Frailty, Sarcopenia, Falls and Fractures

  • Finbarr C. MartinEmail author
Part of the Practical Issues in Geriatrics book series (PIG)


Frailty is a multidimensional phenomenon of increased vulnerability to the challenge of an acute illness, injury or social crisis. It overlaps with but is distinct from multi-morbidity and disability. Frailty is age related but highly variable between older individuals and more prevalent in women. There are several diagnostic definitions and measures of frailty, and different tools are suitable for different contexts. Frailty is modifiable through multicomponent interventions including exercise and nutritional optimisation.

The two main physiological components are sarcopenia and cognition. Sarcopenia is age associated decline in muscle mass and function. Falls occur in about one third of individuals aged 65 plus each year. The majority of falls in older people are associated with frailty and multicomponent impairments, particularly of muscle function, balance and cognition. Falls are therefore regarded as one of the geriatric syndromes. The most effective preventative intervention is multicomponent approach including exercise.

Most fragility fractures are related to falls. Frailty and falls risk is as important as bone health in prevention and management.


Falls Frailty Sarcopenia Prevention Exercise Cognition 


  1. 1.
    Campbell AJ, Buckner DM (1997) Unstable disability and the fluctuations of frailty. Age Ageing 26(4):315–318CrossRefPubMedGoogle Scholar
  2. 2.
    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol Med Sci 59(3):255–263CrossRefGoogle Scholar
  3. 3.
    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–M156CrossRefPubMedGoogle Scholar
  4. 4.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J 173(5):489–495CrossRefGoogle Scholar
  5. 5.
    Romero-Ortuno R (2013) The frailty instrument for primary care of the Survey of Health, Ageing and Retirement in Europe predicts mortality similarly to a frailty index based on comprehensive geriatric assessment. Geriatr Gerontol Int 13:497–504CrossRefPubMedGoogle Scholar
  6. 6.
    Rockwood K, Andrew M, Mitnitski A (2007) A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 62(7):738–743CrossRefPubMedGoogle Scholar
  7. 7.
    Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60(8):1487–1492CrossRefPubMedGoogle Scholar
  8. 8.
    Lang IA, Hubbard RE, Andrew MK, Llewellyn DJ, Melzer D, Rockwood K (2009) Neighborhood deprivation, individual socioeconomic status, and frailty in older adults. J Am Geriatr Soc 57(10):1776–1780CrossRefPubMedGoogle Scholar
  9. 9.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762CrossRefPubMedGoogle Scholar
  10. 10.
    Puts MTE, Visser M, Twisk JWR, Deeg DJH, Lips P (2005) Endocrine and inflammatory markers as predictors of frailty. Clin Endocrinol 63:403–411. doi: 10.1111/j.1365-2265.2005.02355.x CrossRefGoogle Scholar
  11. 11.
    Xue QL, Bandeen-Roche K, Varadhan R, Zhou J, Fried LP (2008) Initial manifestations of frailty criteria and the development of frailty phenotype in the Women’s Health and Aging Study II. J Gerontol A Biol Sci Med Sci 63(9):984–990CrossRefPubMedGoogle Scholar
  12. 12.
    National Institute for Health and Clinical Excellence (2016) Multimorbidity: assessment, prioritisation and management of care for people with commonly occurring multimorbidity. NICE guideline.
  13. 13.
    Rolfson DB, Majumdar SR, Tsuyuki RT et al (2006) Validity and reliability of the Edmonton Frail Scale. Age Ageing 35:526–529CrossRefPubMedGoogle Scholar
  14. 14.
    Hoogendijk EO, Van Der Horst HE, Deeg DJH et al (2013) The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing 42:262–265CrossRefPubMedGoogle Scholar
  15. 15.
    Raiche M, Hebert R, Dubois MF (2008) PRISMA-7: a case-finding tool to identify older adults with moderate to severe disabilities. Arch Gerontol Geriatr 47:9–18CrossRefPubMedGoogle Scholar
  16. 16.
    Rosenberg IH (1989) Summary comments. Am J Clin Nutr 50:1231–1233Google Scholar
  17. 17.
    Goodpaster BH, Park SW, Harris TB et al (2006) The loss of skeletal muscle strength, mass and quality in older adults. J Gerontol A Biol Sci Med Sci 61:1059–1064CrossRefPubMedGoogle Scholar
  18. 18.
    Metter EJ, Talbot LA, Schrager M, Conwit R (2002) Skeletal muscle strength as a predictor of all-cause mortality in healthy men. J Gerontol A Biol Sci Med Sci 57(10):B35CrossRefGoogle Scholar
  19. 19.
    Lexell J (1995) Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci 50:A11–A16Google Scholar
  20. 20.
    Foldvari M, Clark M, Laviolette LC et al (2000) Association of muscle power with functional status in community-dwelling elderly women. J Gerontol A Biol Sci Med Sci 55A:M192–M199CrossRefGoogle Scholar
  21. 21.
    Janssen I, Heymsfield SB, Wang ZM, Ross R (2000) Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol 89(1):81–88PubMedGoogle Scholar
  22. 22.
    Giannoulis MG, Martin FC, Nair KS, Umpleby AM, Sonksen P (2012) Hormone replacement therapy and physical function in healthy older men. Time to talk hormones? Endocr Rev 33(3):314–377. doi: 10.1210/er.2012-1002 CrossRefPubMedGoogle Scholar
  23. 23.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–423CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Vermeulen J, Neyens JC, van Rossum E, Spreeuwenberg MD, de Witte LP (2011) Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr 11:33CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Roberts HC, Syddall HE, Cooper C, Aihie Sayer A (2012) Is grip strength associated with length of stay in hospitalised older patients admitted for rehabilitation? Findings from the Southampton grip strength study. Age Ageing 41(5):641–646CrossRefPubMedGoogle Scholar
  26. 26.
    AGS/BGS Guidelines (2011) Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148–157CrossRefGoogle Scholar
  27. 27.
    National Institute for Health and Care Excellence (2013) NICE clinical guideline 161. Falls: assessment and prevention of falls in older people. Available from Accessed 1 June 2016
  28. 28.
    Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35-S2:ii37–ii41Google Scholar
  29. 29.
    Yamada M, Takechi H, Mori S, Aoyama T, Arai H (2013) Global brain atrophy is associated with physical performance and the risk of falls in older adults with cognitive impairment. Geriatr Gerontol Int 13:437–442CrossRefPubMedGoogle Scholar
  30. 30.
    World health Organization (2007) WHO global report on falls prevention in older age. World Health Organization, GenevaGoogle Scholar
  31. 31.
    Lawlor D, Patel R, Ebrahim S (2003) Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 327:712–717CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83(3):237–252PubMedGoogle Scholar
  33. 33.
    British Geriatrics Society (2014) BGS consensus best practice guidance for the care of older people living with frailty in community and outpatient settings. Available from Accessed 2 June 2016
  34. 34.
    Scott V, Votova K, Scanlan A, Close J (2007) Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age Ageing 36(2):130–139CrossRefPubMedGoogle Scholar
  35. 35.
    Podsiadlo D, Richardson S (1991) The timed “up & go”: a test of basic functional mobility for frail elderly persons (see comment). J Am Geriatr Soc 39:142–148CrossRefPubMedGoogle Scholar
  36. 36.
    Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther 80(9):896–903PubMedGoogle Scholar
  37. 37.
    Muir SW, Berg K, Chesworth B et al (2008) Use of the Berg Balance Scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther 88:449–459CrossRefPubMedGoogle Scholar
  38. 38.
    Gillespie LD, Robertson MC, Gillespie WJ, et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev (9):CD007146Google Scholar
  39. 39.
    Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56:2234–2243CrossRefPubMedGoogle Scholar
  40. 40.
    Gardner MM, Robertson MC, Campbell AJ (2000) Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med 34(1):7–17CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Skelton D, Dinan S, Campbell M, Rutherford O (2005) Tailored group exercise (FallsManagement Exercise-FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 34(6):636–639CrossRefPubMedGoogle Scholar
  42. 42.
    Iliffe S, Kendrick D, Morris R, Masud T, Gage H, Skelton D, Dinan S, Bowling A, Griffin M, Haworth D, Swanwick G, Carpenter H et al (2014) Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. Health Technol Assess 18(49):vii–xxvii. doi: 10.3310/hta18490, 1–105CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Clemson L, Fiatarone-Singh MA, Bundy AM et al (2012) Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomized parallel trial. BMJ 345:e4547CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Schleicher MM, Wedam L, Wu G (2012) Review of Tai Chi as an effective exercise on falls prevention in elderly. Res Sports Med Int J 20(1):137–158Google Scholar
  45. 45.
    Fairhall N, Cherrington C, Lord SR et al (2014) Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing 43(5):616–622CrossRefPubMedGoogle Scholar
  46. 46.
    Yamada M, Aoyama T, Arai H et al (2012) Complex obstacle negotiation exercise can prevent falls in community-dwelling elderly Japanese aged 75 years and older. Geriatr Gerontol Int 12:461–467CrossRefPubMedGoogle Scholar
  47. 47.
    Oliver D, Papaioannou A, Giangregorio L et al (2008) A systematic review and meta-analysis of studies using the STRATIFY tool for prediction of falls in hospital patients: how well does it work? Age Ageing 37:621–627CrossRefPubMedGoogle Scholar
  48. 48.
    Neyens JC, van Haastregt JC, Dijcks BP et al (2011) Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review. J Am Med Dir Assoc 12:410–425CrossRefPubMedGoogle Scholar
  49. 49.
    Kaptoge S, Benevolenskaya LI, Bhalla AK et al (2005) Low BMD is less predictive than reported falls for future limb fractures in women across Europe: results from the European Prospective Osteoporosis Study. Bone 36(3):387–398CrossRefPubMedGoogle Scholar
  50. 50.
    Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P (2008) Analysis – shifting the focus in fracture prevention from osteoporosis to falls. BMJ 336:124–126CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Sternberg SA, Levin R, Dkaidek S, Edelman S, Resnick T, Menczel J (2014) Frailty and osteoporosis in older women – a prospective study. Osteoporos Int 25(2):763–768CrossRefPubMedGoogle Scholar
  52. 52.
    Ensrud KE, Ewing SK, Taylor BC et al (2007) Frailty and the risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62:744–751CrossRefPubMedGoogle Scholar
  53. 53.
    Giangregorio LM, Papaioannou A, MacIntyre NJ (2014) Too fit to fracture: exercise recommendations for individuals with osteoporosis or osteoporotic fracture. Osteoporos Int 25:821–835CrossRefPubMedGoogle Scholar
  54. 54.
    Krishnan M, Beck S, Havelock W, Eeles E, Hubbard RE, Johansen A (2014) Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing 43(1):122–126CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Division of Health and Social Care ResearchKing’s College LondonLondonUK

Personalised recommendations