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. 2018 Mar;66(3):577-583.
doi: 10.1111/jgs.15275. Epub 2018 Feb 10.

Frailty Versus Stopping Elderly Accidents, Deaths and Injuries Initiative Fall Risk Score: Ability to Predict Future Falls

Rebecca S Crow  1   2   3 , Matthew C Lohman  3   4 , Dawna Pidgeon  3   5 , Martha L Bruce  2   3   4 , Stephen J Bartels  2   3   4   6 , John A Batsis  1   2   3   4   6
Affiliations

Frailty Versus Stopping Elderly Accidents, Deaths and Injuries Initiative Fall Risk Score: Ability to Predict Future Falls

Rebecca S Crow et al. J Am Geriatr Soc. 2018 Mar.

Abstract

Objectives: To compare the ability of frailty status to predict fall risk with that of community fall risk screening tools.

Design: Analysis of cross-sectional and longitudinal data from NHATS.

Setting: National Health and Aging Trend Study (NHATS) 2011-2015.

Participants: Individuals aged 65 and older (N = 7,392).

Measurements: Fall risk was defined according to the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative. Frailty was defined as exhaustion, weight loss, low activity, slow gait speed, and weak grip strength. Robust was defined as meeting 0 criteria, prefrailty as 1 or 2 criteria, and frailty as 3 or more criteria. Falls were self-reported and ascertained using NHATS subsequent rounds (2012-2015). We compared the ability of frailty to predict future falls with that of STEADI score, adjusting for age, race, sex, education, comorbidities, hearing and vision impairment, and disability.

Results: Of the 7,392 participants (58.5% female), there 3,545 (48.0%) were classified as being at low risk of falling, 2,966 (40.1%) as being at moderate risk, and 881 (11.9%) as being at high risk. The adjusted risk of falling over the 4 subsequent years was 2.5 times as great for the moderate-risk group (hazard ratio (HR) = 2.50, 95% confidence interval (CI) = 2.16-2.89) and almost 4 times as great (HR = 3.79, 95% CI = 2.76-5.21) for the high-risk group as for the low-risk group. Risk of falling was greater for those who were prefrail (HR = 1.34, 95% CI 1.16-1.55) and frail (HR = 1.20, 95% CI = 0.94-1.54) than for those who were robust.

Conclusion: STEADI score is a strong predictor of future falls. Addition of frailty status does not improve the ability of the STEADI measure to predict future falls.

Keywords: falls; frailty; pre-frailty.

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Conflict of interest statement

Conflict of Interest: There are no conflicts of interest pertaining to this manuscript.

Figures

Figure 1
Figure 1
Adapted Stopping Elderly Accidents, Deaths and Injuries algorithm demonstrating number of participants stratified into three fall risk categories (low, moderate, high).
Figure 2
Figure 2
Predicted probability of falling over subsequent 4 years according to frailty status and Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative. Frailty status defined according to the Fried phenotypic model as: frail, ≥ 3 criteria, prefrail; 1–2 criteria; robust, 0 criteria. Fall risk defined according to Centers for Disease Control and Prevention STEADI initiative, Preventing Falls in Older Patients—A Provider Tool Kit. Number of falls defined as answer of “yes” to the question, “Have you fallen in the last 12 months?” in the succeeding four rounds of longitudinal data collection (2012–2015 National Health and Aging Trends Study). Answering “no” in all four subsequent rounds=0. Answering “yes” in at least one of the four subsequent rounds, ≥1. Bars denote 95% confidence intervals.
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