Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor.
OBJECTIVE
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.


CONCLUSIONS
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.
Seematter-Bagnoud
Laurence
L
Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Lausanne, Switzerland. Laurence.Seematter-Bagnoud@chuv.ch
Santos-Eggimann
Brigitte
B
Rochat
Stéphane
S
Martin
Estelle
E
Karmaniola
Athanassia
A
Aminian
Kamiar
K
Piot-Ziegler
Chantal
C
Büla
Christophe J
CJ
D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000375:Aging / Q000502:physiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D015444:Exercise; D005239:Fear / Q000523:psychology*; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D005684:Gait; D006801:Humans; D008297:Male; D010809:Physical Fitness; D020377:Self Efficacy; D011795:Surveys and Questionnaires