Purpose:
Concerns about falling (CaF) are common in older adults. They are associated with increased risk of
falls, activity restriction, social isolation, and physical deconditioning. This systematic review
assessed if frailty is a risk factor for CaF.
Methods:
Searches of cross-sectional and prospective studies exploring associations between frailty and CaF
were conducted across five databases (Medline, CINAHL, Embase, Psychinfo and Scopus). The Risk
of Bias in Non-randomised Studies of Exposure (ROBINS-E) was used to determine risk of bias.
Results:
The search identified 2492 articles, 12 were included for data extraction: 8 cross-sectional and 4
prospective studies. Participants’ mean ages across the different studies ranged from 67.5 – 81.7
years. All adjusted analyses reported a significant association between increasing frailty and CaF,
except for one cross-sectional paper. Significant adjusted Odd Ratios (ORs) ranged from 1.79 (CI =
1.18-2.71) to 144.78 (CI = 13.86 – 1512.60) for cross-sectional studies, and from 1.33 (CI = 1.04–
1.69) to 12.4 (CI = 7.6-20.1) for prospective studies. Three studies (one cross-sectional and two
prospective) explored the association between frailty and concern-related activity restriction: A
significant association was reported in two prospective studies (adjusted OR = 1.58 (CI=1.09-2.30)
and adjusted RRR = 3.91 (2.61-5.85)), but not the cross-sectional study (adjusted OR = 1.31
(CI=0.62-2.78)).
Conclusion:
This review identifies strong associations between increasing frailty and both CaF and associated
activity restriction. This expands previous work describing the opposite association (that CaF can lead
to frailty), suggesting a bi-directional relationship. Clinicians working with pre-frail and frail older
adults should consider screening for CaF.
Prospero: CRD42023371899.