Review Article
Frailty as a Predictor of Future Falls Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.jamda.2015.06.018Get rights and content

Abstract

Background

Although multiple longitudinal studies have investigated frailty as a predictor of future falls, the results were mixed. Thus far, no systematic review or meta-analysis on this topic has been conducted.

Objective

To review the evidence of frailty as a predictor of future falls among community-dwelling older people.

Methods

Systematic review of literature and meta-analysis were performed using 6 electronic databases (Embase, Scopus, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library) searching for studies that prospectively examined risk of future fall risk according to frailty among community-dwelling older people published from 2010 to April 2015 with no language restrictions.

Results

Of 2245 studies identified through the systematic review, 11 studies incorporating 68,723 individuals were included in the meta-analysis. Among 7 studies reporting odds ratios (ORs), frailty and prefrailty were significantly associated with higher risk of future falls (pooled OR = 1.84, 95% confidence interval [95% CI] = 1.43–2.38, P < .001; pooled OR = 1.25, 95% CI = 1.01–1.53, P = .005, respectively). Among 4 studies reporting hazard ratios (HRs), whereas frailty was significantly associated with higher risk of future falls (pooled HR = 1.24, 95% CI = 1.10–1.41, P < .001), future fall risk according to prefrailty did not reach statistical significance (pooled HR = 1.14, 95% CI = 0.95–1·36, P = .15). High heterogeneity was noted among 7 studies reporting ORs and seemed attributed to difference in gender proportion of cohorts according to subgroup and meta-regression analyses.

Conclusions

Frailty is demonstrated to be a significant predictor of future falls among community-dwelling older people despite various criteria used to define frailty. The future fall risk according to frailty seemed to be higher in men than in women.

Section snippets

Methods

This study was conducted according to a protocol developed with adherence to Meta-analysis of Observational Studies in Epidemiology (MOOSE)21 statements by a clinician researcher who was trained for internal medicine and geriatric medicine and is currently working as a general practitioner.

Selection Processes

Figure 1 shows a flow chart of the literature search and study selection with numbers of studies at each stage. Of 2245 citations identified by the systematic review of the literature using 6 electronic databases, 1306 duplicated articles were excluded and 920 articles were excluded through review of titles and abstracts. One additional article18 was found by manual search and added, leaving 20 articles for full-text review. Of these, 9 articles were excluded because they were review articles

Discussion

This is, to the best of my knowledge, the first study to perform systematic review and meta-analyses on future fall risk associated with frailty among community-dwelling older people. Eleven studies with a total of 68,723 individuals presenting ORs and HRs as fall risk measures for frailty status were identified by this systematic review. A meta-analysis combining their findings consistently showed frailty was associated with higher future fall risk despite different frailty criteria and effect

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    The author declares no conflicts of interest.

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