title: Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor.
abstract: 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.
authors: Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Lausanne, Switzerland. Laurence.Seematter-Bagnoud@chuv.ch
authors: Laurence
authors: L
authors: Seematter-Bagnoud
authors: Brigitte
authors: B
authors: Santos-Eggimann
authors: Stéphane
authors: S
authors: Rochat
authors: Estelle
authors: E
authors: Martin
authors: Athanassia
authors: A
authors: Karmaniola
authors: Kamiar
authors: K
authors: Aminian
authors: Chantal
authors: C
authors: Piot-Ziegler
authors: Christophe J
authors: CJ
authors: Büla
mesh_terms: 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