Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

Objective: The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. Methods: A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48 ± 2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to "Are you afraid of falling?") at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. Results: Multivariable logistic regression showed that prefrailty or frailty increase the risk of not only future falls (odds ratio [OR]: 1.57; 95% CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95% CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95% CI = 1.04-1.68). Conclusions: Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. Impact: Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high risk not only for falls but also for FOF.