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Overlapping status of frailty and fear of falling: an elevated risk of incident disability in community-dwelling older adults

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Abstract

Background

Although overlapping frailty and fear of falling (FoF) are likely to increase with population aging, the combined effect of frailty and FoF on incident disability is not yet well understood.

Aims

The purpose of this study is to examine whether frailty combined with FoF increased the risk of incident disability in older adults. Our secondary purpose was to clarify the synergistic effect of frailty and FoF on incident disability.

Methods

This is a prospective study. Participants were 9372 older adults (mean age 73.5 years). Frailty status was assessed using the Japanese Cardiovascular Health Study index, and FoF was measured using two closed questions. Incident disability was prospectively monitored by their long-term care insurance records.

Results

During the follow-up period (mean duration 23.4 months), 487 (5.2%) participants developed disability. The proportion of incident disability linearly increased according to FoF level regardless of baseline frailty status. Frail participants with FoF had a higher risk of incident disability than those with frailty only or neither (adjusted hazard ratio [HR] 2.63, 95% confidence interval [CI] 1.95–3.54). Frailty in combination with excessive FoF further increased the risk of incident disability (adjusted HR 4.30, 95% CI 2.56–7.23) although no synergistic effect was observed (relative excessive risk due to interaction 1.69, 95% CI − 0.55, 3.93).

Conclusion

The overlapping status of frailty and FoF, especially excessive FoF, increases the risk of incident disability in older adults.

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References

  1. Chen X, Mao G, Leng S (2014) Frailty syndrome: an overview. Clin Interv Aging. https://doi.org/10.2147/CIA.S45300

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kojima G, Iliffe S, Taniguchi Y et al (2017) Prevalence of frailty in Japan: a systematic review and meta-analysis. J Epidemiol 27:347–353. https://doi.org/10.1016/j.je.2016.09.008

    Article  PubMed  Google Scholar 

  3. Collard RM, Boter H, Schoevers RA et al (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60:1487–1492. https://doi.org/10.1111/j.1532-5415.2012.04054.x

    Article  PubMed  Google Scholar 

  4. Makizako H, Shimada H, Doi T et al (2015) Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study. BMJ Open 5:e008462. https://doi.org/10.1136/bmjopen-2015-008462

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146-156. https://doi.org/10.1093/gerona/56.3.m146

    Article  CAS  PubMed  Google Scholar 

  6. Dent E, Martin FC, Bergman H et al (2019) Management of frailty: opportunities, challenges, and future directions. Lancet Lond Engl 394:1376–1386. https://doi.org/10.1016/S0140-6736(19)31785-4

    Article  Google Scholar 

  7. Cesari M, Prince M, Thiyagarajan JA et al (2016) Frailty: an emerging public health priority. J Am Med Dir Assoc 17:188–192. https://doi.org/10.1016/j.jamda.2015.12.016

    Article  PubMed  Google Scholar 

  8. Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45:P239-243. https://doi.org/10.1093/geronj/45.6.p239

    Article  CAS  PubMed  Google Scholar 

  9. Scheffer AC, Schuurmans MJ, van Dijk N et al (2008) Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 37:19–24. https://doi.org/10.1093/ageing/afm169

    Article  PubMed  Google Scholar 

  10. Denkinger MD, Lukas A, Nikolaus T et al (2015) Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review. Am J Geriatr Psychiatry 23:72–86. https://doi.org/10.1016/j.jagp.2014.03.002

    Article  PubMed  Google Scholar 

  11. van Schooten KS, Freiberger E, Sillevis Smitt M et al (2019) Concern about falling is associated with gait speed, independently from physical and cognitive function. Phys Ther 99:989–997. https://doi.org/10.1093/ptj/pzz032

    Article  PubMed  Google Scholar 

  12. Hadjistavropoulos T, Delbaere K, Fitzgerald TD (2011) Reconceptualizing the role of fear of falling and balance confidence in fall risk. J Aging Health 23:3–23. https://doi.org/10.1177/0898264310378039

    Article  PubMed  Google Scholar 

  13. Sawa R, Asai T, Doi T et al (2020) The association between physical activity, including physical activity intensity, and fear of falling differs by fear severity in older adults living in the community. J Gerontol Ser B 75:953–960. https://doi.org/10.1093/geronb/gby103

    Article  Google Scholar 

  14. Deshpande N, Metter EJ, Lauretani F et al (2008) Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study. J Am Geriatr Soc 56:615–620. https://doi.org/10.1111/j.1532-5415.2007.01639.x

    Article  PubMed  PubMed Central  Google Scholar 

  15. Belloni G, Büla C, Santos-Eggimann B et al (2020) Is fear of falling associated with incident disability? A prospective analysis in young-old community-dwelling adults. J Am Med Dir Assoc. https://doi.org/10.1016/j.jamda.2020.05.051

    Article  PubMed  Google Scholar 

  16. Martínez-Arnau FM, Prieto-Contreras L, Pérez-Ros P (2021) Factors associated with fear of falling among frail older adults. Geriatr Nurs N Y N 42:1035–1041. https://doi.org/10.1016/j.gerinurse.2021.06.007

    Article  Google Scholar 

  17. Merchant RA, Chen MZ, Wong BLL et al (2020) Relationship between fear of falling, fear-related activity restriction, frailty, and sarcopenia. J Am Geriatr Soc 68:2602–2608. https://doi.org/10.1111/jgs.16719

    Article  PubMed  Google Scholar 

  18. Qin Y, Li J, McPhillips M et al (2021) Association of fear of falling with frailty in community-dwelling older adults: a cross-sectional study. Nurs Health Sci 23:516–524. https://doi.org/10.1111/nhs.12840

    Article  PubMed  PubMed Central  Google Scholar 

  19. Esbrí-Víctor M, Huedo-Rodenas I, López-Utiel M et al (2017) Frailty and fear of falling: the FISTAC study. J Frailty Aging 6:136–140. https://doi.org/10.14283/jfa.2017.19

    Article  PubMed  Google Scholar 

  20. Tsutsumimoto K, Doi T, Shimada H et al (2016) Combined effect of slow gait speed and depressive symptoms on incident disability in older adults. J Am Med Dir Assoc 17:123–127. https://doi.org/10.1016/j.jamda.2015.08.012

    Article  PubMed  Google Scholar 

  21. Doi T, Tsutsumimoto K, Ishii H et al (2021) Frailty and driving status associated with disability: a 24-month follow-up longitudinal study. BMJ Open 11:e042468. https://doi.org/10.1136/bmjopen-2020-042468

    Article  PubMed  PubMed Central  Google Scholar 

  22. Satake S, Shimada H, Yamada M et al (2017) Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the cardiovascular health study criteria. Geriatr Gerontol Int 17:2629–2634. https://doi.org/10.1111/ggi.13129

    Article  PubMed  Google Scholar 

  23. Tsutsui T, Muramatsu N (2005) Care-needs certification in the long-term care insurance system of Japan. J Am Geriatr Soc 53:522–527. https://doi.org/10.1111/j.1532-5415.2005.53175.x

    Article  PubMed  Google Scholar 

  24. Makino K, Makizako H, Doi T et al (2018) Impact of fear of falling and fall history on disability incidence among older adults: p rospective cohort study. Int J Geriatr Psychiatry 33:658–662. https://doi.org/10.1002/gps.4837

    Article  PubMed  Google Scholar 

  25. Knol MJ, VanderWeele TJ (2012) Recommendations for presenting analyses of effect modification and interaction. Int J Epidemiol 41:514–520. https://doi.org/10.1093/ije/dyr218

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kojima G (2017) Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis. Disabil Rehabil 39:1897–1908. https://doi.org/10.1080/09638288.2016.1212282

    Article  PubMed  Google Scholar 

  27. Hoogendijk EO, Afilalo J, Ensrud KE et al (2019) Frailty: implications for clinical practice and public health. Lancet Lond Engl 394:1365–1375. https://doi.org/10.1016/S0140-6736(19)31786-6

    Article  Google Scholar 

  28. Matsue Y, Kamiya K, Saito H et al (2020) Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail 22:2112–2119. https://doi.org/10.1002/ejhf.1926

    Article  CAS  PubMed  Google Scholar 

  29. Tsutsumimoto K, Doi T, Nakakubo S et al (2020) Cognitive frailty as a risk factor for incident disability during late life: a 24-month follow-up longitudinal study. J Nutr Health Aging 24:494–499. https://doi.org/10.1007/s12603-020-1365-9

    Article  CAS  PubMed  Google Scholar 

  30. Shimada H, Lee S, Doi T et al (2019) Prevalence of psychological frailty in Japan: NCGG-SGS as a Japanese National Cohort Study. J Clin Med 8:E1554. https://doi.org/10.3390/jcm8101554

    Article  Google Scholar 

  31. Belloni G, Büla C, Santos-Eggimann B et al (2020) A single question as a screening tool to assess fear of falling in young-old community-dwelling persons. J Am Med Dir Assoc. https://doi.org/10.1016/j.jamda.2020.01.101

    Article  PubMed  Google Scholar 

  32. Howland J, Lachman ME, Peterson EW et al (1998) Covariates of fear of falling and associated activity curtailment. Gerontologist 38:549–555. https://doi.org/10.1093/geront/38.5.549

    Article  CAS  PubMed  Google Scholar 

  33. Li F, Fisher KJ, Harmer P et al (2003) Fear of falling in elderly persons: association with falls, functional ability, and quality of life. J Gerontol B Psychol Sci Soc Sci 58:P283-290. https://doi.org/10.1093/geronb/58.5.p283

    Article  PubMed  Google Scholar 

  34. Hladek MD, Zhu J, Buta BJ et al (2021) Self-efficacy proxy predicts frailty incidence over time in non-institutionalized older adults. J Am Geriatr Soc. https://doi.org/10.1111/jgs.17417

    Article  PubMed  PubMed Central  Google Scholar 

  35. Dent E, Hoogendijk EO (2014) Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older people. BMC Geriatr 14:108. https://doi.org/10.1186/1471-2318-14-108

    Article  PubMed  PubMed Central  Google Scholar 

  36. Makizako H, Shimada H, Doi T et al (2015) Physical frailty predicts incident depressive symptoms in elderly people: prospective findings from the Obu study of health promotion for the elderly. J Am Med Dir Assoc 16:194–199. https://doi.org/10.1016/j.jamda.2014.08.017

    Article  PubMed  Google Scholar 

  37. Visschedijk J, van Balen R, Hertogh C et al (2013) Fear of falling in patients with hip fractures: prevalence and related psychological factors. J Am Med Dir Assoc 14:218–220. https://doi.org/10.1016/j.jamda.2012.10.013

    Article  PubMed  Google Scholar 

  38. Schmid AA, Arnold SE, Jones VA et al (2015) Fear of falling in people with chronic stroke. Am J Occup Ther Off Publ Am Occup Ther Assoc 69:6903350020. https://doi.org/10.5014/ajot.2015.016253

    Article  Google Scholar 

  39. Maki BE, Holliday PJ, Topper AK (1991) Fear of falling and postural performance in the elderly. J Gerontol 46:M123-131. https://doi.org/10.1093/geronj/46.4.m123

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank the Obu City and Nagoya City Office for supporting our participant recruitment in this study. We thank Diane Williams, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

This work was supported under the Grant-in-Aid for Scientific Research (B) [grant number 23300205] and the Grant-in-Aid for Young Scientists [grant number 18K17393] from the Japanese Ministry of Health, Labour and Welfare; the Research Funding for Longevity Sciences [grant numbers 22-16, 24-18 and 25-26] from the National Center for Geriatrics and Gerontology; and the JST Strategic Basic Research Programs (RISTEX Redesigning Communities for Aged Society).

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Authors and Affiliations

  1. Department of Physical Therapy, Faculty of Health Science, Juntendo University, 3-2-12 Hongo Bunkyo-Ku, Tokyo, 113-0033, Japan

    Ryuichi Sawa

  2. Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan

    Ryuichi Sawa, Takehiko Doi, Kota Tsutsumimoto, Sho Nakakubo, Satoshi Kurita, Yuto Kiuchi, Kazuhei Nishimoto & Hiroyuki Shimada

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Contributions

Conceptualization, RS, TD, KT, SN, SK, YK, KN, and HS; methodology, RS, TD, KT, SN, and HS; formal analysis, RS, and TD; writing-original draft preparation, RS; writing-review and editing, TD, KT, SN, SK, YK, KN, and HS; supervision, TD, and HS; All authors have read and agreed to the submitted version of the manuscript.

Corresponding author

Correspondence to Ryuichi Sawa.

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Ethical approval was obtained from the ethics committee of the National Center for Geriatrics and Gerontology.

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Sawa, R., Doi, T., Tsutsumimoto, K. et al. Overlapping status of frailty and fear of falling: an elevated risk of incident disability in community-dwelling older adults. Aging Clin Exp Res 35, 1937–1944 (2023). https://doi.org/10.1007/s40520-023-02474-z

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