A Multidomain Longitudinal Analysis of Frailty, Functional Limitation, Balance and Falls in Older Adults.

Background/

Objectives

Falls are a major threat to healthy ageing and the preservation of independence, yet the risk of falls in older adults commonly arises from multiple interacting domains rather than a single factor. This longitudinal analysis assessed whether frailty, functional limitation, and balance performance were associated with future falls among older adults.

Methods

This longitudinal analysis assessed older adults aged 65 years and older over a three-year follow-up interval, using baseline data collected in 2015 and follow-up falls data collected in 2018. Baseline health, functional, and physical performance measures were evaluated in relation to self-reported falls at follow-up. Candidate predictors comprised sociodemographic, health, functional, and physical performance variables. Univariable logistic regression, adjusted screening models, and a final complete-case multivariable logistic regression model were used.

Results

The eligible analytic sample comprised 1932 participants, of whom 480 (24.8%) reported falls at follow-up. In adjusted analyses, greater frailty index, greater ADL limitation, female sex, shorter full-tandem balance time, depressive symptoms, and greater self-rated mobility severity were associated with higher odds of future falls. However, only frailty index, ADL limitation, full-tandem balance time, and female sex were retained in the final multivariable model. In the final multivariable model of 1451 participants, frailty index per 0.1-unit increase (OR 1.26, 95% CI 1.07-1.48), ADL limitation score per 1-point increase (OR 1.30, 95% CI 1.16-1.45), female sex (OR 1.62, 95% CI 1.17-2.25) and longer full-tandem balance time per 10 s increase (OR 0.89, 95% CI 0.82-0.96) remained associated with falls. The final model showed modest discrimination and acceptable apparent calibration.

Conclusions

Higher frailty, greater ADL limitation, poorer tandem balance and female sex were associated with subsequent falls. These results reinforce the value of a multidomain approach to fall-risk assessment.