Frailty is associated with greater long-term risk for fall- and fracture-related hospitalizations and mortality in community-dwelling older Australian women

Frailty is a complex condition associated with declines in multiple systems with detrimental effects on capacity and quality of life. An underlying assumption being the frailer an individual is, the more likely they are to fall and fracture. We examined whether grades of frailty are related to long-term risk of hospitalized falls and fractures as well as all-cause mortality in community-dwelling older women. 1261 women (mean +/- SD 75.1 +/- 2.7 years) were followed over 14.5 years. Frailty was operationalized using a frailty index (FI) of cumulative deficits from 33 variables (as developed by Rockwood) across multiple health
domains (physical, psychosocial, comorbidities) at baseline. Participants were graded as either fit (FI <=0.12), mildly frail (FI >0.12-0.24), moderately frail (FI >0.24-0.36) or severely frail (FI >0.36) based on established criteria. Fall- (n=498), any fracture (n=347) and hip fracture-related hospitalizations (n=137) and deaths (n=482) were obtained from linked health records. Associations between FI grades and each of the clinical outcomes were analyzed using multivariable-adjusted Cox-proportional hazard models including risk factors such as age, treatment (calcium/placebo), body mass index, smoking history, socioeconomic status, plasma 25-hydroxyvitamin D status plus season obtained, physical activity, self-reported prevalent falls and fractures. At baseline, women were classified as fit (n=713, 56.5%), mildly- (n=350, 27.8%), moderately- (n=163, 12.9%) and severely-frail (n=35, 2.8%). In the multivariable-adjusted analysis, compared to fit women, those with mild, moderate and severe frailty had significantly higher hazards for a fall- (46%, 104%, 168%), any fracture- (88%, 193%), hip fracture-related hospitalization (93%, 127%, 129%) and all-cause mortality (47%, 126%, 242%) (Figure). When DXA-derived hip BMD was included as an additional covariate to the multivariable-adjusted model (subset of women with available data, n=865), the results remained unchanged. For community-dwelling older women, our study supports the use of the FI to identify women at risk for falls and fractures. requiring hospitalization, as well as all-cause mortality. Accordingly, the FI may be incorporated into falls assessment and fracture prevention strategies to identify older women with poorer clinical prognosis who will benefit from tailored primary prevention programs.