Skip to main content

Advertisement

SpringerLink
Log in

Prevention of Falls and Frailty in Older Adults with Diabetes

  • Nutrition, Obesity, and Diabetes (H Florez, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Type 2 diabetes mellitus (T2DM) is a major risk factor for falls and frailty in older adults. The purpose of this review was to survey, the current literature on risk factors and interventions for prevention of falls and frailty in older adults with T2DM.

Recent Findings

Screening for falls and frailty in the clinical setting is recommended. Exercise to improve balance, strength, and mobility; health education; and diabetes self-management are potential interventions for falls and frailty in older adults with T2DM. Pharmacologic agents are the focus of current studies which may lead to potential future interventions for both falls and frailty.

Summary

Evidence-based guidelines and tools for prevention and management of falls and frailty have been developed for clinicians caring for older adults. Because of the reciprocal relationship between falls and frailty, interventions to prevent one may also improve the other geriatric syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ACCORD:

Action to Control Cardiovascular Risk in Diabetes

ADA:

American Diabetes Association

AGS:

American Geriatrics Society

AUC:

Area under the curve

BGS:

British Geriatrics Society

BMD:

Bone mineral density

CDC:

Centers for Disease Control

CI:

Confidence interval

DHEAS:

Dehydroepiandrosterone sulfate

DSE:

Diabetes support and education

DPN:

Diabetic peripheral neuropathy

HRQL:

Health-related quality of life

ILI:

Intensive lifestyle intervention

LIFE:

Lifestyle Interventions and Independence for Elders

OR:

Odds ratio

STEADI:

Stopping Elderly Accidents, Deaths, & Injuries

T2DM:

Type 2 diabetes mellitus

WBV:

Whole body vibration

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Diabetes Association. Statistics About Diabetes. 2016,December 12. http://www.diabetes.org/diabetes-basics/statistics/?rererrer=https://www.google.com. Accessed 02 February 2017.

  2. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–56. doi:10.1111/jgs.12035.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kim KS, Kim SK, Sung KM, Cho YW, Park SW. Management of type 2 diabetes mellitus in older adults. Diabetes Metab J. 2012;36(5):336–44. doi:10.4093/dmj.2012.36.5.336.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Laiteerapong N, Karter AJ, Liu JY, Moffet HH, Sudore R, Schillinger D, et al. Correlates of quality of life in older adults with diabetes: the diabetes & aging study. Diabetes Care. 2011;34(8):1749–53. doi:10.2337/dc10-2424.

    Article  PubMed  PubMed Central  Google Scholar 

  5. •• American Geriatrics Society. Falls. In: JE FJaL, editor. Geriatrics evaluation & management tools: clinical templates to support clinicians and systems that are caring for Older adults. New York, NY2015. Provides an evidence-based tool for falls screening and management in the clinical setting.

  6. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged >/=65 years—United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(37):993–8. doi:10.15585/mmwr.mm6537a2.

    Article  PubMed  Google Scholar 

  7. Centers for Disease Control and Prevention. Costs of falls among older adults. 2016. https://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html. Accessed April 2 2017.

  8. • Yang Y, Hu X, Zhang Q, Zou R. Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis. Age Ageing. 2016;45(6):761–7. doi:10.1093/ageing/afw140. Identifies six prospective cohort studies conducted through November 2015 that have sufficient information to perform a meta-analysis to estimate the increased risk of falls in older adults with T2DM.

    Article  PubMed  Google Scholar 

  9. Pijpers E, Ferreira I, de Jongh RT, Deeg DJ, Lips P, Stehouwer CD, et al. Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam. Age Ageing. 2012;41(3):358–65. doi:10.1093/ageing/afr145.

    Article  PubMed  Google Scholar 

  10. Yau RK, Strotmeyer ES, Resnick HE, Sellmeyer DE, Feingold KR, Cauley JA, et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care. 2013;36(12):3985–91. doi:10.2337/dc13-0429.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Crews RT, Yalla SV, Fleischer AE, Wu SC. A growing troubling triad: diabetes, aging, and falls. J Aging Res. 2013;2013:342650. doi:10.1155/2013/342650.

    Article  PubMed  PubMed Central  Google Scholar 

  12. •• Vinik AI, Vinik EJ, Colberg SR, Morrison S. Falls risk in older adults with type 2 diabetes. Clin Geriatr Med. 2015;31(1):89–99. doi:10.1016/j.cger.2014.09.002. Reviews earlier literature on falls prevention with a focus on modifiable risk factors.

    Article  PubMed  Google Scholar 

  13. Caspersen CJ, Thomas GD, Boseman LA, Beckles GL, Albright AL. Aging, diabetes, and the public health system in the United States. Am J Public Health. 2012;102(8):1482–97. doi:10.2105/AJPH.2011.300616.

    Article  PubMed  PubMed Central  Google Scholar 

  14. American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes Mellitus. Guidelines abstracted from the American Geriatrics Society Guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc. 2013;61(11):2020–6.

    Article  PubMed Central  Google Scholar 

  15. Morrison S, Colberg SR, Parson HK, Vinik AI. Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy. J Diabetes Complicat. 2014;28(5):715–22. doi:10.1016/j.jdiacomp.2014.04.007.

    Article  Google Scholar 

  16. Chau RM, Ng TK, Kwan RL, Choi CH, Cheing GL. Risk of fall for people with diabetes. Disabil Rehabil. 2013;35(23):1975–80. doi:10.3109/09638288.2013.770079.

    Article  PubMed  Google Scholar 

  17. Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr. 2012;31(5):652–8. doi:10.1016/j.clnu.2012.02.007.

    Article  PubMed  Google Scholar 

  18. Ko SU, Stenholm S, Chia CW, Simonsick EM, Ferrucci L. Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy—results from the Baltimore Longitudinal Study of Aging. Gait Posture. 2011;34(4):548–52. doi:10.1016/j.gaitpost.2011.07.014.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lalli P, Chan A, Garven A, Midha N, Chan C, Brady S, et al. Increased gait variability in diabetes mellitus patients with neuropathic pain. J Diabetes Complicat. 2013;27(3):248–54. doi:10.1016/j.jdiacomp.2012.10.013.

    Article  Google Scholar 

  20. • Karmakar S, Rashidian H, Chan C, Liu C, Toth C. Investigating the role of neuropathic pain relief in decreasing gait variability in diabetes mellitus patients with neuropathic pain: a randomized, double-blind crossover trial. J Neuroeng Rehabil. 2014;11:125. doi:10.1186/1743-0003-11-125. Found that treatment of neuropathic pain with an analgesic drug rather than reducing the altered gait pattern of individuals with this condition resulted in increased gait variability, likely due to the potential adverse effects of analgesic drugs in increasing fall risk.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384–95. doi:10.2337/dc12-2480.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Johnston SS, Conner C, Aagren M, Ruiz K, Bouchard J. Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. Diabetes Obes Metab. 2012;14(7):634–43. doi:10.1111/j.1463-1326.2012.01583.x.

    Article  CAS  PubMed  Google Scholar 

  23. Signorovitch JE, Macaulay D, Diener M, Yan Y, Wu EQ, Gruenberger JB, et al. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab. 2013;15(4):335–41. doi:10.1111/dom.12031.

    Article  CAS  PubMed  Google Scholar 

  24. Chiba Y, Kimbara Y, Kodera R, Tsuboi Y, Sato K, Tamura Y, et al. Risk factors associated with falls in elderly patients with type 2 diabetes. J Diabetes Complicat. 2015;29(7):898–902. doi:10.1016/j.jdiacomp.2015.05.016.

    Article  Google Scholar 

  25. • Kachroo S, Kawabata H, Colilla S, Shi L, Zhao Y, Mukherjee J, et al. Association between hypoglycemia and fall-related events in type 2 diabetes mellitus: analysis of a U.S. commercial database. J Manag Care Spec Pharm. 2015;21(3):243–53. doi:10.18553/jmcp.2015.21.3.243. Well-designed study using a large US healthcare claims data base found that elderly patients with T2DM who had a hypoglycemic episode had a twofold increased risk of falls at 1 year following the episode compared to those with no hypoglycemic episodes.

    Article  PubMed  Google Scholar 

  26. Zhao Y, Kachroo S, Kawabata H, Colilla S, Mukherjee J, Fonseca V, et al. Association between hypoglycemia and fall-related fractures and health care utilization in older veterans with type 2 diabetes. Endocr Pract. 2016;22(2):196–204. doi:10.4158/EP15640.OR.

    Article  PubMed  Google Scholar 

  27. Lu CL, Hsu PC, Shen HN, Chang YH, Chen HF, Li CY. Association between history of severe hypoglycemia and risk of falls in younger and older patients with diabetes. Medicine (Baltimore). 2015;94(33):e1339. doi:10.1097/MD.0000000000001339.

    Article  CAS  Google Scholar 

  28. Schwartz AV, Margolis KL, Sellmeyer DE, Vittinghoff E, Ambrosius WT, Bonds DE, et al. Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial. Diabetes Care. 2012;35(7):1525–31. doi:10.2337/dc11-2184.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364–79. doi:10.2337/dc12-0413.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bruce D, Hunter M, Peters K, Davis T, Davis W. Fear of falling is common in patients with type 2 diabetes and is associated with increased risk of falls. Age Ageing. 2015;44(4):687–90. doi:10.1093/ageing/afv024.

    Article  PubMed  Google Scholar 

  31. American Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148–57.

    Article  Google Scholar 

  32. • Paton J, Glasser S, Collings R, Marsden J. Getting the right balance: insole design alters the static balance of people with diabetes and neuropathy. J Foot Ankle Res. 2016;9:40. doi:10.1186/s13047-016-0172-3. Calls attention to iatrogenic effects on postural instability and increased risk of falls associated with current off-loading footwear to relieve pain in diabetic ulcers.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Xiao CM, Zhuang YC. Effects of Tai Chi ball on balance and physical function in older adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2015;63(1):176–7. doi:10.1111/jgs.13207.

    Article  PubMed  Google Scholar 

  34. Morrison S, Colberg SR, Parson HK, Vinik AI. Relation between risk of falling and postural sway complexity in diabetes. Gait Posture. 2012;35(4):662–8. doi:10.1016/j.gaitpost.2011.12.021.

    Article  CAS  PubMed  Google Scholar 

  35. Morrison S, Colberg SR, Mariano M, Parson HK, Vinik AI. Balance training reduces falls risk in older individuals with type 2 diabetes. Diabetes Care. 2010;33(4):748–50. doi:10.2337/dc09-1699.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sanudo B. A primary care-based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112–8. doi:10.1016/j.apmr.2013.05.030.

    Article  PubMed  Google Scholar 

  37. • Becker C, Lord SR, Studenski SA, Warden SJ, Fielding RA, Recknor CP, et al. Myostatin antibody (LY2495655) in older weak fallers: a proof-of-concept, randomised, phase 2 trial. The lancet Diabetes & endocrinology. 2015;3(12):948–57. Demonstrates the potential for a novel pharmacological intervention to increase lean muscle mass and muscle power that may lead to its further development as a falls prevention intervention in weak older fallers.

    Article  CAS  Google Scholar 

  38. • Centers for Disease Control and Prevention. STEADI—older adult fall prevention. https://www.cdc.gov/steadi. Accessed April 22 2017. Includes materials for providers’ older adult patients as well as provider training and continuing education. Of particular importance is the focus on modifiable risk factors for falls and specification of appropriate and effective interventions.

  39. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults evidence for a phenotype. J Gerontol Ser A Biol Med Sci. 2001;56(3):M146–M57.

    Article  CAS  Google Scholar 

  40. Cesari M, Prince M, Thiyagarajan JA, De Carvalho IA, Bernabei R, Chan P, et al. Frailty: an emerging public health priority. J Am Med Dir Assoc. 2016;17(3):188–92.

    Article  PubMed  Google Scholar 

  41. Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004;52(1):80–5.

    Article  PubMed  Google Scholar 

  42. • Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty in older adults: a nationally representative profile in the United States. J Gerontol Ser A Biol Med Sci. 2015;70(11):1427–34. Characterized frailty in a large national study and reported on prevalence and outcomes.

    Article  Google Scholar 

  43. Vaingankar JA, Chong SA, Abdin E, Picco L, Chua BY, Shafie S et al. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatrics & Gerontology International. 2016.

  44. Castrejón-Pérez RC, Gutiérrez-Robledo LM, Cesari M, Pérez-Zepeda MU. Diabetes mellitus, hypertension and frailty: a population-based, cross-sectional study of Mexican older adults. Geriatr Gerontol Int. 2016;

  45. Espinoza SE, Jung I, Hazuda H. Frailty transitions in the San Antonio longitudinal study of aging. J Am Geriatr Soc. 2012;60(4):652–60.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Sinclair A, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabet Endocrinol. 2015;3(4):275–85.

    Article  Google Scholar 

  47. • Zaslavsky O, Woods NF, LaCroix AZ, Cauley JA, Johnson KC, Cochrane BB, et al. Identification of risk factors for mortality and poor-quality-of-life survival in frail older women participating in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2016;64(4):831–7. Diabetes was associated with increased mortality and poorer quality of life in older, frail women participants of the Women’s Health Initiative Observational Study.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Castro-Rodríguez M, Carnicero JA, Garcia-Garcia FJ, Walter S, Morley JE, Rodríguez-Artalejo F, et al. Frailty as a major factor in the increased risk of death and disability in older people with diabetes. J Am Med Dir Assoc. 2016;17(10):949–55.

    Article  PubMed  Google Scholar 

  49. Kelaiditi E, Cesari M, Canevelli M, Van Kan GA, Ousset P-J, Gillette-Guyonnet S, et al. Cognitive frailty: rational and definition from an (IANA/IAGG) international consensus group. J Nutr Health Aging. 2013;17(9):726–34.

    Article  CAS  PubMed  Google Scholar 

  50. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol Ser A Biol Med Sci. 2007;62(7):722–7.

    Article  Google Scholar 

  51. Li J, Nie S, Wang S, Li Y, Zou Y, Jing X, et al. Operationalization of frailty index in diabetic older patients. J Am Med Dir Assoc. 2016;17(3):273.

    Article  PubMed  Google Scholar 

  52. Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc. 2004;52(11):1929–33.

    Article  PubMed  Google Scholar 

  53. Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681–7.

    Article  PubMed  Google Scholar 

  54. • Cesari M, Gambassi G, van Kan GA, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing. 2014;43(1):10–2. Discussion of the differences between Fried frailty phenotype and Rockwood frailty index and suggestion for application in the clinical setting for frailty screening.

    Article  PubMed  Google Scholar 

  55. Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med. 2002;162(20):2333–41.

    Article  PubMed  Google Scholar 

  56. Shamsi KS, Pierce A, Ashton AS, Halade DG, Richardson A, Espinoza SE. Proteomic screening of glycoproteins in human plasma for frailty biomarkers. J Gerontol Ser A Biol Med Sci. 2012;67(8):853–64.

    Article  Google Scholar 

  57. Darvin K, Randolph A, Ovalles S, Halade D, Breeding L, Richardson A et al. Plasma protein biomarkers of the geriatric syndrome of frailty. J Geront Ser A Biol Sci Med Sci. 2013:glt183.

  58. Baylis D, Bartlett D, Syddall H, Ntani G, Gale C, Cooper C, et al. Immune-endocrine biomarkers as predictors of frailty and mortality: a 10-year longitudinal study in community-dwelling older people. Age. 2013;35(3):963–71.

    Article  CAS  PubMed  Google Scholar 

  59. Barzilay JI, Blaum C, Moore T, Xue QL, Hirsch CH, Walston JD, et al. Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med. 2007;167(7):635–41.

    Article  PubMed  Google Scholar 

  60. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Article  PubMed  Google Scholar 

  61. • Mohler MJ, Fain MJ, Wertheimer AM, Najafi B, Nikolich-Žugich J. The Frailty syndrome: clinical measurements and basic underpinnings in humans and animals. Exp Gerontol. 2014;54:6–13. Review and discussion of current basic and translational research relative to the geriatric syndrome of frailty.

    Article  PubMed  Google Scholar 

  62. Fedarko NS. The biology of aging and frailty. Clin Geriatr Med. 2011;27(1):27–37.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP. The association between obesity and the frailty syndrome in older women: the Women’s Health and Aging Studies. J Am Geriatr Soc. 2005;53(6):927–34.

    Article  PubMed  Google Scholar 

  64. Hubbard RE, Lang IA, Llewellyn DJ, Rockwood K. Frailty, body mass index, and abdominal obesity in older people. J Gerontol Ser A Biol Med Sci. 2010;65(4):377–81.

    Article  Google Scholar 

  65. Morley JE, Malmstrom TK, Rodriguez-Mañas L, Sinclair AJ. Frailty, sarcopenia and diabetes. J Am Med Dir Assoc. 2014;15(12):853–9.

    Article  PubMed  Google Scholar 

  66. Espinoza SE, Jung I, Hazuda H. Lower frailty incidence in older Mexican Americans than in older European Americans: the San Antonio longitudinal study of aging. J Am Geriatr Soc. 2010;58(11):2142–8.

    Article  PubMed  PubMed Central  Google Scholar 

  67. de Souza MB, Ferreira Sampaio R, Rossana Cavalcanti Furtado S, Correa Dias R, Noce Kirkwood R. The relationship between diabetes mellitus, geriatric syndromes, physical function, and gait: a review of the literature. Curr Diabetes Rev. 2016;12(3):240–51.

    Article  Google Scholar 

  68. • García-Esquinas E, Graciani A, Guallar-Castillón P, López-García E, Rodríguez-Mañas L, Rodríguez-Artalejo F. Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults. J Am Med Dir Assoc. 2015;16(9):748–54. Type 2 diabetes was associated with over twice the odds of incident frailty in community-dwelling older adults, which was partially explained by obesity, unhealthy lifestyle habits, poor glycemic control, and altered lipid profile.

    Article  PubMed  Google Scholar 

  69. Fugate Woods N, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2005;53(8):1321–30.

    Article  Google Scholar 

  70. Lee JS, Auyeung T-W, Leung J, Kwok T, Woo J. Transitions in frailty states among community-living older adults and their associated factors. J Am Med Dir Assoc. 2014;15(4):281–6.

    Article  PubMed  Google Scholar 

  71. Bouillon K, Kivimäki M, Hamer M, Shipley MJ, Akbaraly TN, Tabak A, et al. Diabetes risk factors, diabetes risk algorithms, and the prediction of future frailty: the Whitehall II prospective cohort study. J Am Med Dir Assoc. 2013;14(11):851. e1–6.

    Article  Google Scholar 

  72. Kalyani RR, Corriere M, Ferrucci L. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabet Endocrinol. 2014;2(10):819–29.

    Article  Google Scholar 

  73. Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L. Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care. 2015;38(1):82–90.

    Article  PubMed  Google Scholar 

  74. Jang HC. Sarcopenia, frailty, and diabetes in older adults. Diabet Metab J. 2016;40(3):182–9.

    Article  Google Scholar 

  75. Umegaki H. Sarcopenia and frailty in older patients with diabetes mellitus. Geriatrics & gerontology international. 2016.

  76. Sinclair AJ, Rodriguez-Mañas L. Diabetes and frailty: two converging conditions? Can J Diabetes. 2016;40(1):77–83.

    Article  PubMed  Google Scholar 

  77. Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, et al. Decreased muscle strength and quality in older adults with type 2 diabetes. Diabetes. 2006;55(6):1813–8.

    Article  CAS  PubMed  Google Scholar 

  78. Wang C-P, Hazuda HP. Better glycemic control is associated with maintenance of lower-extremity function over time in Mexican American and European American older adults with diabetes. Diabetes Care. 2011;34(2):268–73.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Kalyani RR, Tra Y, Yeh HC, Egan JM, Ferrucci L, Brancati FL. Quadriceps strength, quadriceps power, and gait speed in older US adults with diabetes mellitus: results from the National Health and Nutrition Examination Survey, 1999–2002. J Am Geriatr Soc. 2013;61(5):769–75.

    Article  PubMed  PubMed Central  Google Scholar 

  80. • Zaslavsky O, Walker RL, Crane PK, Gray SL, Larson EB. Glucose levels and risk of frailty. J Gerontol Ser A Biol Sci Med Sci. 2016:glw024. Hyperglycemia increased risk for incident frailty in older adults without diabetes but with higher than normal fasting glucose levels, suggesting that pre-diabetes is a risk factor for frailty.

  81. Espinoza SE, Jung I, Hazuda H. The Hispanic paradox and predictors of mortality in an aging biethnic cohort of Mexican Americans and European Americans: the san antonio longitudinal study of aging. J Am Geriatr Soc. 2013;61(9):1522–9.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Lee JS, Auyeung T-W, Leung J, Kwok T, Leung P-C, Woo J. Physical frailty in older adults is associated with metabolic and atherosclerotic risk factors and cognitive impairment independent of muscle mass. J Nutr Health Aging. 2011;15(10):857–62.

    Article  CAS  PubMed  Google Scholar 

  83. Rodríguez-Mañas L, Féart C, Mann G, Viña J, Chatterji S, Chodzko-Zajko W, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement. The frailty operative definition-consensus conference project. J Gerontol Ser A Biol Med Sci. 2013;68(1):62–7.

    Article  Google Scholar 

  84. Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, et al. Treating frailty—a practical guide. BMC Med. 2011;9(1):83.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Hoogendijk EO, van der Horst HE, Deeg DJH, Frijters DHM, Prins BAH, Jansen APD, et al. The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing. 2013;42(2):262–5. doi:10.1093/ageing/afs163.

    Article  PubMed  Google Scholar 

  86. van Kan GA, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med. 2010;26(2):275–86.

    Article  Google Scholar 

  87. •• American Geriatrics Society. Frailty. In: Talebreza S, editor. Geriatrics evaluation & management tools: clinical templates to support clinicians and systems that are caring for older adults. New York, NY: American Geriatrics Society; 2015. Provides an evidence-based tool for frailty screening and management in the clinical setting.

  88. Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing. 2014:afu157.

  89. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004;52(4):625–34.

    Article  PubMed  Google Scholar 

  90. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Bibas L, Levi M, Bendayan M, Mullie L, Forman DE, Afilalo J. Therapeutic interventions for frail elderly patients: part I. Published randomized trials. Prog Cardiovasc Dis. 2014;57(2):134–43.

    Article  PubMed  Google Scholar 

  92. Bendayan M, Bibas L, Levi M, Mullie L, Forman DE, Afilalo J. Therapeutic interventions for frail elderly patients: part II. Ongoing and unpublished randomized trials. Prog Cardiovasc Dis. 2014;57(2):144–51.

    Article  PubMed  Google Scholar 

  93. Cameron ID, Fairhall N, Langron C, Lockwood K, Monaghan N, Aggar C, et al. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med. 2013;11(1):65.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Starr KNP, McDonald SR, Bales CW. Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials. J Am Med Dir Assoc. 2014;15(4):240–50.

    Article  Google Scholar 

  95. Cameron ID, Nicola F, Gill, Liz; Lockwood, Keri, Langron, Colleen, Aggar, Christina, Monaghan, Noeline, Kurrle, Susan;. Developing interventions for frailty. Advances in Geriatrics. 2015;2015.

    Article  Google Scholar 

  96. Association AD. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37(Supplement 1):S14–80.

    Article  Google Scholar 

  97. Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA, et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. Journal of aging research. 2011;2011

  98. • Cesari M, Vellas B, Hsu F-C, Newman AB, Doss H, King AC, et al. A physical activity intervention to treat the frailty syndrome in older persons—results from the LIFE-P study. J Gerontol Ser A Biol Med Sci. 2015;70(2):216–22. Results from a large clinical trial of exercise in older adults with sedentary lifestyle demonstrating reduction in frailty.

    Article  Google Scholar 

  99. • Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364(13):1218–29. doi:10.1056/NEJMoa1008234. A small, but important randomized controlled trial showing that an intervention with a combination of weight loss and exercise produces greater improvement in physical function and reduced frailty than an intervention utilizing either weight loss or exercise alone.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. • Rejeski WJ, Ip EH, Bertoni AG, Bray GA, Evans G, Gregg EW, et al. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012;366(13):1209–17. doi:10.1056/NEJMoa1110294. A large multicenter, randomized controlled trial showing that at the end of 4 years, an ILI intervention group compared to a DSE control group had a 48% reduction in risk of loss of mobility. Importantly, mediation analysis showed that both weight loss and improved fitness were significant mediators of this effect.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Fairhall N, Sherrington C, Kurrle SE, Lord SR, Lockwood K, Cameron ID. Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. BMC Med. 2012;10(1):120.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Norris SL, Engelgau MM, Narayan KV. Effectiveness of self-management training in type 2 diabetes. Diabetes Care. 2001;24(3):561–87.

    Article  CAS  PubMed  Google Scholar 

  103. Pariser G, Hager K, Gillette P, Golemboski K, Jackson K. Active steps for diabetes a community-campus partnership addressing frailty and diabetes. Diabet Educ. 2014;40(1):60–7.

    Article  Google Scholar 

  104. Liu H, Bravata DM, Olkin I, Nayak S, Roberts B, Garber AM, et al. Systematic review: the safety and efficacy of growth hormone in the healthy elderly. Ann Intern Med. 2007;146(2):104–15.

    Article  PubMed  Google Scholar 

  105. Nair KS, Rizza RA, O'brien P, Dhatariya K, Short KR, Nehra A, et al. DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med. 2006;355(16):1647–59.

    Article  CAS  PubMed  Google Scholar 

  106. Spitzer M, Huang G, Basaria S, Travison TG, Bhasin S. Risks and benefits of testosterone therapy in older men. Nat Rev Endocrinol. 2013;9(7):414–24.

    Article  CAS  PubMed  Google Scholar 

  107. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536–59.

    Article  CAS  PubMed  Google Scholar 

  108. • Cesari M, Fielding R, Bénichou O, Bernabei R, Bhasin S, Guralnik J, et al. Pharmacological interventions in frailty and sarcopenia: report by the international conference on frailty and sarcopenia research task force. J Frailty Aging. 2015;4(3):114. Results from a recent meeting of the International Conference on Frailty and Sarcopenia Task Force, which provides update on translational research on pharmacological interventions for frailty.

    CAS  PubMed  PubMed Central  Google Scholar 

  109. Dam T-T, Peters KW, Fragala M, Cawthon PM, Harris TB, McLean R, et al. An evidence-based comparison of operational criteria for the presence of sarcopenia. J Gerontol Ser A Biol Med Sci. 2014;69(5):584–90.

    Article  Google Scholar 

  110. Vellas B, Fielding R, Bhasin S, Cerreta F, Goodpaster B, Guralnik J, et al. Sarcopenia trials in specific diseases: report by the International Conference on Frailty and Sarcopenia Research Task Force. J Frailty Aging. 2016;5(4):194.

    CAS  PubMed  Google Scholar 

  111. Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med. 2006;166(4):418–23.

    Article  PubMed  Google Scholar 

  112. Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Idoate F, Millor N, Gómez M, et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age. 2014;36(2):773–85.

    Article  PubMed  Google Scholar 

  113. Fiatarone MA, O'neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330(25):1769–75.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Helen P. Hazuda

  2. Division of Geriatics, Gerontology & Palliative Medicine, Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Sara E. Espinoza

  3. Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Helen P. Hazuda & Sara E. Espinoza

  4. Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA

    Sara E. Espinoza

Authors
  1. Helen P. Hazuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara E. Espinoza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helen P. Hazuda.

Ethics declarations

Conflict of Interest

Sara Espinoza and Helen Hazuda declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Nutrition, Obesity, and Diabetes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hazuda, H.P., Espinoza, S.E. Prevention of Falls and Frailty in Older Adults with Diabetes. Curr Geri Rep 6, 158–167 (2017). https://doi.org/10.1007/s13670-017-0209-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-017-0209-x

Keywords

Search

Navigation