Advertisement

Osteoporosis International

, Volume 24, Issue 9, pp 2397–2403 | Cite as

Does frailty predict increased risk of falls and fractures? A prospective population-based study

  • O. J. de VriesEmail author
  • G. M. E. E. Peeters
  • P. Lips
  • D. J. H. Deeg
Original Article

Abstract

Summary

A frailty concept that includes psychological and cognitive markers was prospectively shown to be associated with increased risk of multiple falls and fractures among 1,509 community dwelling older adults, especially in those aged 75 and over. The predictive ability of frailty is not superior to falls history.

Introduction

The concept of frailty has been defined with or without psychological and cognitive markers. Falls are associated with multiple risk factors, including cognitive and mood disorders. The purpose of this study was to investigate the association of a comprehensive concept of frailty and its components with falls and fractures in community-dwelling older adults and to compare its predictive ability with having a history of falls.

Methods

One thousand five hundred nine participants in the Longitudinal Aging Study Amsterdam aged ≥65 were assessed to determine fall history and the prevalence of nine frailty markers, including cognitive and psychological factors. The number of falls and time to second fall were prospectively registered for 1 year. Fractures were registered for 6 years.

Results

Frailty was significantly associated with time to second fall: hazard ratio of 1.53 [95 % confidence interval (CI), 1.07–2.18] and area under the receiver operating characteristic curve (AUC) of 0.58 (CI, 0.53–0.62). In participants aged ≥75, frailty was associated with ≥2 falls: odds ratio (OR) of 1.74 (CI, 1.19–2.55) and AUC of 0.62 (CI, 0.55–0.68). Frailty, adjusted for age and sex, was significantly associated with ≥2 fractures: OR of 3.67 (CI, 1.47–9.15). The AUCs for falls history (aged ≥75) ranged from 0.62 (CI, 0.58–0.67) for ≥1 falls to 0.67 (CI, 0.59–0.74) for ≥3 falls.

Conclusions

A concept of frailty including psychological and cognitive markers is associated with both multiple falls and fractures. However, frailty is not superior to falls history for the selection of old persons at increased risk of recurrent falls.

Keywords

Falls Fractures Frailty Older adults 
HR

Hazard ratio

OR

Odds ratio

AUC

Area under the receiver operating characteristic curve

CI

95 % confidence interval

Notes

Conflicts of interest

None.

References

  1. 1.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156PubMedCrossRefGoogle Scholar
  2. 2.
    Morley JE, Perry HM III, Miller DK (2002) Editorial: something about frailty. J Gerontol A Biol Sci Med Sci 57:M698–M704PubMedCrossRefGoogle Scholar
  3. 3.
    Puts MT, Lips P, Deeg DJ (2005) Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. J Clin Epidemiol 58:1188–1198PubMedCrossRefGoogle Scholar
  4. 4.
    Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA 261:2663–2668PubMedCrossRefGoogle Scholar
  5. 5.
    Nevitt MC, Cummings SR, Hudes ES (1991) Risk factors for injurious falls: a prospective study. J Gerontol 46:M164–M170PubMedCrossRefGoogle Scholar
  6. 6.
    Stalenhoef PA, Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF (2002) A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol 55:1088–1094PubMedCrossRefGoogle Scholar
  7. 7.
    Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P (1998) Predictors for falls and fractures in the longitudinal aging study Amsterdam. J Bone Miner Res 13:1932–1939PubMedCrossRefGoogle Scholar
  8. 8.
    Tromp AM, Ooms ME, Popp-Snijders C, Roos JC, Lips P (2000) Predictors of fractures in elderly women. Osteoporos Int 11:134–140PubMedCrossRefGoogle Scholar
  9. 9.
    Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, Lips P (2006) A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 17:417–425PubMedCrossRefGoogle Scholar
  10. 10.
    Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, Tracy JK, Cummings SR (2008) Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 168:382–389PubMedCrossRefGoogle Scholar
  11. 11.
    Romero-Ortuno R, Cogan L, Foran T, Kenny RA, Fan CW (2011) Continuous non-invasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people. J Am Geriatr Soc 59:655–665PubMedCrossRefGoogle Scholar
  12. 12.
    Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T (1996) Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT group. Frailty and injuries: cooperative studies of intervention techniques. J Am Geriatr Soc 44:489–497PubMedGoogle Scholar
  13. 13.
    Huisman M, Poppelaars J, van der Horst M, Beekman A, Brug J, van Tilburg T, Deeg D (2011) Cohort profile: the longitudinal aging study Amsterdam. Int J Epidemiol 40:868–876PubMedCrossRefGoogle Scholar
  14. 14.
    Deeg DJ, van Tilburg T, Smit JH, de Leeuw ED (2002) Attrition in the longitudinal aging study Amsterdam. The effect of differential inclusion in side studies. J Clin Epidemiol 55:319–328PubMedCrossRefGoogle Scholar
  15. 15.
    Cook NR, Albert MS, Berkman LF, Blazer D, Taylor JO, Hennekens CH (1995) Interrelationships of peak expiratory flow rate with physical and cognitive function in the elderly: MacArthur Foundation studies of aging. J Gerontol A Biol Sci Med Sci 50:M317–M323PubMedCrossRefGoogle Scholar
  16. 16.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
  17. 17.
    Pearlin LI, Schooler C (1978) The structure of coping. J Health Soc Behav 19:2–21PubMedCrossRefGoogle Scholar
  18. 18.
    Radloff LS, Teri L (1986) Use of the center for epidemiological studies-depression scale with older adults. Clinical Gerontology 5:119–136CrossRefGoogle Scholar
  19. 19.
    Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P (2004) Comparison of the LASA physical activity questionnaire with a 7-day diary and pedometer. J Clin Epidemiol 57:252–258PubMedCrossRefGoogle Scholar
  20. 20.
    Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P (2003) A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc 51:1356–1364PubMedCrossRefGoogle Scholar
  21. 21.
    Kellogg International Work Group on the Prevention of Falls by the Elderly (1987) The prevention of falls in later life. Dan Med Bull 34(4):1–24Google Scholar
  22. 22.
    Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy. J Clin Epidemiol 49:1407–1417PubMedCrossRefGoogle Scholar
  23. 23.
    Oksanen T, Kivimaki M, Pentti J, Virtanen M, Klaukka T, Vahtera J (2010) Self-report as an indicator of incident disease. Ann Epidemiol 20:547–554PubMedCrossRefGoogle Scholar
  24. 24.
    Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62:744–751PubMedCrossRefGoogle Scholar
  25. 25.
    Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, Dam TT, Marshall LM, Orwoll ES, Cummings SR (2009) A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc 57:492–498PubMedCrossRefGoogle Scholar
  26. 26.
    Avila-Funes JA, Amieva H, Barberger-Gateau P, Le GM, Raoux N, Ritchie K, Carriere I, Tavernier B, Tzourio C, Gutierrez-Robledo LM, Dartigues JF (2009) Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc 57:453–461PubMedCrossRefGoogle Scholar
  27. 27.
    Eggermont LH, Penninx BW, Jones RN, Leveille SG (2012) Depressive symptoms, chronic pain, and falls in older community-dwelling adults: the Mobilize Boston Study. J Am Geriatr Soc 60:230–237PubMedCrossRefGoogle Scholar
  28. 28.
    Muir SW, Gopaul K, Montero Odasso MM (2012) The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 41(3):299–308PubMedCrossRefGoogle Scholar
  29. 29.
    Yamashita T, Jeon H, Bailer AJ, Nelson IM, Mehdizadeh S (2011) Fall risk factors in community-dwelling elderly who receive Medicaid-supported home- and community-based care services. J Aging Health 23:682–703PubMedCrossRefGoogle Scholar
  30. 30.
    de Vries OJ, Peeters GM, Elders PJ, Muller M, Knol DL, Danner SA, Bouter LM, Lips P (2010) Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: a randomized controlled trial. Arch Intern Med 170:1110–1117PubMedCrossRefGoogle Scholar
  31. 31.
    Gerdhem P, Ringsberg KA, Magnusson H, Obrant KJ, Akesson K (2003) Bone mass cannot be predicted by estimations of frailty in elderly ambulatory women. Gerontology 49:168–172PubMedCrossRefGoogle Scholar
  32. 32.
    Gerdhem P, Ringsberg K, Akesson K, Obrant KJ (2004) Just one look, and fractures and death can be predicted in elderly ambulatory women. Gerontology 50:309–314PubMedCrossRefGoogle Scholar
  33. 33.
    de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW (2011) Outcome instruments to measure frailty: a systematic review. Ageing Res Rev 10:104–114PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • O. J. de Vries
    • 1
    Email author
  • G. M. E. E. Peeters
    • 2
  • P. Lips
    • 1
  • D. J. H. Deeg
    • 3
  1. 1.Department of Internal MedicineVU University Medical CenterAmsterdamThe Netherlands
  2. 2.School of Human Movement StudiesThe University of QueenslandBrisbaneAustralia
  3. 3.Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands

Personalised recommendations