and nonneurological interactions. At the molecular level, the role of vasopressin receptors in the bladder's modulation and their potential relevance to therapeutic strategies for LUTS are explored. Frailty emerges as a parallel concept to lifelong LUTS, with a complex and synergistic relationship. Frailty, not solely an age-related condition, accentuates LUTS severity with insufficient evidence regarding the effectiveness and safety profile of the available therapeutic modalities.

CONCLUSION

Understanding lifelong LUTSs offers insights into genetic, anatomical, neurological, and molecular mechanisms. Further research could identify predictive biomarkers, elucidate the role of clinically translatable elements in pelvic cross-talk, and uncover molecular signatures for personalized management.

Osteosarcopenia: Prevalence and 10-Year Fracture and Mortality Risk - A Longitudinal, Population-Based Study of 75-Year-Old Women

Osteosarcopenia is the coexistence of low bone mass and sarcopenia. In older women, its prevalence is not well described, and it is unknown if sarcopenia is additive to low bone mass for fracture and mortality risk. The study investigated prevalence of osteosarcopenia and if osteosarcopenia is associated with higher fracture and mortality risk than low bone mass alone in older community-dwelling women. The longitudinal, population-based OPRA Cohort (n = 1044), all aged 75 at inclusion, followed for 10 years. Using WHO and EWGSOP2 definitions for low bone mass (T-score < -1.0 femoral neck) and sarcopenia (knee strength; appendicular lean muscle mass) women were categorized (1) Normal, (2) Low bone mass (LBM), and 3) Osteosarcopenia (probable; confirmed). Risk of hip, major osteoporotic fracture, and mortality were estimated. Osteosarcopeniaconfirmed prevalence increased from age 75 to 80 and 85 from 3.0% (29/970) to 4.9% (32/656) to 9.2% (33/358) but prevalence is potentially 2-4 times higher (11.8%, 13.4%, 20.3%) based on osteosarcopeniaprobable. Having osteosarcopeniaprobable significantly increased 10-year risk of hip fracture (HRadj 2.67 [1.34-5.32]), major osteoporotic fracture (HRadj 2.04 [1.27-3.27]), and mortality (HRadj 1.91 [1.21-3.04]). In contrast, LBM increased osteoporotic fracture risk (HRadj 2.08 [1.46-2.97], but not hip fracture (HRadj 1.62 [0.92-2.85]) or mortality (HRadj 0.94 [0.64-1.38]). Median time-to-hip fracture was 7.6 years (normal), 6.0 years (LBM), and 5.7 years (osteosarcopeniaprobable). Prevalence of confirmed osteosarcopenia is almost 10% at age 85. Probable osteosarcopenia significantly increased risk of hip and major osteoporotic fractures and mortality more so than low bone mass alone.

Incorporating frailty to address the key challenges to geriatric economic evaluation

BACKGROUND

The multidimensional and dynamically complex process of ageing presents key challenges to economic evaluation of geriatric interventions, including: (1) accounting for indirect, long-term effects of a geriatric shock such as a fall; (2) incorporating a wide range of societal, non-health outcomes such as informal caregiver burden; and (3) accounting for heterogeneity within the demographic group. Measures of frailty aim to capture the multidimensional and syndromic nature of geriatric health. Using a case study of community-based falls prevention, this article explores how incorporating a multivariate frailty index in a decision model can help address the above key challenges.

METHODS

A conceptual structure of the relationship between geriatric shocks and frailty was developed. This included three key associations involving frailty: (A) the shock-frailty feedback loop; (B) the secondary effects of shock via frailty; and (C) association between frailty and intervention access. A case study of economic modelling of community-based falls prevention for older persons aged 60 + was used to show how parameterising these associations contributed to addressing the above three challenges. The English Longitudinal Study of Ageing (ELSA) was the main data source for parameterisation. A new 52-item multivariate frailty index was generated from ELSA. The main statistical methods were multivariate logistic and linear regressions. Estimated regression coefficients were inputted into a discrete individual simulation with annual cycles to calculate the continuous variable value or probability of binary event given individuals' characteristics.

RESULTS

All three conceptual associations, in their parameterised forms, contributed to addressing challenge (1). Specifically, by worsening the frailty progression, falls incidence in the model increased the risk of falling in subsequent cycles and indirectly impacted the trajectories and levels of EQ-5D-3 L, mortality risk, and comorbidity care costs. Intervention access was positively associated with frailty such that the greater access to falls prevention by frailer individuals dampened the falls-frailty feedback loop. Association (B) concerning the secondary effects of falls via frailty was central to addressing challenge (2). Using this association, the model was able to estimate how falls prevention generated via its impact on frailty paid and unpaid productivity gains, out-of-pocket care expenditure reduction, and informal caregiving cost reduction. For challenge (3), frailty captured the variations within demographic groups of key model outcomes including EQ-5D-3 L, QALY, and all-cause care costs. Frailty itself was shown to have a social gradient such that it mediated socially inequitable distributions of frailty-associated outcomes.

CONCLUSION

The frailty-based conceptual structure and parameterisation methods significantly improved upon the methods previously employed by falls prevention models to address the key challenges for geriatric economic evaluation. The conceptual structure is applicable to other geriatric and non-geriatric intervention areas and should inform the data selection and statistical methods to parameterise structurally valid economic models of geriatric interventions.

Developing a framework of concerns from people living with frailty, for the Measure Yourself Concerns and Wellbeing (MYCaW) person-centred outcome measure

INTRODUCTION

Measure Yourself Concerns and Wellbeing is a validated person-centred outcome measure, piloted as a core monitoring tool to understand what matters to people living with frailty in Gloucestershire. This paper describes the acceptability of MYCaW used in this setting, and the development of a framework for analysing personalised concerns from people living with frailty.

METHODS

MYCaW was implemented in the Complex Care at Home service and South Cotswold Frailty Service from November 2020 onwards. MYCaW was completed at the person's first meeting with a community matron and then 3 months later. Nineteen staff completed an anonymous survey to provide feedback on the acceptability of the tool. A framework of concerns bespoke to people living with frailty was created via iterative rounds of independent coding of 989 concerns from 526 people. The inter-rater reliability of the framework was determined by using the Cronbach alpha test.

RESULTS

MYCaW was simple to use and helped health professionals' discussions to be patient focused. A pictorial scale accompanying the Numerical Rating Scale was developed and tested to help people engage with scoring their concerns and well-being more easily. A framework of concerns from people living with frailty was produced with five main supercategories: Mental and Emotional Concerns; Physical Concerns; Healthcare and Service Provision Concerns, Concerns with General Health and Well-being and Practical Concerns. Inter-rater reliability was kappa=0.905.

CONCLUSIONS

MYCaW was acceptable as a core monitoring tool for people living with frailty and enabled a systematic approach to opening 'What Matters to Me' conversations. The personalised data generated valuable insights into how the frailty services positively impacted the outcomes for people living with frailty. The coding framework demonstrated a wide range of concerns-many linked to inequalities and not identified on existing outcome measures recommended for people living with frailty.

Assessment, Prevalence, and Correlates of Frailty among Moroccan People Aged 50 and above Living with HIV

BACKGROUND

Persons living with HIV experience many challenges, such as premature aging and geriatric syndromes. Frailty has become an important determinant of a series of adverse health outcomes. This research aimed to evaluate the prevalence and risk factors for frailty in this population.

METHODS

A cross-sectional outpatient investigation was conducted in an urban HIV clinic. Patients aged 50 and older living with HIV were included. Frailty phenotype was evaluated using the original Fried criteria, and we calculated the Veterans Aging Cohort Study (VACS) index, Charlson Comorbidity Index, Fracture Risk Assessment Tool scores, and Mini-mental State Exam scores.

RESULTS

One hundred and nine individuals were studied. Ninety-two (84.4%) were men, with a mean age of 57.65.2 years. Fourteen (12.8%) participants were frail. Frail participants were older (P = 0.001) and less likely to be virally suppressed (P = 0.01). Having ≥3 comorbidities, VACS index, polypharmacy, and 5-year mortality risk was significantly greater in the frail group. Frailty was significantly associated with poorer quality of life (P = 0.02). The cognitive impairment, falls, and malnutrition risk were significantly associated with a risk to manifest a frail phenotype.

CONCLUSION

Frailty is common among Moroccans with HIV, and it is associated with greater morbidity and mortality rates. Our findings should serve as a warning sign to standardize frailty and geriatric syndrome screening in this population.

Fall risk question-based tools for fall screening in community-dwelling older adults: a systematic review of the literature

Fall screening tools aim to accurately identify the high fall risk individuals. To increase ease of administration and cost-effectiveness many studies focus on question-based tools. The purpose of this systematic review was to identify question-based tools for fall risk assessment in community-dwelling older adults over the age of 60 and the risk factors that are covered by these tools. The PRISMA guidelines were followed. A literature search was conducted in PubMed/MEDLINE, Web of Science and Google Scholar. Data quality assessment was performed with the Ottawa-Newcastle scale. The results identified 20 studies that used 22 question-based tools to assess fall risk. The number of questions per tool varied from 1 to 41 questions. Data quality varied greatly, with values 3-9 for cohort and 2-7 for cross-sectional studies. The most commonly reported fall risk factors were fall history, feeling of unsteadiness, fear of falling, muscle strength, gait limitation and incontinence. Healthcare providers should use the above tools with caution regarding the limitations of each tool. Further studies should be designed to address individuals with high fall risk, such as individuals with cognitive impairment, as they are under-represented or excluded from most of the existing studies.

Converging Pathways: Exploring the Interplay of Malnutrition, Sarcopenia, and Frailty in Nursing Home Residents: A Cross-sectional Study

Background

Within the context of nursing home care, malnutrition, sarcopenia, and frailty stand as notable conditions, each exerting distinct yet interconnected impacts on residents' well-being. The objective of this cross-sectional study is to elucidate the intricate interplay among malnutrition, sarcopenia, and frailty among nursing home residents.

Methodology

It is a community-based, cross-sectional, descriptive study among nursing home residents of Vatsalyadham Vrudhsharam, which is an institution for aged old-age people in Jamnagar from April 2023 to July 2023. The estimated minimum sample size was 345. A self-structured questionnaire was used to collect the data containing sociodemographic characteristics, anthropometric assessment, and bio-impedance indices. The handgrip was measured by a hand dynamometer. Assessment of the risk of malnutrition was performed using the Mini Nutritional Assessment-Short Form questionnaire and was confirmed by the Global Leadership Initiative for Malnutrition (GLIM) criteria. Sarcopenia was assessed by a bio-impedance analyzer using the Asian Working Group of Sarcopenia 2019. Frailty was assessed using the fatigue, resistance, ambulation, illness, and loss (FRAIL) screener. Descriptive statistics were used for the representation of percentages and frequencies. Both Chi-square and logistic regression analyses were used for the association. P < 0.05 was considered statistically significant, respectively.

Results

About 345 participants were included, and mean age of the participants was 85 ± 5.6 years, about 159 (49%) participants belonged to the age group of more than 80 years, 220 (63.7%) were males, then malnutrition was diagnosed by GLIM criteria, about 154 (44.6%) were found to have malnutrition. Sarcopenia was found in 184 (53%) participants. The FRAIL screening was used to identify frailty, according to that prefrail was around 170 (49%) and frail was about 122 (35%), respectively. Age, gender, and history of falls were associated with frailty and sarcopenia (P < 0.001). Only, age and gender were associated with malnutrition but not a history of falls.

Conclusion

The findings of this study suggest that frailty, sarcopenia, and malnutrition are prevalent among nursing home residents. Health-care providers should identify and manage these conditions in older adults to improve their quality of life.

A comparative overview of health and social care policy for older people in England and Scotland, United Kingdom (UK)

BACKGROUND

Responsibility for health and social care was devolved to Scotland in 1999 with evidence of diverging policy and organisation of care compared to England. This paper provides a comparative overview of major health and social care policies in England and Scotland published between 2011 and 2023 relating to the care of older people.

METHODS

We searched United Kingdom (UK) and Scotland government websites for macro-level policy documents between 2011 and 2023 relating to the health and social care of older people (aged 65+). Data were extracted and emergent themes were summarised according to Donabedian's structure-process-outcome model.

RESULTS

We reviewed 27 policies in England and 28 in Scotland. Four main policy themes emerged that were common to both countries. Two related to the structure of care: integration of care and adult social care reform. Two related to service delivery/processes of care: prevention and supported self-management and improving mental health care. Cross-cutting themes included person-centred care, addressing health inequalities, promoting use of technology, and improving outcomes.

CONCLUSION

Despite differences in the structure of care, including more competition, financial incentivization, and consumer-based care in England compared to Scotland, there are similarities in policy vision around delivery/processes of care (e.g. person-centred care) and performance and patient outcomes. Lack of UK-wide health and social care datasets hinders evaluation of policies and comparison of outcomes between both countries.

Effects of Fear of Falling on the Single-Step Threshold for Lateral Balance Recovery in Older Women

BACKGROUND AND PURPOSE

Fear of falling is associated with poor physical health and influences postural stability during whole-body movement. The ability to recover from lateral balance loss is required to prevent falls; however, the relationship between lateral balance recovery and fear of falling has not been established. This study aimed to investigate whether fear of falling is associated with the stepping threshold for lateral balance recovery.

METHODS

This study included 56 ambulatory, community-dwelling women aged 65 years or older. We determined the single-step threshold as the maximum lean magnitude normalized with body weight from which participants could be suddenly released and still recover balance using a single side step. The short-form Falls Efficacy Scale International was used as a measure of fear of falling.

RESULTS AND DISCUSSION

The single-step threshold significantly correlated with age ( rs =-0.603) and the short-form Falls Efficacy Scale International score ( rs =-0.439). Ordinal regression analysis revealed that age (odds ratio, 0.826; 95% confidence interval, 0.742-0.920) and the short-form Falls Efficacy Scale International score (odds ratio, 0.811; 95% confidence interval, 0.680-0.966) were significantly associated with the single-step threshold, such that older age and greater fear of falling each independently predicted that failure to recover balance with a single step would occur at a lower percentage of body weight.

CONCLUSIONS

Greater fear of falling was associated with reduced ability to recover from lateral balance loss in addition to aging. Future studies should explore whether evidence-based interventions to reduce fear of falling combined with perturbation training might lead to improved ability to recover from balance loss.

Economic model of community-based falls prevention: seeking methodological solutions in evaluating the efficiency and equity of UK guideline recommendations

Background

Falls significantly harm geriatric health and impose substantial costs on care systems and wider society. Decision modelling can inform the commissioning of falls prevention but face methodological challenges, including: (1) capturing non-health outcomes and societal intervention costs; (2) considering heterogeneity and dynamic complexity; (3) considering theories of human behaviour and implementation; and (4) considering issues of equity. This study seeks methodological solutions in developing a credible economic model of community-based falls prevention for older persons (aged 60 +) to inform local falls prevention commissioning as recommended by UK guidelines.

Methods

A framework for conceptualising public health economic models was followed. Conceptualisation was conducted in Sheffield as a representative local health economy. Model parameterisation used publicly available data including English Longitudinal Study of Ageing and UK-based falls prevention trials. Key methodological developments in operationalising a discrete individual simulation model included: (1) incorporating societal outcomes including productivity, informal caregiving cost, and private care expenditure; (2) parameterising dynamic falls-frailty feedback loop whereby falls influence long-term outcomes via frailty progression; (3) incorporating three parallel prevention pathways with unique eligibility and implementation conditions; and (4) assessing equity impacts through distributional cost-effectiveness analysis (DCEA) and individual-level lifetime outcomes (e.g., number reaching ‘fair innings’). Guideline-recommended strategy (RC) was compared against usual care (UC). Probabilistic sensitivity, subgroup, and scenario analyses were conducted.

Results

RC had 93.4% probability of being cost-effective versus UC at cost-effectiveness threshold of £20,000 per QALY gained under 40-year societal cost-utility analysis. It increased productivity and reduced private expenditure and informal caregiving cost, but productivity gain and private expenditure reduction were outstripped by increases in intervention time opportunity costs and co-payments, respectively. RC reduced inequality delineated by socioeconomic status quartile. Gains in individual-level lifetime outcomes were small. Younger geriatric age groups can cross-subsidise their older peers for whom RC is cost-ineffective. Removing the falls-frailty feedback made RC no longer efficient or equitable versus UC.

Conclusion

Methodological advances addressed several key challenges associated with falls prevention modelling. RC appears cost-effective and equitable versus UC. However, further analyses should confirm whether RC is optimal versus other potential strategies and investigate feasibility issues including capacity implications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-023-03916-z.

Risk factors for nursing home admission among older adults: Analysis of basic movements and activities of daily living

This retrospective study aimed to clarify the risk of older adults' nursing home placement in terms of basic movements and activities of daily living (ADLs) by analyzing data from a long-term care insurance certification survey in 2016‒2018 in City A. Of the 21,520 people certified as needing care, 16,865 could be followed up until 2018. Data on sex, age, household structure, and level of care required were obtained. Those who lived at home and at nursing homes were categorized as the "Unchanged group" and the "Changed group," respectively. Multivariate binomial logistic regression analysis was performed, with group type as the dependent variable and basic movement and ADL scores as the independent variables. For factor analysis according to care level, participants were classified into support need levels 1 and 2, care need levels 1 and 2, and care need levels 3, 4, and 5. For those categorized into support need levels 1 and 2, standing on one leg and transferring (basic movements) and urination and face cleaning (ADLs) were associated with nursing home placement. For those in care need levels 1 and 2, getting up and transferring (basic movements) and bathing, urination, face cleaning, and hair styling (ADL) were significantly associated with nursing home placement. For those in care need levels 3, 4, and 5, sitting and transferring (basic movements) and self-feeding and defecation (ADL) were significant. Occupational therapists must focus on older adults' declining ADLs and basic movements and relay the necessary information to patients, families, and other healthcare professionals to ensure appropriate and prompt care delivery.

Frailty Is a Risk Factor for Falls in the Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

There is little evidence in the literature about the relationship between frailty and falls in older adults. Our objective was to explore the relationship between frailty and falls, and to analyze the effect factors (e.g., gender, different frailty assessment tools, areas, level of national economic development, and year of publication) of the association between frailty and falls among older adults.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Cohort studies that evaluated the association between frailty and falls in the older adults were included. We excluded any literature outside of cohort studies.

METHODS

We did a systematic literature search of English databases PubMed, Scopus, Web of Science, EBSCOhost, and SciElO, as well as the Chinese databases CNKI, WANFANG, and VIP from 2001 until October 2022. The eligible studies were evaluated for potential bias using the Newcastle-Ottawa Scale (NOS). Study selection, data extraction and assessment of study quality were each conducted by two investigators. In Stata/MP 17.0 software, we calculated pooled estimates of the prevalence of falls by using a random-effects model, Subgroup analysis was conducted based on gender, different frailty assessment tools, areas, level of economic development, and year of publication. The results are presented using a forest plot.

RESULTS

Twenty-nine studies were included in this meta-analysis and a total of 1,093,270 participants aged 65 years and above were enrolled. Among the older adults, frailty was significantly associated with a higher risk for falls, compared with those without frailty (combined RR-relative risk = 1.48, 95% CI-confidence interval: 1.27-1.73, I2=98.9%). In addition, the results of subgroup analysis indicated that men had a higher risk for falls than women among the older adults with frailty (RR 1.94, 95% CI: 1.18-3.2 versus RR 1.44, 95% CI: 1.24-1.67). Subgroup analysis by different frailty assessment tools revealed an increased risk of falls in older adults with frailty when assessed using the Frailty Phenotype (combined RR 1.32, 95%CI: 1.17-1.48), FRAIL score (combined RR 1.82, 95%CI: 1.36-2.43), and Study of Osteoporotic Fractures index (combined RR 1.54, 95%CI: 1.10-2.16). Furthermore, subgroup analysis by areas and level of national economic development found the highest fall risk in Oceania (combined RR 2.35, 95%CI: 2.28-2.43) and the lowest in Europe (combined RR 1.20, 95%CI: 1.05-1.38). Developed countries exhibited a lower fall risk compared to developing countries (combined RR 1.44, 95%CI: 1.21-1.71). Analysis by year of publication showed the highest fall risk between 2013-2019 (combined RR 1.79, 95%CI: 1.45-2.20) and the lowest between 2001-2013 (combined RR 1.21, 95%CI: 1.13-1.29).

CONCLUSION

Frailty represents a significant risk factor for falls in older adults, with the degree of risk varying according to the different frailty assessment tools employed, and notably highest when using the FRAIL scale. Additionally, factors such as gender, areas, level of national economic development, and healthcare managers' understanding of frailty may all impact the correlation between frailty and falls. Thus, it's imperative to select suitable frailty diagnostic tools tailored to the specific characteristics of the population in question. This, in turn, facilitates the accurate identification of frailty in older adults and informs the development of appropriate preventive and therapeutic strategies to mitigate fall risk.

Characterizing fall risk factors in Belgian older adults through machine learning: a data-driven approach

BACKGROUND

Falls are a major problem associated with ageing. Yet, fall-risk classification models identifying older adults at risk are lacking. Current screening tools show limited predictive validity to differentiate between a low- and high-risk of falling.

OBJECTIVE

This study aims at identifying risk factors associated with higher risk of falling by means of a quality-of-life questionnaire incorporating biological, behavioural, environmental and socio-economic factors. These insights can aid the development of a fall-risk classification algorithm identifying community-dwelling older adults at risk of falling.

METHODS

The questionnaire was developed by the Belgian Ageing Studies research group of the Vrije Universiteit Brussel and administered to 82,580 older adults for a detailed analysis of risk factors linked to the fall incidence data. Based on previously known risk factors, 139 questions were selected from the questionnaire to include in this study. Included questions were encoded, missing values were dropped, and multicollinearity was assessed. A random forest classifier that learns to predict falls was trained to investigate the importance of each individual feature.

RESULTS

Twenty-four questions were included in the classification-model. Based on the output of the model all factors were associated with the risk of falling of which two were biological risk factors, eight behavioural, 11 socioeconomic and three environmental risk factors. Each of these variables contributed between 4.5 and 6.5% to explaining the risk of falling.

CONCLUSION

The present study identified 24 fall risk factors using machine learning techniques to identify older adults at high risk of falling. Maintaining a mental, physical and socially active lifestyle, reducing vulnerability and feeling satisfied with the living situation contributes to reducing the risk of falling. Further research is warranted to establish an easy-to-use screening tool to be applied in daily practice.

Multimorbidity and its socio-economic associations in community-dwelling older adults in rural Tanzania; a cross-sectional study

Objectives

This paper aims to describe the prevalence and socio-economic associations with multimorbidity, by both self-report and clinical assessment/screening methods in community-dwelling older people living in rural Tanzania.

Methods

A randomised frailty-weighted sample of non-institutionalised adults aged ≥ 60 years underwent comprehensive geriatric assessment and in-depth assessment. The comprehensive geriatric assessment consisted of a history and focused clinical examination. The in-depth assessment included standardised questionnaires, screening tools and blood pressure measurement. The prevalence of multimorbidity was calculated for self-report and non-self-reported methods (clinician diagnosis, screening tools and direct measurement). Multimorbidity was defined as having two or more conditions. The socio-demographic associations with multimorbidity were investigated by multiple logistic regression.

Results

A sample of 235 adults participated in the study, selected from a screened sample of 1207. The median age was 74 years (range 60 to 110 inter-quartile range (IQR) 19) and 136 (57.8%) were women. Adjusting for frailty-weighting, the prevalence of self-reported multimorbidity was 26.1% (95% CI 16.7–35.4), and by clinical assessment/screening was 67.3% (95% CI 57.0–77.5). Adjusting for age, sex, education and frailty status, multimorbidity by self-report increased the odds of being financially dependent on others threefold (OR 3.3 [95% CI 1.4–7.8]), and of a household member reducing their paid employment nearly fourfold (OR 3.8. [95% CI 1.5–9.2]).

Conclusions

Multimorbidity is prevalent in this rural lower-income African setting and is associated with evidence of household financial strain. Multimorbidity prevalence is higher when not reliant on self-reported methods, revealing that many conditions are underdiagnosed and undertreated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14340-0.

Frailty as a Predictor of Adverse Outcomes among Spanish Community-Dwelling Older Adults

Spain is one of the European countries with the oldest populations. The prevalence of frailty among Spanish older people ranges from 8.4 to 29.4% and currently, is one of the most relevant public health challenges. The Tilburg Frailty indicator (TFI) has been widely used in the community and in healthcare settings for assessing frailty. The objective of this study is to evaluate the predictive performance of the TFI for several adverse outcomes among Spanish community-dwelling older adults. The predictive performance was tested through linear regression analyses and receiver operating characteristics (ROC) curves. A total of 552 Spanish older adults composed the study sample. Participants were assessed at baseline and after 6 months. Main results showed that frailty was strongly and significantly correlated with disability, physical health, mental health and falls efficacy. The TFI score predicted most of these adverse outcomes. The ROC analyses confirmed the acceptable predictive performance of the total frailty. This study provides new evidence confirming that the TFI is a valid tool to predict several adverse outcomes in Spanish older adults, which may allow professionals to plan and activate health and social care resources to support frail patients' needs.

Systematic review and critical methodological appraisal of community-based falls prevention economic models

BACKGROUND

Falls impose significant health and economic burdens on community-dwelling older persons. Decision modelling can inform commissioning of alternative falls prevention strategies. Several methodological challenges arise when modelling public health interventions including community-based falls prevention. This study aims to conduct a systematic review (SR) to: systematically identify community-based falls prevention economic models; synthesise and critically appraise how the models handled key methodological challenges associated with public health modelling; and suggest areas for further methodological research.

METHODS

The SR followed the 2021 PRISMA reporting guideline and covered the period 2003-2020 and 12 academic databases and grey literature. The extracted methodological features of included models were synthesised by their relevance to the following challenges: (1) capturing non-health outcomes and societal intervention costs; (2) considering heterogeneity and dynamic complexity; (3) considering theories of human behaviour and implementation; and (4) considering equity issues. The critical appraisal assessed the prevalence of each feature across models, then appraised the methods used to incorporate the feature. The methodological strengths and limitations stated by the modellers were used as indicators of desirable modelling practice and scope for improvement, respectively. The methods were also compared against those suggested in the broader empirical and methodological literature. Areas of further methodological research were suggested based on appraisal results.

RESULTS

46 models were identified. Comprehensive incorporation of non-health outcomes and societal intervention costs was infrequent. The assessments of heterogeneity and dynamic complexity were limited; subgroup delineation was confined primarily to demographics and binary disease/physical status. Few models incorporated heterogeneity in intervention implementation level, efficacy and cost. Few dynamic variables other than age and falls history were incorporated to characterise the trajectories of falls risk and general health/frailty. Intervention sustainability was frequently based on assumptions; few models estimated the economic/health returns from improved implementation. Seven models incorporated ethnicity- and severity-based subgroups but did not estimate the equity-efficiency trade-offs. Sixteen methodological research suggestions were made.

CONCLUSION

Existing community-based falls prevention models contain methodological limitations spanning four challenge areas relevant for public health modelling. There is scope for further methodological research to inform the development of falls prevention and other public health models.

Creation of a new frailty scale in primary care: the Zulfiqar Frailty Scale

Background

Preventing dependency is a public health objective. We want to evaluate the ability of the "Zulfiqar Frailty Scale" (ZFS) tool to detect frailty as defined by Fried's criteria among a group of patients aged 75 and older.

Methods

Prospective study conducted in Poitou-Charentes (France) for 12 months on patients aged 75 and over and considered autonomous in terms of the ADL scale. To be eligible, the patients could not reside in a nursing home and needed an ADL score of 4 or higher.

Results

Among the group of 200 patients (with a mean age of 81.4 years, +/- 4.82), the prevalence of frailty according to Fried's criteria was 32.5%. The prevalence of frailty according to the "Zulfiqar Frailty Scale" tool was 35.0% and all items except home confinement were significantly associated with frailty. With this tool, the threshold for identifying frailty was 3 out of 6 criteria. It was quick (average completion time of 2 minutes and 2 seconds) with a sensitivity score of 88.0% and a negative predictive value of 91.0%.

Conclusion

The "Zulfiqar Frailty Scale" tool measures frailty just as effectively as Fried's criteria, with sensitivity and negative predictive values no lower than the latter.

Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study

Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients. Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention. Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT). Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients' exercise motivation and rehabilitation success.

Medical and Social Factors Associated with Referral for Elder Abuse Services in a National Healthcare System

BACKGROUND

Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target healthcare-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national US healthcare system.

METHODS

We conducted a national case-control study in US Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010-18. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models.

RESULTS

Of 5,567,664 Veterans meeting eligibility criteria during the study period, 15,752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (aOR; 95%CI), age ≥85 (3.56 v. age 60-64; 3.24-3.91), female sex (1.96; 1.76-2.21), child as next-of-kin (1.70 v. spouse; 1.57-1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15-1.21), dementia diagnosis (3.01; 2.77-3.28) and receiving a VA pension (1.34; 1.23-1.46) were associated with receiving EA services.

CONCLUSION

In the largest cohort of patients receiving EA-related healthcare services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in healthcare-based EA surveillance and detection.

Zulfiqar Frailty Scale: Overview, Stakes, and Possibilities

Very few frailty scales are used by general practitioners, as they are time consuming and cumbersome. We developed a frailty screening tool for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). This scale was tested in multiple general practitioners’ offices in France, and these studies were published. In this paper, we offer a summary of these results.

In community-dwelling women frailty is associated with imminent risk of osteoporotic fractures

Frailty reflects an accelerated health decline. Frailty is a consequence of fracture and contributes to fracture. Greater frailty was associated with higher fracture risk. Frail women were at immediate risk (within 24 months) of a hip or major fracture. Fracture prevention could be improved by considering frailty status.

INTRODUCTION

Frailty encompasses the functional decline in multiple systems, particularly the musculoskeletal system. Frailty can be a consequence of and contribute to fracture, leading to a cycle of further fractures and greater frailty. This study investigates this association, specifically time frames for risk, associated fracture types, and how grade of frailty affects risk.

METHODS

The study is performed in the OPRA cohort of 1044, 75-year-old women. A frailty index was created at baseline and 5 and 10 years. Women were categorized as frail or nonfrail and in quartiles (Q1 least frail; Q4 most frail). Fracture risk was assessed over short (1 and 2 years) and long terms (5 and 10 years). Fracture risk was defined for any fracture, major osteoporotic fractures (MOFs), and hip and vertebral fracture, using models including bone mineral density (BMD) and death as a competing risk.

RESULTS

For women aged 75, frailty was associated with higher risk of fracture within 2 years (Hip SHR_adj. 3.16 (1.34-7.47)) and MOF (2 years SHR_adj. 1.88 (1.12-3.16)). The increased risk continued for up to 5 years (Hip SHR_adj. 2.02 (1.07-3.82)); (MOF SHR_adj. 1.43 (0.99-2.05)). Grade of frailty was associated with increased 10-year probability of fracture (p = 0.03). Frailty predicted fracture independently of BMD. For women aged 80, frailty was similarly associated with fracture.

CONCLUSION

Frail elderly women are at immediate risk of fracture, regardless of bone density and continue to be at risk over subsequent years compared to identically aged nonfrail women. Incorporating regular frailty assessment into fracture management could improve identification of women at high fracture risk.

Associations Between Intellectual and Social Activities With Frailty Among Community-Dwelling Older Adults in China: A Prospective Cohort Study

Background: Frailty is one of the most important global health challenges. We aimed to examine the associations between frequency of intellectual and social activities and frailty among community-dwelling older adults in China.

Methods: This is a prospective analysis of older adults (aged ≥60 years) who had intellectual and social activity data and were free of frailty from the national representative China Health and Retirement Longitudinal Study (CHARLS). The exposure was frequency of intellectual and social activities. Frailty was measured by the frailty index (FI) and defined as FI ≥ 0.25. Frailty incidents were followed up for 2 years. We estimated the relative risks (RRs) with 95% confidence intervals (CIs) using log-linear binominal regression adjusting for potential confounders.

Results: We documented 655 frailty cases over the past 2 years. Participants who had frequent intellectual activities had a lower frailty risk compared with participants who did not have intellectual activity (adjusted RR = 0.65, 95%CI = 0.47–0.90). The adjusted RRs were 0.51 (95%CI = 0.33–0.77) for participants who did not have a slip or a fall accident and 1.06 (95%CI = 0.65–1.75) for participants who had experienced slip and fall accidents (P = 0.01 for interaction). Having frequent social activities was not associated with a significant decrease in frailty risk compared with participants who did not have social activity (adjusted RR = 0.93, 95%CI = 0.78–1.12).

Conclusions: This observational study showed that having frequent intellectual activities was associated with a decreased frailty risk. The association was likely to be stronger in participants without a slip or a fall accident. Randomized controlled trials are needed to confirm this observational finding.

Frailty, with or without Cognitive Impairment, is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults

BACKGROUND

Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults.

METHODS

The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017).

RESULTS

Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13).

CONCLUSIONS

Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

Closing the Osteoporosis Care Gap

PURPOSE OF REVIEW

This review outlines the scope of the problem in osteoporosis care and secondary fracture prevention and describes fracture prevention strategies, with a focus on the frail elderly.

RECENT FINDINGS

Despite heightened awareness among patients and clinicians alike and the availability of efficacious anti-osteoporosis medications, osteoporosis is still underdiagnosed and undertreated. However, the introduction of systematic risk assessment and secondary fracture prevention programmes has gained momentum, and evidence of success is accumulating. We possess today the knowledge required to close the osteoporosis care gap. The basic components in a secondary prevention model are similar in all health care settings, number one being a dedicated fracture coordinator, with anti-osteoporosis medications and multifaceted falls prevention as cornerstones, particularly in the frailest, both in the near and long-term. Initiation of structured care pathways including the key elements - identification, investigation, intervention and follow-up of adherence - demonstrably reduces re-fracture rates and is cost-effective.

A Non-Controlled Study of a Multi-Factorial Exercise and Nutritional Intervention to Improve Functional Performance and Prevent Frailty Progression in Community-Dwelling Pre-Frail Older Adults

Background

Preventing frailty is important to avoid adverse health outcomes. Intervention studies have largely focused on frail elderly, although the intermediate pre-frail state may be more amenable to improvement.

Objectives

This study aims to assess how physical performance may change among pre-frail elderly enrolled in a pragmatic non-controlled exercise and nutritional intervention programme.

Methods

This is a non-controlled study involving a 4-month exercise and nutritional intervention for community dwelling pre-frail older adults. Pre-frailty was defined as the presence of 1 or 2 positive responses on the FRAIL questionnaire, or evidence of weak grip strength (<26kg for males; <18kg for females) or slow gait speed (<0.8m/s) amongst participants who were asymptomatic on FRAIL. Physical performance in flexibility, grip and lower limb strength, endurance, balance, and Short Physical Performance Battery were measured at 3 time-points: baseline, 3-month from recruitment (without intervention), and immediate post-intervention. Repeated measures mixed model analysis was performed to compare physical performance measures across the 3 time-points.

Results

94 pre-frail participants were eligible for intervention, of whom 59 (mean age = 70.9±7.2 years) were ready for the post-intervention review. 21 (35.6%) transitioned to robust phenotype while 32 (54.2%) remained as pre-frail. Significant improvement post-intervention was observed in lower limb strength and power, evident on reduction in time taken for 5 sit-to-stand repetitions (0.46±0.20s, p=0.03). There was no significant change to the other physical performance measures examined.

Conclusion

We observed reversibility of pre-frailty, and the benefit of multi-component intervention in improving physical performance of pre-frail older adults. The findings in this non-controlled study will need to be corroborated with future controlled trials.

Correlation between timed up and go test and skeletal muscle tensiomyography in female nursing home residents

OBJECTIVES

Tensiomyography (TMG) derived contraction time (Tc) and amplitude (Dm) are related to muscle fibre composition and to muscle atrophy/tone, respectively. However, the link between mobility and TMG-derived skeletal muscle contractile properties in older persons is unknown. The aim of the study was to correlate lower limb skeletal muscle contractile properties with balance and mobility measures in senior female residents of retirement homes in Austria.

METHODS

Twenty-eight female participants (aged from 67-99 years) were included in measurements of contractile properties (TMG) of four skeletal muscles: vastus lateralis, vastus medialis, biceps femoris and gastrocnemius medialis. Their balance and mobility performance was measured using a timed up and go test (TUG).

RESULTS

Time needed to complete TUG is negatively correlated to biceps femoris (r= -0.490; p= 0.008), vastus lateralis (r= -0.414; p=0.028) and vastus medialis (r= -0.353; p=0.066) Dm and positively correlated to vastus lateralis Tc (r=0.456; p=0.015). Overall, vastus lateralis Tc and vastus medialis Dm explained 37% of TUG time variance.

CONCLUSIONS

Our study demonstrates that TMG-derived quadriceps muscle contractile parameters are correlated with the balance and mobility function in female nursing home residents.

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

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.

Electronic supplementary material

The online version of this article (10.1007/s40520-019-01467-1) contains supplementary material, which is available to authorized users.

Predicting Short-Term Risk of Falls in a High-Risk Group With Dementia

OBJECTIVES

To develop a prognostic model to predict the probability of a short-term fall (within the next 7 to 30 days) in older adults with dementia.

DESIGN

Prospective observational study.

SETTING AND PARTICIPANTS

Fifty-one individuals with dementia at high risk of falls from a specialized dementia inpatient unit.

METHODS

Clinical and demographic measures were collected and a vision-based markerless motion capture was used to record the natural gait of participants over a 2-week baseline. Falls were tracked throughout the length of stay. Cox proportional hazard regression analysis was used to build a prognostic model to determine fall-free survival probabilities at 7 days and at 30 days. The model's discriminative ability was also internally validated.

RESULTS

Fall history and gait stability (estimated margin of stability) were statistically significant predictors of time to fall and included in the final prognostic model. The model's predicted survival probabilities were close to observed values at both 7 and 30 days. The area under the receiver operating curve was 0.80 at 7 days, and 0.67 at 30 days and the model had a discrimination performance (the Harrel concordance index) of 0.71.

CONCLUSIONS AND IMPLICATIONS

Our short-term falls risk model had fair to good predictive and discrimination ability. Gait stability and recent fall history predicted an imminent fall in our population. This provides some preliminary evidence that the degree of gait instability may be measureable in natural everyday gait to allow dynamic falls risk monitoring. External validation of the model using a separate data set is needed to evaluate model's predictive performance.

Risk factors for future falls among community-dwelling older adults without a fall in the previous year: A prospective one-year longitudinal study

INTRODUCTION

One of the main risk factor for falls is a history of falls itself. Henceforth, preventing a fall is an important strategy for the prevention of new ones. The objective of the present study was to determine whether personal self-perception questions and functional tests might represent risk factors for a fall during the year following a year without any falls among independent community-dwelling older adults, considering a period of 12 prospective months.

METHODS

A total of 101 community-dwelling older adults without a fall in the previous year underwent an initial evaluation (sample characterization, self-perception questionnaire and functional tests) and monthly monitoring of prospective fall episodes by telephone contact. We determined the association between the occurrence of prospective falls (dependent variable) and personal questions and functional tests (independent variables) with multiple binary logistic regression adjusted for confounding variables.

RESULTS

Only age (p = 0.005) and self-perception of general health (p = 0.019) showed association with the occurrence of prospective falls.

CONCLUSION

Our results showed that the only factors bearing an association with the occurrence of prospective falls were age and general health self-perception, which demonstrates the importance of administrating self-perception measures in clinical practice or in epidemiological studies for the prevention of a fall during the year following a year without any falls in older adults.

Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study

A reduction in hip fracture incidence following population screening might reflect the effectiveness of anti-osteoporosis therapy, behaviour change to reduce falls, or both. This post hoc analysis demonstrates that identifying high hip fracture risk by FRAX was not associated with any alteration in falls risk.

INTRODUCTION

To investigate whether effectiveness of an osteoporosis screening programme to reduce hip fractures was mediated by modification of falls risk in the screening arm.

METHODS

The SCOOP study recruited 12,483 women aged 70-85 years, individually randomised to a control (n = 6250) or screening (n = 6233) arm; in the latter, osteoporosis treatment was recommended to women at high risk of hip fracture, while the control arm received usual care. Falls were captured by self-reported questionnaire. We determined the influence of baseline risk factors on future falls, and then examined for differences in falls risk between the randomisation groups, particularly in those at high fracture risk.

RESULTS

Women sustaining one or more falls were slightly older at baseline than those remaining falls free during follow-up (mean difference 0.70 years, 95%CI 0.55-0.85, p < 0.001). A higher FRAX 10-year probability of hip fracture was associated with increased likelihood of falling, with fall risk increasing by 1-2% for every 1% increase in hip fracture probability. However, falls risk factors were well balanced between the study arms and, importantly, there was no evidence of a difference in falls occurrence. In particular, there was no evidence of interaction (p = 0.18) between baseline FRAX hip fracture probabilities and falls risk in the two arms, consistent with no impact of screening on falls in women informed to be at high risk of hip fracture.

CONCLUSION

Effectiveness of screening for high FRAX hip fracture probability to reduce hip fracture risk was not mediated by a reduction in falls.

Trajectory of recurrent falls in post-menopausal breast cancer survivors and in matched cancer-free controls

PURPOSE

Cross-sectional studies suggest that falls are prevalent among older breast cancer survivors. However, fall risk in this population has not been comprehensively examined. Therefore, we compared fall risk in older women post-breast cancer diagnosis to fall risk before cancer diagnosis and to risk in cancer-free matched controls.

METHODS

Among 2019 women in the Women's Health Initiative with localized breast cancer diagnosed at age ≥ 60 years with fall assessment data for 3 years pre-diagnosis and 3 years post-diagnosis, recurrent fall risk post-diagnosis was compared to risk in 2019 cancer-free controls matched by age, year of WHI entry, and baseline fall frequency. Generalized estimating equations under a logistic regression model were used to compare fall recurrence in breast cancer survivors and controls. Multi-variable models were adjusted for the matching factors, race/ethnicity, body mass index, and multiple chronic conditions.

RESULTS

In breast cancer survivors aged 70.8 years (mean) at diagnosis, over the 3-year pre-diagnosis interval, recurrent falls were reported by 18.5%. Over the 3-year post-diagnosis interval, recurrent falls were reported by 21.8% of breast cancer survivors and 20.0% of controls over the same time period (P = 0.27). Recurrent fall risk did not differ between breast cancer survivors and control women (OR 1.07, 95% CI 0.92-1.25), even after multi-variable adjustment.

CONCLUSIONS

In contrast to prior reports, older breast cancer survivors were not more likely to experience recurrent falls than age-matched counterparts. These findings underscore the need for incorporation of cancer-free control populations in survivorship studies to distinguish cancer sequelae from processes related to aging.

Frailty Is an Independent Risk Factor for Mortality, Cardiovascular Disease, Bone Disease, and Diabetes Among Aging Adults With Human Immunodeficiency Virus

BACKGROUND

We characterized associations between frailty and incident cardiovascular disease (CVD), diabetes mellitus (DM), bone disease, and mortality within a cohort of aging persons with human immunodeficiency virus (PWH).

METHODS

Participants underwent frailty evaluations using the Fried frailty assessment (baseline and annually). Frailty was defined as having ≥3 frailty criteria. Clinical outcomes of mortality, CVD events, DM, and bone disease events were recorded throughout the study period (baseline to most recent study or clinic visit, or date of clinical outcome, whichever came first). Poisson regression models were used to evaluate associations between baseline frailty, change in frailty score over 48 weeks, and each clinical outcome.

RESULTS

Among 821 men and 195 women (median age 51 years), 62 (6%) were frail at baseline. Frailty scores increased by ≥1 component among 194 participants (19%) from baseline to 48 weeks. Baseline frailty was associated with an increased risk of incident CVD and DM, with a trend toward a significant association with bone events. Among frailty components, slow gait speed was associated with incident DM and borderline associated with incident CVD. An increase in frailty from baseline to week 48 was associated with mortality but not with the other clinical outcomes.

CONCLUSIONS

Baseline frailty was associated with multiple adverse health outcomes (incident CVD, DM, and bone disease), while increase in frailty score was associated with mortality among PWH engaged in care. Incorporation of frailty assessments into the care of PWH may assist in improvement of functional status and risk stratification for age-related chronic diseases.

Frailty in men living with HIV: a cross-sectional comparison of three frailty instruments

BACKGROUND

Potent antiretroviral treatment has resulted in near normal life expectancy for people living with HIV. Consequently, there is an increased focus on comorbidities, frailty and quality of life.

METHODS

We assessed and compared the prevalence of frailty, associated factors and relationship with quality of life in older Australian men living with HIV in a cross-sectional study using three frailty measurements. The Frailty Phenotype, Frailty Index and Edmonton Frail Scale were applied to 93 HIV-infected men aged over 50 years, on antiretroviral therapy. Multivariable ordinal logistic regression was used to analyse the associations of frailty with covariates and quality of life.

RESULTS

The prevalence of frailty was 10.8% (n=10) using the Frailty Phenotype; 22.6% (n=21) using the Frailty Index and 15.1% (n=14) using the Edmonton Frail Scale. Frailty Phenotype-defined pre-frailty/frailty was associated with pre-1996 ART initiation (OR, 3.56; CI, 1.23, 10.36; P=0.020) and depression (OR, 3.74; CI, 1.24, 11.27; P=0.019). Osteoporosis, serious non-AIDS events and AIDS were associated with Frailty Index-defined frailty (OR, 4.84, CI, 1.27, 18.43, P=0.021; OR, 4.27, CI, 1.25, 14.58, P=0.020; OR, 4.62, CI, 1.30, 16.45, P=0.018, respectively) and Edmonton Frail Scale-defined frailty (OR, 7.51; CI, 1.55, 36.42; P=0.012; OR, 7.71; CI, 1.62, 36.75; P=0.010; OR, 8.53; CI, 1.70, 42.73; P=0.009, respectively), independent of age and current CD4⁺ T-cell count. Frailty, defined by any of the instruments, was significantly associated with poorer quality of life (P<0.001).

CONCLUSIONS

Identifying frailty is an increasingly important contemporary consideration of HIV care related to ageing and quality of life.

Frailty as the basis for physiotherapeutic procedures for 65+ patients

Introduction: The frailty syndrome (FS) is a syndrome of functional limitations related to the older age, and its specificity, as well as the scale of occurrence, justify the need for its description and ordering of knowledge in this area. Aim: The aim of the literature review is to systematize knowledge in the field of individual descriptive elements of FS and rehabilitation dedicated to FS. Material and metods: The publication is a review and systematizes research material in the field of syndrome frailty. The narrative review was based on the analysis of publications contained in the Pubmed database in the period 2012-2017 and Polish sources published in this period. The sources were selected in accordance with the purpose of the work. Results: The frailty syndrome is defined and defined in various ways, although the main reference refers to its first description, formulated by L. Fried et al. There are three main phenotypes of the weakness group, classified based on the criteria of the creators of this team. Different scales are used in diagnostics: CHS, FRAIL, ESF, as well as GFI, TFI and PLFI indicators. The frailty syndrome develops based on the causes and effects of the so-called a cascade of weaknesses, among them chronic inflammatory processes, sarcopenia and immunological changes are of key importance. Recommended physiotherapy regimens cover various cycles and types of physical activity, with the use of a 12-week program of exercises of various types most often emphasized. Conclusions: Frailty is a state of exhaustion of reserves and functional limitations of the older age, also referred to as a team of weakness, frailty and fragility. Most reports confirm the use and usefulness of the CHS scale. Lack of unambiguous physiotherapy regimens for FS. Article received: 04.01.2019; Accepted: 16.07.2019 Key words: frailty, weakness syndrome, exhaustion syndrome, the elderly, rehabilitation

Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents

BACKGROUND

Orthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents.

METHODS

From the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error.

RESULTS

Data were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (- 17.8 ± 4.2 vs - 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (- 22.7 ± 4.3 vs - 11.5 ± 3.3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005).

CONCLUSIONS

Frailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk.

Transitions between frailty states among community-dwelling older people: A systematic review and meta-analysis

Frailty is a well-established risk factor for adverse health outcomes. However, comparatively little is known about the dynamic nature of frailty and the extent to which it can improve. The purposes of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age>60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1-10 years), 13.7% (95%CI = 11.7-15.8%) improved, 29.1% (95%CI = 25.9-32.5%) worsened and 56.5% (95%CI = 54.2-58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI = 48.8-59.1%), 40.6% (95%CI = 36.7-44.7%) and 4.5% (95%CI = 3.2-6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI = 18.8-27.6%), 58.2% (95%CI = 55.6-60.7%) and 18.2% (95%CI = 14.9-21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI = 1.6-5.5%), 40.3% (95%CI = 34.6-46.1%) and 54.5% (95%CI = 47.6-61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered.

The relationship between the houseboundedness and frailty of community-dwelling elderly persons

This study aimed to verify whether the incidence of frailty in elderly individuals is higher among those who are housebound than those who are not. This study found no correlation between elderly people's houseboundedeness and physical, mental, social, and overall frailty. However, the Tilburg Frailty Indicator (TFI) frailty score and grip strength value were higher in non-housebound elderly persons than in housebound elderly ones. This suggests that being housebound may lead to frailty. On the other hand, it is thought that individual interaction with family and friends, and lack of anxiety about falls correlates with the prevention of frailty in housebound elderly persons. The results of the study also suggest that the basic checklist may be effective for ascertaining the actual situation of housebound elderly people who may be manifesting frailty.

Progression of frailty and prevalence of osteoporosis in a community cohort of older women-a 10-year longitudinal study

In community dwelling, 75-year-old women followed 10 years, a frailty index was created at each of three visits. Frailty score increased by ~ 6-7% annually. A higher frailty score was equivalent to being 5-10 years chronologically older. Frailty was associated with low bone density and higher risk of dying.

INTRODUCTION

To understand the distribution of frailty among a population-based sample of older community-dwelling women, progression over 10 years, and association with mortality and osteoporosis.

METHODS

The study is performed in a cohort designed to investigate osteoporosis. The OPRA cohort consists of 75-year-old women, n = 1044 at baseline, and follow-up at age 80 and 85. A frailty index (scored from 0.0-1.0) based on deficits in health across multiple domains was created at all time-points; outcomes were mortality up to 15 years and femoral neck bone density.

RESULTS

At baseline, the proportion least frail, i.e., most robust (FI 0.0-0.1) constituted 48%, dropping to 25 and 14% at age 80 and 85. On average, over 10 years, the annual linear frailty score progression was approximately 6-7%. Among the least frail, 11% remained robust over 10 years. A higher frailty score was equivalent to being 5 to 10 years older. Mortality was substantially higher in the highest quartile compared to the lowest based on baseline frailty score; after 10 years, 48.7% had died vs 17.2% (p = 1.7 × 10^-14). Mortality risk over the first 5 years was highest in the frailest (Q4 vs Q1; HR_unadj 3.26 [1.86-5.73]; p < 0.001) and continued to be elevated at 10 years (HR_unadj 3.58 [2.55-5.03]; p < 0.001). Frailty was associated with BMD after adjusting for BMI (overall p = 0.006; Q1 vs Q4 p = 0.003).

CONCLUSIONS

The frailty index was highly predictive of mortality showing a threefold increased risk of death in the frailest both in a shorter and longer perspective. Only one in ten older women escaped progression after 10 years. Frailty and osteoporosis were associated.

Recent History of Serious Fall Injuries and Posttransplant Outcomes Among US Kidney Transplant Recipients

BACKGROUND

Serious fall injuries are associated with poor outcomes among dialysis patients, but whether these associations hold in patients with a history of serious fall injury before kidney transplantation is unknown.

METHODS

In national administrative data, 22 474 US adults receiving a first kidney transplant in 2011-2014 with at least 1 year of follow-up before transplant were identified. Serious fall injuries in the year before transplant were identified using diagnostic codes for falls and simultaneous fractures, dislocations, or head trauma in inpatient or outpatient claims. We used multivariable Cox proportional hazards models to estimate associations of incident posttransplant outcomes with serious fall injury in the year before transplant.

RESULTS

A total of 620 (2.8%) recipients had serious fall injuries before transplant and were more likely to be white, female, and have more comorbid conditions than those without a fall injury. Although posttransplant recipient survival did not differ by recent serious fall injuries (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.78-1.36), these injuries were associated with 33% higher rates of graft failure (HR, 1.33; 95% CI, 1.03-1.72). Patients with serious fall injuries spent 12.1% of posttransplant follow-up hospitalized, a 3.3-fold higher rate than those without a fall, and had nearly 2-fold higher rates of skilled nursing facility utilization (HR, 1.98; 95% CI, 1.52-2.57).

CONCLUSIONS

Serious fall injuries are independently associated with significantly greater resource requirements and lower graft survival. Further study is needed to delineate the relationship between falls and adverse outcomes in transplant and reduce the incidence and deleterious effects of these events.

Quick and Simple FRAIL Scale Predicts Incident Activities of Daily Living (ADL) and Instrumental ADL (IADL) Disabilities: A Systematic Review and Meta-analysis

OBJECTIVES

To quantitatively examine frailty defined by FRAIL scale as a predictor of incident disability risks by conducting a systematic review and meta-analysis.

DESIGN

Systematic review and meta-analysis.

SETTING

A systematic review was conducted using 4 electronic databases (Embase, MEDLINE, CINAHL, and PsycINFO) in April 2018 for prospective cohort studies of middle-aged or older people examining associations between frailty and incident disability. Reference lists of the included studies were hand-searched for additional studies. Authors of potentially eligible studies were contacted for additional data if necessary. Methodological quality was assessed by the Newcastle-Ottawa scale.

PARTICIPANTS

Community-dwelling middle-aged and older people.

MEASUREMENTS

Incident risks of activities of daily living (ADL) or instrumental activities of daily living (IADL) disability according the FRAIL scale-defined frailty.

RESULTS

Seven studies provided odds ratios of incident disability risks according to frailty and were included in the meta-analysis. A random effects meta-analysis showed that frailty and prefrailty were significant predictors of ADL [pooled odds ratio (OR) = 9.82, 95% confidence interval (CI) = 4.71-20.46, P < .001 for frailty (FRAIL scale = 3-5) and pooled OR = 2.08, 95% CI = 1.77-2.45, P < .001 for prefrailty (FRAIL scale = 1-2) compared with robustness (FRAIL scale = 0); pooled OR = 4.44, 95% CI = 3.26-6.04, P < .001 for frailty compared with nonfrailty (FRAIL scale = 0-2)] and IADL (pooled OR = 2.50, 95% CI = 1.67-3.73, P < .001, for frailty and pooled OR = 1.74, 95% CI = 1.10-2.77, P = .02, for prefrailty compared with robustness). There was no evidence of publication bias.

CONCLUSIONS/IMPLICATIONS

The current study demonstrated that frailty status defined by the FRAIL scale was a significant predictor of disability among community-dwelling middle-aged and older individuals. In light of feasibility of the FRAIL scale, especially in a clinical setting, it may be a promising tool to facilitate the translation of frailty research into clinical practice.

Factors associated with frailty in older adults: a longitudinal study

OBJECTIVE

To determine the demographic and health factors related to the frailty syndrome in older adults.

METHODS

This is a longitudinal quantitative study carried out with 262 older adults aged 65 years and older, of both sexes, living at home. Data collection was carried out in Period 1 between October 2007 and February 2008, and in Period 2 between July and December 2013. For data collection, we used the sociodemographic profile instrument, the Edmonton Frail Scale, the Mini-Mental State Examination, the number of falls in the last 12 months, the number of self-reported diseases and used drugs, the Functional Independence Measure, and the Lawton and Brody Scale. We used descriptive statistics for data analysis, in the comparison of the means between periods, the nonparametric Wilcoxon test, and the method of Generalized Estimating Equations, which is considered an extension of the Generalized Linear Models with p ≤ 0.05.

RESULTS

Of the 515 participants, 262 completed the follow-up, with a predominance of females, older individuals, and those who had no partner; there was an increase in frail older adults. In the Generalized Estimating Equations analysis, frailty score was related to sociodemographic (increase in age, no partner, and low education level) and health variables (more diseases, drugs, falls, and decrease in functional capacity). There was an association between the variables of age (older), marital status (no partner), and loss of functional capacity.

CONCLUSIONS

Frailty syndrome was associated with increasing age, having no partner, and decreased functional capacity over time, and investments are required to prevent this syndrome and promote quality in aging.

Toward Smart Footwear to Track Frailty Phenotypes-Using Propulsion Performance to Determine Frailty

Frailty assessment is dependent on the availability of trained personnel and it is currently limited to clinic and supervised setting. The growing aging population has made it necessary to find phenotypes of frailty that can be measured in an unsupervised setting for translational application in continuous, remote, and in-place monitoring during daily living activity, such as walking. We analyzed gait performance of 161 older adults using a shin-worn inertial sensor to investigate the feasibility of developing a foot-worn sensor to assess frailty. Sensor-derived gait parameters were extracted and modeled to distinguish different frailty stages, including non-frail, pre-frail, and frail, as determined by Fried Criteria. An artificial neural network model was implemented to evaluate the accuracy of an algorithm using a proposed set of gait parameters in predicting frailty stages. Changes in discriminating power was compared between sensor data extracted from the left and right shin sensor. The aim was to investigate the feasibility of developing a foot-worn sensor to assess frailty. The results yielded a highly accurate model in predicting frailty stages, irrespective of sensor location. The independent predictors of frailty stages were propulsion duration and acceleration, heel-off and toe-off speed, mid stance and mid swing speed, and speed norm. The proposed model enables discriminating different frailty stages with area under curve ranging between 83.2–95.8%. Furthermore, results from the neural network suggest the potential of developing a single-shin worn sensor that would be ideal for unsupervised application and footwear integration for continuous monitoring during walking.

Have outcomes improved in trauma patients age 90 years and older over the past decade: Experience at a level II trauma center

INTRODUCTION

Managing trauma in the elderly is challenging and requires a multidisciplinary team approach. The aim of this study is to characterize and compare outcomes in patients 90 years and older in the last two decades.

METHODS

Retrospective review of trauma patients 90 years and older admitted from 1996 to 2015. The patients were divided into two groups: Early Decade (ED) and Late Decade (LD).

RESULTS

A total of 1697 patients were recorded, 551 (ED) and 1146 (LD). The mean age was 92.92 ± 8(90-108)[ED] and 92.9 ± 2.7(90-105)[LD] years. The most common mechanism and type of injury was falls and extremity trauma. Hospital length of stay (LOS) was shorter in the LD. There was no significant difference in in-hospital mortality or ICU LOS.

CONCLUSION

Trauma admission has increased in the last decade. However, in-hospital mortality remains low. It is important for multidisciplinary teams to allocate resources to treat this elderly population.

Cognitive Frailty is Associated with Fall-Related Fracture among Older People

OBJECTIVE

Cognitive frailty refers to cognitive impairment and physical frailty. Both cognitive impairment and physical frailty include risks of falling. The purpose of the study is to examine cognitive frailty and falling with/without a fracture.

DESIGN

Cross-sectional observation study.

SETTING

General communities in Japan.

PARTICIPANTS

Data of 10,202 older adults aged ≥ 65 years were collected.

MEASUREMENTS

Physical frailty was characterized as slow walking speed and/or muscle weakness. Assessment of cognitive function included word lists memory, attention, executive function, and processing speed. Cognitive impairment refers to one or more cognitive decline indicated by at least 1.5 standard deviations below the threshold after adjusting for age and education. We operationally defined cognitive frailty as having both cognitive impairment and physical frailty. Participants were interviewed about their falling, history of fall-related fractures, and several potentially confounding factors such as demographic characteristics.

RESULTS

Multinomial logistic regression analysis revealed that functional decline in all groups, as compared to the robust group, was significantly associated with falling without fractures, after adjusting for the covariates; cognitive impairment group (P = .017), physical frailty group (P = .002), and cognitive frailty group (P < .001). Only the cognitive frailty group had a significant association with fall-related fracture after adjusting for the covariates (OR 1.92, 95% CI: 1.20-3.08, P = .007).

CONCLUSION

Cognitive frailty is associated with not only falling but also fall-related fractures. Cognitive frailty may have a greater risk for fall-related fractures than cognitive impairment or physical frailty alone. Future research should examine causal the relationship between fall-related fractures and cognitive frailty.

Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation-based balance training (PBT) is an emerging task-specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill-based systems and therapist-applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long-term follow-up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; 17: 2294-2303..

Prevalence and risk factors of frailty among home care clients

BACKGROUND

Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated factors among 75-year-old or older home care clients.

METHODS

The study participants were 75-year-old or older home care clients living in three cities in Eastern and Central Finland. Home care clients who had completed the abbreviated Comprehensive Geriatric Assessment (aCGA) for frailty (n = 257) were included in the present study. Baseline data were obtained on functional status, cognitive status, depressive symptoms, self-rated health, ability to walk 400 m, nutritional status, drug use and comorbidities.

RESULTS

Most of the home care clients (90%) were screened for frailty using the aCGA. Multivariate analysis showed that the risk of malnutrition or malnutrition (OR = 4.27, 95% CI = 1.56, 11.68) and a low level of education (OR = 1.14, 95% CI = 1.07, 1.23) were associated with frailty.

CONCLUSION

Frailty is a prevalent problem among home care clients. The risk of malnutrition or malnourishment and a lower level of education increase the risk of frailty. Screening for frailty should be done to detect the most vulnerable older people for further intervention to prevent adverse health problems.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02214758 .

Predicting mortality and hospitalization of older adults by the multimorbidity frailty index

Background

Existing operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan’s claim database, and to understand its ability to predict adverse event.

Methods

This is a retrospective cohort study. Subjects aged 65 to 100 years who have full National Health Insurance coverage in 2005 were included. We constructed the multimorbidity frailty index using cumulative deficit approach and categorized study population according to the multimorbidity frailty index quartiles: fit, mild frailty, moderate frailty and severe frailty. The multimorbidity frailty index included deficits from outpatient and inpatient diagnosis. Associations with all-cause mortality, unplanned hospitalization and intensive care unit admission were assessed using Kaplan-Meier curves and Cox regression analyses.

Results

The multimorbidity frailty index incorporated 32 deficits, with mean multimorbidity frailty index score of 0.052 (standard deviation = 0.060) among 86,133 subjects included. Compared to subjects in fit category, subjects with severe frailty were associated with a 5.0-fold (adjusted hazard ratio, aHR 4.97; 95% confidence interval, 95% CI 4.49–5.50) increased risk of death at 1 year after adjusting for age and gender. Subjects with moderate frailty or mild frailty was associated with 3.1- (adjusted HR 3.08; 95% CI 2.80–3.39) or 1.9- (adjusted HR 1.86; 95% CI 1.71–2.01) folds increased risk, respectively.4.49–5.50). The risk trend of unplanned hospitalization and intensive care unit admission is similar among the study population. Besides, the association between the frailty categories and all three outcomes was slightly stronger among women.

Conclusion

The multimorbidity frailty index was highly associated with all-cause mortality, unplanned hospitalization and ICU admission. It could serve as an efficient tool for stratifying older adults into different risk groups for planning care management programs.

Timed up and go test combined with self-rated multifactorial questionnaire on falls risk and sociodemographic factors predicts falls among community-dwelling older adults better than the timed up and go test on its own

BACKGROUND

Early detection of falls risk among older adults using simple tools may assist in fall prevention strategies. The aim of this study was to identify the best parameters associated with previous falls, either the timed up and go (TUG) test combined with sociodemographic factors and a self-rated multifactorial questionnaire (SRMQ) on falls risk or the TUG on its own. Falls risk was determined based on parameters associated with previous falls.

DESIGN

This was a retrospective cohort study.

SETTING

The study was conducted in a community setting.

PARTICIPANTS

The participants were 1,086 community-dwelling older adults, with mean age of 69.6±5.6 years. Participants were categorized into fallers and nonfallers based on their history of falls in the past 12 months.

METHOD

Participants' sociodemographic data was taken, and SRMQ consisting of five falls-related questions was administered. Participants performed the TUG test twice, and the mean was taken as the result.

RESULTS

A total of 161 participants were categorized as fallers (14.8%). Multivariate logistic regression analysis showed that the model (χ2(6)=61.0, p<0.001, Nagelkerke R2=0.10) consisting of the TUG test, sociodemographic factors (gender, cataract/glaucoma and joint pain), as well as the SRMQ items "previous falls history" (Q1) and "worried of falls" (Q5), was more robust in terms of falls risk association compared to that with TUG on its own (χ2(1)=10.3, p<0.001, Nagelkerke R2=0.02).

CONCLUSION

Combination of sociodemographic factors and SRMQ with TUG is more favorable as an initial falls risk screening tool among community-dwelling older adults. Subsequently, further comprehensive falls risk assessment may be performed in clinical settings to identify the specific impairments for effective management.

The Complex Association Between Fear of Falling and Mobility Limitation in Relation to Late-Life Falls: A SHARE-Based Analysis

OBJECTIVE

This study examines fear of falling (FOF) in relation to falls in light of mobility limitation.

METHOD

Data on community-dwelling older Europeans, aged 65+, were drawn from two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analysis regressed fall status in 2013 on reported FOF 2 to 3 years earlier, controlling for previous falls.

RESULTS

FOF predicted subsequent falls when mobility limitation was low to moderate. However, the effect of FOF on fall probability was reversed when mobility limitation was high.

DISCUSSION

The analysis underscores a complex association between FOF and mobility limitation in relation to late-life falls. People who are worried about falling tend to fall more. Those having high mobility limitation but lacking FOF are also more likely to fall. In cases of considerable mobility limitation, FOF may act as a protective buffer. The less worried in this group, however, may be subject to greater falling, and thus require greater attention.