Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

Does concern about falling predict future falls in older adults? A systematic review and meta-analysis

BACKGROUND

The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.

METHODS

Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.

RESULTS

About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.

CONCLUSIONS

Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.

Risk factors for falls in older people with pre-frailty: A systematic review and meta-analysis

BACKGROUND

Frailty is considered highly prevalent among the elderly, and falls are a severe adverse event that occurs at a significantly higher rate in frail elderly patients, leading to serious consequences. The pre-frailty stage represents a reversible transitional state between health and frailty, and targeted interventions for pre-frail older adults can effectively reduce the incidence of falls in this population. Existing studies have not definitely identified the risk factors for falls in pre-frail older adults. This paper explores the relevant risk factors for falls in pre-frail older adults.

METHODS

PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wan fang, and VIP databases were searched for studies published from inception to 2023, without language restrictions. Observational studies were included in this systematic review that analyzed risk factors for accidental falls in pre-frail older adults. The NOS scale was used to evaluate the quality of cohort studies and case-control studies, while the AHRQ scale was used to evaluate the quality of the cross-sectional study. We utilized odds ratios (OR) and their corresponding 95 % confidence intervals (CI) to describe the statistical indicators. OR and 95 % CI values were directly extracted and organized in Excel. In cases where OR and CI values were not directly available, we extracted β and p values, calculated Exp using functions, and subsequently derived OR and 95 % CI using formulas. Finally, data pertaining to each risk factor were incorporated into RevMan 5.4 software for statistical analysis and effect size synthesis. We performed tests for heterogeneity and evaluated publication bias.

RESULTS

A total of 14,370 studies were initially identified, and 26 studies were included in the systematic review. Among these studies, 14 were of high quality, while the remaining 12 were of moderate quality. A total of 16 risk factors were identified as potential risk factors for falls in pre-frail older adults. Significant risk factors were peripheral neuropathy(OR = 3.18, 95 %CI:3.02-3.35), decreased gait speed(OR = 1.90, 95 %CI:1.60-2.27), decreased ability to perform activities of daily living(OR = 1.57, 95 % CI:1.42-1.75), grip strength decreases(OR = 1.53, 95 % CI:1.17-2.00), gender (female)(OR = 1.51, 95 % CI:1.39-1.64), pain(OR = 1.47, 95 %CI:1.41-1.54), history of falls(OR = 1.20, 95 %CI:1.13-1.28) and age(OR = 1.10, 95 %CI:1.07-1.14).

CONCLUSIONS

The occurrence of falls in pre-frail older adults is associated with multiple risk factors. These risk factors can provide clinical nursing staff with specific focal points for monitoring this population and devising targeted fall prevention measures, with the aim of reducing the incidence of falls in pre-frail older adults.

REGISTRATION

The systematic review was registered on the International Prospective Register of Systematic Review (CRD42023450670).

Risk prediction model of physical frailty for a rural older population: a cross-sectional study in Hunan Province, China

Introduction

Physical frailty is a common medical syndrome characterized by low muscle strength, low endurance, and reduced physiological function that leads to significantly negative health outcomes in older adults. This study investigated the risk variables among rural older adults in Hunan Province, China, and developed a physical frailty prediction model to inform policymaking to enhance their health and well-being.

Methods

This study was conducted from July 22 to September 3, 2022. A total of 291 participants were recruited using stratified cluster random sampling from five large villages in Hunan Province. Frailty screening was performed based on the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale, Geriatric Depression Scale 15-item version (GDS-15), Falls Efficacy Scale-International (FES-I), and Mini Nutrition Assessment-Short Form (MNA-SF). A logistic regression analysis was performed to identify the predictive factors for physical frailty and develop a physical frailty prediction model based on the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and Youden index.

Results

The physical frailty prevalence among rural older adults in Hunan Province was 21.31% (n = 62). Household income and expenditure [odds ratio (OR): 1.826, 95% confidence interval (CI): 1.142-2.918], physical exercise frequency (OR: 1.669, 95% CI: 1.137-2.451), depressive symptoms (OR: 9.069, 95% CI: 3.497-23.516), and fear of falling (OR: 3.135, 95% CI: 1.689-5.818) were identified as significant predictors of physical frailty in rural older individuals. The AUC for the frailty predictive model was 0.860 (95% CI: 0.805, 0.914). The sensitivity and specificity at the optimal cutoff value were 80.6 and 76.0%, respectively, with a Youden index of 0.566.

Conclusion

The prediction model constructed in this study demonstrated promise as a potential tool for evaluating physical frailty risk in older adults, which can contribute to healthcare providers' screenings for high-risk populations. Further multidimensional and experimental intervention studies should be conducted to prevent the occurrence and delay the progression of physical frailty in older adults.

A multiple correspondence analysis of the fear of falling, sociodemographic, physical and mental health factors in older adults

Fear of falling (FoF) is a disabling condition due to different factors. The present study assessed potential FoF predictors, among sociodemographic, physical, and mental health domains, and explored their structural patterns. This cross-sectional study is part of the Physical Activity Promotion & Domestic Accidents Prevention (PAP & DAP) project, and was targeted to a sample of 229 independent older people (M 14.0%, F 86.0%) aged over 60 (mean 70.5 ± 5.96), both normal and overweight (median BMI 25.8 kg/m2, Interquartile Range 5.24). Standardized tools were used to assess the variables: the Short Falls Efficacy Scale International for the FoF; an information questionnaire for the socio-demographic variables, the presence of diseases, and previous falls; the International Physical Activity Questionnaire for the PA level; the Senior Fitness Test for physical fitness data; the Short Form 12 questionnaire for variables in the mental domain; and the Psychological Well-Being Scale 24 for the psychological well-being. Correlation/regression analyses were used to explore relationships between FoF and the considered variables. A Multiple Correspondence Analysis (MCA) was conducted to show graphical patterns projected into space dimensions. A percentage of 59.0 of the sample showed moderate/high concern of falling. The multiple regression model showed the following variables being significant predictors (p < 0.05) of the FoF: BMI (coeff 0.44, SE 0.104), musculoskeletal disease (1.55, 0.681), upper body strength (0.33, 0.117), mobility and balance (0.76, 0.320), perceived physical health (- 0.21, 0.047), and self-acceptance (- 0.52, 0.190). MCA evidenced two dimensions: the first one explained 41.8% of the variance and was described mostly by FoF (square residuals 0.721), gender (0.670), leg strength (0.617), perceived mental health (0.591), musculoskeletal diseases (0.572), and PA level (0.556); the second dimension (12.3% of the variance), was characterized mainly by perceived physical health (0.350), life objectives (0.346), education (0.301), upper body strength (0.278), and living in family/alone (0.260). The pattern elicited by MCA was characterized by older subjects with moderate/high FoF having low education or no occupation, being overweight and inactive, suffering from different diseases, having low physical fitness, and declaring low perceived physical and mental health. These results suggest that interventions aimed at reducing FoF should be addressed to this specific profile of older people.

Is frailty associated with increased concerns about falling and activity restriction in community-dwelling older adults? A systematic review

PURPOSE

Concerns about falling (CaF) are common in older adults. They are associated with increased risk of falls, activity restriction, social isolation, and physical deconditioning. This systematic review assessed if frailty is a risk factor for CaF.

METHODS

Searches of cross-sectional and prospective studies exploring associations between frailty and CaF were conducted across five databases (Medline, CINAHL, Embase, Psychinfo and Scopus). The Risk of Bias in Non-randomised Studies of Exposure (ROBINS-E) was used to determine risk of bias.

RESULTS

The search identified 2492 articles, 12 were included for data extraction: 8 cross-sectional and 4 prospective studies. Participants' mean ages across the different studies ranged from 67.5 - 81.7 years. All adjusted analyses reported a significant association between increasing frailty and CaF, except for one cross-sectional paper. Significant adjusted Odd Ratios (ORs) ranged from 1.79 (CI = 1.18-2.71) to 144.78 (CI = 13.86 - 1512.60) for cross-sectional studies, and from 1.33 (CI = 1.04-1.69) to 12.4 (CI = 7.6-20.1) for prospective studies. Three studies (one cross-sectional and two prospective) explored the association between frailty and concern-related activity restriction: A significant association was reported in two prospective studies (adjusted OR = 1.58 (CI=1.09-2.30) and adjusted RRR = 3.91 (2.61-5.85)), but not the cross-sectional study (adjusted OR = 1.31 (CI=0.62-2.78)).

CONCLUSION

This review identifies strong associations between increasing frailty and both CaF and associated activity restriction. This expands previous work describing the opposite association (that CaF can lead to frailty), suggesting a bi-directional relationship. Clinicians working with pre-frail and frail older adults should consider screening for CaF.

PROSPERO

CRD42023371899.

Independent Association Between Frailty and Fear of Falling in Older Adults After Hip Fracture Surgery: A Cross-Sectional Study Using a Secondary Analysis

Purpose: This study aimed to investigate the independent association between the fear of falling (FOF) and frailty in Korean older adults after hip fracture surgery. Methods: The study included 149 participants. Participants were asked to provide general characteristics and complete walking speed, grip strength, frailty, and Short Falls Efficacy Scale-International assessments. A binary logistic regression model was used to investigate the independent association of the FOF with frailty. Results: Among the participants, 49% were found to be prefrail and 24.8% were frail. Additionally, 86.5% reported a moderate to severe FOF. Participants with a FOF were 1.23 times more likely to be frail, and those aged 85 years and older were 13.25 times more likely to be frail. Conclusion: This study's findings serve as a basis for developing and applying interventions to reduce frailty in older adults after hip fracture surgery. These interventions should consider the oldest-old (≥ 85 years) age group when they are designed.

Association Between Musculoskeletal Pain and Frailty Over Time in Older Adults

BACKGROUND AND PURPOSE

There is a high frequency of frailty in patients with musculoskeletal pain. Pain from osteoarthritis and lower back pain may be associated with frailty. However, the future risk of frailty among older adults with pain remains unclear. Thus, the primary objective of this study was to examine the association between musculoskeletal pain and the risk of becoming prefrail and frail in older adults.

PARTICIPANTS AND METHODS

A secondary analysis was performed using data from baseline and 1-, 2-, 3-, 4-, 6-, and 8-year follow-ups of the Osteoarthritis Initiative (OAI). The OAI recruited participants from 4 clinical sites in the United States, between February 2004 and May 2006. A self-reported questionnaire was used to determine the baseline musculoskeletal pain status in older adults (n = 1780) 65 years and older, including pain in the lower back, hip, knee, and at 2 or more sites. Using the Fried phenotypic criteria, participants were classified as nonfrail, prefrail, and frail at each period over 8 years.

RESULTS

After adjusting for age, sex, race, education, marital status, annual income, smoking status, comorbidities, and body mass index, binary logistic regression modeling using generalized estimating equations revealed that in older adults musculoskeletal pain in the lower back and at multiple sites was associated with a slightly but significantly decreased risk of prefrailty over time (adjusted odds ratio [AOR] = 0.98, 95% CI = 0.95-0.99, P = .019; AOR = 0.96, CI = 0.92-0.99, P = .032). The association between musculoskeletal pain and frailty among older adults was not statistically significant (all P > .05).

CONCLUSIONS

Musculoskeletal pain did not independently significantly increase the risk of prefrailty or frailty over time. It remains possible that when musculoskeletal is combined with other factors, the risk of prefrailty and frailty may be heightened. Further research into the combination of characteristics that best predict prefrailty and frailty, including but not limited to musculoskeletal pain, is warranted.

Impact of activity limitations due to fear of falling on changes in frailty in Korean older adults: a longitudinal study

This study investigated the frailty change patterns among Korean older adults during 2006-2020 and the effect of activity limitations induced by the fear of falling (FOF) on these patterns. We employed a descriptive longitudinal design utilizing data from Waves 1 to 8 of the Korean Longitudinal Study of Aging. The exclusion criteria were a baseline age < 65 years, frailty index (FI) captured only at baseline, and death or unknown survival status. Multilevel modeling, combining regression equations at two levels, was used to examine the effect of activity limitations due to FOF on frailty, adjusting for other confounding factors. An increase in FI (1.97; p < .001) was demonstrated in participants who had experienced falls versus those who had not in the past 2 years. Notably, those facing activity limitations due to FOF exhibited a more significant increase in FI (4.62; p < .001) compared with those without; frailty progression intensified over time in the former (0.54, p < .001). Activity limitations due to FOF had a more pronounced impact on frailty than falls; moreover, these activity limitations accelerated the progression of frailty. Healthcare providers must prioritize addressing FOF by employing both physical and psychological interventions to mitigate activity limitations and ultimately decelerate frailty.

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis

BACKGROUND

As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.

OBJECTIVES

To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.

DESIGN

A systematic review and meta-analysis was conducted by PRISMA guidelines.

METHODS

Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.

RESULTS

A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.

CONCLUSION

The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Physical-activity interventions to reduce fear of falling in frail and pre-frail older adults: a systematic review of randomized controlled trials

BACKGROUND

Frailty in older adults leads to progressive deterioration of their physical condition and makes them prone to develop Fear of Falling (FoF). Physical-activity interventions appear to be effective in managing the components of frailty but there is no clear evidence to determine whether physical-activity may affect FoF in frail and pre-frail older adults.

OBJECTIVE

Τhis systematic literature review aims to synthesize evidence on the relationship between the physical interventions to ameliorate balance, strength, and mobility and FoF reduction in frail and pre-frail older adults.

METHODS

Studies assessing physical-activity interventions for frail and pre-frail older adults aged 60 years and older were identified in English through searches in PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials databases till February 2023. Study quality was assessed, and a qualitative synthesis of results was performed.

RESULTS

A total of 13 studies published were included. All of them were Randomized Control Trials and the most frequent assessment tool used to assess FoF (10 of 13 studies) was the Fall Efficacy Scale-International (FES-I). Six studies were assessed as having a low risk of bias. Cumulatively, the findings of this review indicate that physical-activity interventions are effective in reducing the FoF of frail and pre-frail older adults.

CONCLUSION

The results are encouraging and recapitulate the positive role of physical interventions in FoF reduction. However, future research would benefit from longer follow-up periods, longer intervention duration, and participation of interdisciplinary teams.

Association between willingness to participate in physical and social activities and loneliness in older adults: A stratified analysis by social isolation status

BACKGROUND

This study aimed to examine the relationship between willingness to participate in physical activity (PA) and social activity (SA) and loneliness among community-dwelling older adults and to identify differences depending on whether or not they were socially isolated.

METHOD

This study included 4,590 participants aged 65 years or older. The study used the UCLA Loneliness Scale and a questionnaire to assess the willingness to participate in PA/SA. Social isolation was defined as the presence of two or more of the following conditions: domestic isolation, less social contact, and social disengagement. A binomial logistic regression analysis was conducted with loneliness as the dependent variable and willingness to participate in PA/SA as the independent variable, stratified by social isolation.

RESULTS

Those who experienced loneliness (n=1,595, 34.7%) were significantly more unwilling to participate in PA/SA than those who did not (p<0.05). For those in social isolation (n=321, 7.0%), there was no association between willingness to participate in PA/SA and loneliness [odds ratio (95% confidence interval); PA, 0.89 (0.41-1.92); SA, 0.52 (0.22-1.20)]. Those without social isolation showed no association between willingness to participate in PA and loneliness; however, there was a significant association with willingness to participate in SA [PA, 1.05 (0.81-1.36); SA, 0.54 (0.41-0.72)].

CONCLUSION

Among people without social isolation, the willingness to participate in SA was associated with reduced loneliness. However, the results suggest that environmental factors may limit activity and increase loneliness among people with social isolation, even when willing to participate in PA/SA.

Bidirectional relationship between fear of falling and frailty among community-dwelling older adults: A longitudinal study

This study aims to examine the bidirectional association between fear of falling (FOF) and frailty among community-dwelling older adults. Longitudinal analyses were conducted over a representative sample of 5,829 community-dwelling individuals ≥65 years from the National Health and Aging Trends Study. FOF was ascertained by asking participants whether they worried about falling and if this worry ever limited their activities. Frailty status was assessed based on frailty phenotype. At baseline, 71.4% of participants reported no FOF, 16.7% reported FOF without fear-related activity restriction (FAR), and 11.9% reported FOF with FAR. The proportion of robust, pre-frail and frail respondents at baseline was 36.1%, 48.7% and 15.2%, respectively. Multinomial logistic regression models indicated FOF with and without FAR predicted pre-frailty and frailty. Pre-frailty predicted FOF with and without FAR, while frailty only predicted FOF with FAR. Tailored intervention strategies are needed for preventing adverse outcomes of FOF and frailty among the older population.

Recurrent Falls over Three Years among Older Adults Age 70+: Associations with Physical and Mental Health Status, Exercise, and Hospital Stay

We used the 2019-2021 U.S. National Health and Aging Trend Study (N = 3,063, age 70+) and multinomial logistic regression and generalized linear models with Poisson and log link to identify correlates of (1) recurrent falls (2 + falls) over 3 years (2019-2021); and (2) any subsequent fall among those who had a fall in 2019. We also examined the associations between falls and hospitalization in 2021. Results show that those with recurrent falls had greater physical/functional and psychological health problems in 2019, while single fallers over the 3 years were not significantly different from those without a fall. Exercise was associated with a lower likelihood of a subsequent fall among those who fell in 2019. Both a single fall and recurrent falls over the 3 years were associated with a higher risk of hospitalization in 2021. Multifactorial fall preventions including exercise and depression/anxiety treatment are needed to mitigate recurrent fall risks.

Longitudinal Relationship between Mobility Device Use, Falls and Fear of Falling (FOF) Differed by Frailty Status among Community-Dwelling Older Adults

OBJECTIVES

This study examined the longitudinal relationship between mobility device use, falls and fear of falling (FOF) among community-dwelling older adults by frailty status over a one-year follow-up.

DESIGN

A longitudinal cohort study.

SETTING

Communities in the United States.

PARTICIPANTS

Community-dwelling older adults from the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States (N=5,896).

MEASUREMENTS

Based on yes or no response to the corresponding items for the variables, fall-related outcomes were determined separately including falls and FOF. Falls were assessed by asking participants whether they had a fall and if they had fallen down more than one time. FOF was measured by asking participants whether they worried about falling and if this worry ever limited activities. Mobility device use was determined by asking whether participants used any type of mobility devices and the number of devices used, including cane, walker, wheelchair and scooter. Frailty was assessed using the frailty phenotype. Multinomial logistic regression models were conducted to examine the association between mobility device use and fall-related outcomes among older adults by frailty status.

RESULTS

At Year 1, 28.6% of participants reported using mobility devices. Among robust participants, using one mobility device had 3.58 times higher risks of FOF with fear-related activity restriction (FAR) than non-device users (95% CI: 1.10-11.65). Cane-only robust users had 5.94 and 2.18 times higher risks of FOF with and without FAR (95% CI: 1.80-19.57; 95% CI: 1.12-4.22) than non-device users. Among pre-frail participants, using one mobility device was associated with recurrent falls and FOF with FAR (RRR=2.02, 95% CI: 1.30-3.14; RRR=2.13, 95% CI: 1.25-3.63). Using ≥2 devices was associated with one fall (RRR=2.08, 95% CI: 1.30-3.33), recurrent falls (RRR=2.92, 95% CI: 1.62-5.25) and FOF with FAR (RRR=2.84, 95% CI: 1.34-6.02). Pre-frail cane-only users were more likely to have one fall (RRR=1.57, 95% CI: 1.06-2.32), recurrent falls (RRR=2.36, 95% CI: 1.48-3.77) and FOF with FAR (RRR=2.08, 95% CI: 1.12-3.87) than non-device users. The number of mobility device used and the use of canes failed to be significantly associated with fall-related outcomes among frail participants.

CONCLUSION

The number of mobility devices used and the only use of canes were associated with fall-related outcomes among robust and pre-frail individuals. Further research is needed to develop targeted strategies for preventing falls and FOF among older adults with mobility device use, particularly for those in the early stages of frailty.

Care and support networks of community-dwelling frail individuals in North West London: a comparison of patient and healthcare workers' perceptions

BACKGROUND

Evidence suggests that successful assessment and care for frail individuals requires integrated and collaborative care and support across and within settings. Understanding the care and support networks of a frail individual could therefore prove useful in understanding need and designing support. This study explored the care and support networks of community-dwelling older people accessing a falls prevention service as a marker of likely frailty, by describing and comparing the individuals' networks as perceived by themselves and as perceived by healthcare providers involved in their care.

METHODS

A convenience sample of 16 patients and 16 associated healthcare professionals were recruited from a community-based NHS 'Falls Group' programme within North-West London. Individual (i.e., one on one) semi-structured interviews were conducted to establish an individual's perceived network. Principles of quantitative social network analysis (SNA) helped identify the structural characteristics of the networks; qualitative SNA and a thematic analysis aided data interpretation.

RESULTS

All reported care and support networks showed a high contribution level from family and friends and healthcare professionals. In patient-reported networks, 'contribution level' was often related to the 'frequency' and 'helpfulness' of interaction. In healthcare professional reported networks, the reported frequency of interaction as detailed in patient records was used to ascertain 'contribution level'.

CONCLUSION

This study emphasises the importance of the role of informal carers and friends along with healthcare professionals in the care of individuals living with frailty. There was congruence in the makeup of 'patient' and 'provider' reported networks, but more prominence of helper/carers in patients' reports. These findings also highlight the multidisciplinary makeup of a care and support network, which could be targeted by healthcare professionals to support the care of frail individuals.

Association between oral function and physical pre-frailty in community-dwelling older people: a cross-sectional study

BACKGROUND

Few studies have examined the relationship between oral functions and the physical pre-frailty status, classified using physical function tests. This cross-sectional study aimed to clarify this association among community-dwelling older people from the Itoshima Frail Study in Itoshima Fukuoka Prefecture.

METHODS

Of the 1,555 individuals invited to join the study, 381 (188 males and 193 females) enrolled. Their physical pre-frailty was assessed with a classification system consisting of two physical indicators (fatigue and unintentional weight loss, determined with a questionnaire), two functional components (declined walking speed and muscle weakness, determined using a body function measuring instrument), and declined physical activity (examined using a triaxial accelerometer). Subsequently, the individuals were classified into three groups: robust, pre-frailty, and frailty. Along with the number of teeth remaining, oral functions, such as masticatory performance, tongue pressure strength, and oral diadochokinesis (ODK), were examined. Data regarding social activity and exercise habits were collected, and the individuals' body compositions were measured. Odds ratios (ORs) and 95% confidence intervals (CIs) for the physical pre-frailty were calculated using logistic regression models.

RESULTS

In this study, 126 (33%) participants presented with physical pre-frailty. The participants in the robust group were younger, had stronger maximum handgrip strength, and walked faster than those in the physical pre-frailty group (p < 0.001). The robust group presented with better oral functions (masticatory performance, p = 0.015; oral ODK /ta/, p = 0.004). The physical pre-frailty status was significantly associated with age (OR, 1.111; 95% CI, 1.048-1.178; p < 0.001), masticatory performance (OR, 0.819; 95% CI, 0.680-0.986; p = 0.035), low ODK/ta/ (OR, 1.864; 95% CI, 1.069-3.250; p = 0.028), and low social activity (OR, 2.273; 95% CI, 1.308-3.951; p = 0.004).

CONCLUSION

This study indicated that older people with higher age, lower anterior tongue movement, lower masticatory performance, and lower social activity are positively associated with physical pre-frailty.

Fear of Falling in Older Adults Treated at a Geriatric Day Hospital: Results from a Cross-Sectional Study

(1) Background: The fear of falling (FOF) is a geriatric syndrome that causes a decrease in daily activities and personal autonomy. Its prevalence is highly variable as are the methodologies used to assess it. This study aimed at estimating the prevalence and describing the main determinants of FOF in older adults attending a geriatric day hospital. (2) Methods: Descriptive, cross-sectional study of individuals aged ≥70 years, who attended an ambulatory functional rehabilitation group in the metropolitan area of Barcelona. FOF was assessed using the Activities-Specific Balance Confidence (ABC) scale. Other recorded outcomes were: sex, age, marital status, living alone, level of education, degree of autonomy, pain, previous falls, visual acuity, and signs of depression. Prevalence was estimated overall and according to the possible determinants. (3) Results: The study included 62 individuals (66.1% women), with a prevalence of fear of falling of 38.7% (95% CI 26.2–51.2%). The identified determinants were pain (OR = 7.4, 95% CI 1.4–39.7), a history of falls (OR = 25.3, 95% CI 2.1–303.4), poor visual acuity (OR = 5.6, 95% CI 1.0–29.8), and signs of depression (OR = 19.3, 95% CI 1.4–264.3). (4) Conclusions: The prevalence and determinants of fear of falling in older adults attending geriatric day hospitals were similar to those described in those dwelling in the community.

Association of frailty with fall events in older adults: A 12-year longitudinal study in Korea

BACKGROUND

Evidence has shown that frailty is associated with the risk of falls in older people. However, the components of frailty that have the highest association with fall events are largely unknown.

METHODS

This study analyzed panel data from the Korean Longitudinal Study of Aging. We used the Korean Frailty Instrument, which includes domains for social isolation, exhaustion and weakness estimated by grip strength, to assess frailty. Fall event data were collected during follow-up visits.

RESULTS

A total of 3122 community-dwelling adults aged 65 years or older were included at baseline in 2006 and were followed up every 2 years until 2018. The participants with frailty had a higher risk of falls than those without frailty (OR=1.31, 95% CI=1.11-1.54, P = 0.001; fully adjusted model). We found that three components of frailty, namely, social isolation, exhaustion, and weakness, were independently and significantly related to fall events in the unadjusted model. In the fully adjusted model, social isolation and exhaustion were significantly associated with fall events (OR=1.38, 95% CI=1.18-1.61, P < 0.001 and OR=1.28, 95% CI=1.10-1.51, P = 0.006, respectively), and there was no significant association between weakness and the risk of falls (OR=1.11, 95% CI=0.91-1.34, P = 0.307).

CONCLUSIONS AND IMPLICATIONS

Frailty was associated with more fall events in Korean older adults. Social isolation and exhaustion but not weakness were significantly associated with fall events. Our study suggests that interventions should be tailored to older adults with social and psychological frailty.

Simplified Decision-Tree Algorithm to Predict Falls for Community-Dwelling Older Adults

The present study developed a simplified decision-tree algorithm for fall prediction with easily measurable predictors using data from a longitudinal cohort study: 2520 community-dwelling older adults aged 65 years or older participated. Fall history, age, sex, fear of falling, prescribed medication, knee osteoarthritis, lower limb pain, gait speed, and timed up and go test were assessed in the baseline survey as fall predictors. Moreover, recent falls were assessed in the follow-up survey. We created a fall-prediction algorithm using decision-tree analysis (C5.0) that included 14 nodes with six predictors, and the model could stratify the probabilities of fall incidence ranging from 30.4% to 71.9%. Additionally, the decision-tree model outperformed a logistic regression model with respect to the area under the curve (0.70 vs. 0.64), accuracy (0.65 vs. 0.62), sensitivity (0.62 vs. 0.50), positive predictive value (0.66 vs. 0.65), and negative predictive value (0.64 vs. 0.59). Our decision-tree model consists of common and easily measurable fall predictors, and its white-box algorithm can explain the reasons for risk stratification; therefore, it can be implemented in clinical practices. Our findings provide useful information for the early screening of fall risk and the promotion of timely strategies for fall prevention in community and clinical settings.

Factors associated with frailty in Japanese patients with rheumatoid arthritis: results from the Institute of Rheumatology Rheumatoid Arthritis cohort study

This study aimed to evaluate the prevalence of, and the factors associated with, frailty in Japanese patients with rheumatoid arthritis (RA). Patients with RA enrolled in the Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort completed self-administered questionnaires, which included the 5-item frailty screening index. Patients were classified as frail, prefrail, or robust based on the 5 components of the frailty screening index. Logistic regression analyses were used to evaluate associations between clinical variables and frailty. Among 3,290 Japanese patients with RA (86.7% female, mean age 62.4 years) who participated this frailty study, 549 (16.7%) patients were categorized as frailty, 2,063 (62.7%) as prefrailty, and 678 (20.6%) as robust. In multivariable models, body mass index (BMI) ≥ 25 kg/m² (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.41 to 2.47), BMI < 18.5 kg/m² (OR 1.31, 95% CI 1.00 to 1.71), disease activity scores in 28 joints (DAS28) (OR 1.32, 95% CI 1.18 to 1.47), Japanese version of Health Assessment Questionnaire disability index (J-HAQ) (OR 1.26, 95% CI 1.04 to 1.52), the European Quality of Life-5 Dimensions (EQ-5D) (OR 0.80, 95% CI 0.74 to 0.85), non-steroidal anti-inflammatory drug (NSAID) use (OR 1.59, 95% CI 1.23 to 1.98), and methotrexate (MTX) use (OR 0.75, 95% CI 0.60 to 0.94) were significantly (P < 0.05) associated with frailty. BMI (both overweight and underweight), DAS28, J-HAQ, EQ-5D, NSAID use, and MTX nonuse appear to be associated with frailty in Japanese patients with RA. Key Points • This is the largest study showing the prevalence and the associated factors of frailty in patients with RA. • Maintaining normal BMI appears to be important for preventing frailty in patients with RA. • We confirmed the significant associations of frailty with high disease activity, high degree of disability, and poor health related QOL in Japanese patients with RA. • NSAID use and MTX nonuse were associated with the frailty in Japanese patients with RA, which could be explained by patients' background.

Factors associated with fear of falling among frail older adults

Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.

Association between self-reported or perceived fatigue and falls among older people: A systematic review

AIM

The aim of the present review was to examine the evidence of the relationship between self-reported or perceived fatigue and falls among older adults.

METHODS

A systematic review, following the PRISMA recommendations, was performed. PubMed, Scopus, Web of Science, and Cinahl were searched from February 2021 until March 2021, without any limitation on publication date. The methodological quality of the recruited studies was assessed with the Newcastle-Ottawa scale.

RESULTS

Of the 2,296 initially retrieved records, 20 met the inclusion criteria; 11 cohort and 9 cross-sectional studies. They were classified as "good or very good" studies. Data on 59,852 older adults was reported. Most studies reported a strong association between fatigue and incidence or risk of falls, with odds ratios ranging from 1.04 to 3.53. Evidence obout the relationship between fatigue and recurrent, as well as injurious, falls is limited.

CONCLUSIONS

Self-reported or perceived fatigue is associated with the incidence of falls or risk of falling among older adults. Nurses could contribute to decreasing the inicdence of falls through prevention and proper geriatric assessment, including the management of fatigue in their daily clinical practice. The evidence about the potential effect of fatigue on falls-related injuries is inconclusive and on recurrent falls remains to be further defined.