Frailty is strongly associated with increased risk of recurrent falls among older HIV-infected adults

Abstract

Objective: Both frailty and falls occur at earlier-than-expected ages among HIV-infected individuals, but the contribution of frailty-to-fall risk in this population is not well understood. We examined this association among participants enrolled in AIDS Clinical Trials Group (ACTG) A5322.

Design: A prospective, multicenter cohort study of HIV-infected men and women aged at least 40 years.

Methods: Frailty assessment included a 4-m walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity. Multinomial logistic regression assessed the association between baseline frailty, grip, and 4-m walk, and single and recurrent (2+) falls over the next 12 months; logistic regression assessed effect modification by several factors on association between frailty and any (1+) falls.

Results: Of 967 individuals, 6% were frail, 39% prefrail, and 55% nonfrail. Eighteen percent had at least one fall, and 7% had recurrent falls. In multivariable models, recurrent falls were more likely among frail (odds ratio 17.3, 95% confidence interval 7.03-42.6) and prefrail (odds ratio 3.80, 95% CI 1.87-7.72) than nonfrail individuals. Significant associations were also seen with recurrent falls and slow walk and weak grip. The association between frailty and any falls was substantially stronger among individuals with peripheral neuropathy.

Conclusion: Aging HIV-infected prefrail and frail individuals are at significantly increased risk of falls. Incorporation of frailty assessments or simple evaluations of walk speed or grip strength in clinical care may help identify individuals at greatest risk for falls. Peripheral neuropathy further increases fall risk among frail persons, defining a potential target population for closer fall surveillance, prevention, and treatment.

Figure 1. Proportion of Participants with Single and Recurrent Falls by Baseline Frailty Status

Chi-square test p-value <0.001, comparing the proportion of individuals with single and recurrent falls by frailty group (non-frail, pre-frail and frail).

Figure 2. Multivariable Associations between Frailty Characteristics and Falls

Frailty-falls model adjusted for: age (categorical), race/ethnicity, alcohol use, current substance use, neurocognitive function. Gait speed-falls model adjusted for: age (continuous), race/ethnicity, education level, current alcohol use, neurocognitive function. Grip strength-falls model adjusted for: age (categorical), race/ethnicity, current substance use, physical activity, diabetes, health insurance, current alcohol use.

Figure 3. Effect Modification by Peripheral Neuropathy on Association between Frailty Status and Any (1+) Falls

Model adjusted for: age, race/ethnicity, current alcohol use, current substance use, and neurocognitive function; interaction term between peripheral neuropathy and frailty status also included.