Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor
Laurence Seematter-Bagnoud1,2, Brigitte Santos-Eggimann2, Stéphane Rochat1, Estelle Martin1, Athanassia Karmaniola2, Kamiar Aminian3, Chantal Piot-Ziegler4 and Christophe J. Büla1
1Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, 2Institute of Social and Preventive Medicine, University of Lausanne Hospital Center, 3Laboratory of Movement Analysis and Measurements (LMAM), Ecole Polytechnique Federale de Lausanne (EPFL), 4Institute of Psychology, Social and Political Sciences Faculty, University of Lausanne, Switzerland

Background and aims: Falls efficacy has been shown to predict functional decline, but whether it is independently associated with frailty is still unclear. This study investigated the cross-sectional association between falls efficacy and the frailty phenotype in high-functioning older persons. Methods: Subjects (n=861) were a sub-sample of community-dwelling persons aged 65 to 70 years enrolled in the “Lc65+” cohort, who had gait assessment. Data included demographics, functional, cognitive, affective and health status, as well as measures of physical performance. Falls efficacy was measured with the Falls Efficacy Scale-International (FES-I) and frailty with Fried’s criteria. Participants were categorized into robust (no frailty criterion) and vulnerable (1 or more criteria). Low falls efficacy was defined as a FES-I score in the lowest quartile. Results: Overall, 23.9% of participants were vulnerable. Compared with robust participants, they were more likely to report low falls efficacy (43.3% vs 19.1%, p<0.001) and had poorer health and functional and mental status. They had slower gait speed (1.07±0.18 vs 1.15±0.15 m/s, p<0.001) and increased gait speed variability (coefficient of variation 4.10±4.03 vs 3.33±1.45%, p<0.001), although only 6 participants (0.7%) fulfilled Fried’s slow walking criterion. In multivariate analysis, low falls efficacy remained associated with being vulnerable (adjusted OR 1.80, 95% CI 1.19-2.74, p=0.006), independent of comorbidity, functional status, falls history and gait performance. Conclusion: In high-functioning older persons, low falls efficacy was associated with vulnerability, even after controlling for gait performance and falls history. Whether low falls efficacy is a potential target on the pathway leading to frailty should be further examined prospectively. (Aging Clin Exp Res 2010; 22: 212-218) ©2010, Editrice Kurtis

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