title: Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study.
abstract: BACKGROUND
  Patients undergoing hemodialysis are at high risk of falls, with subsequent complications including fractures, loss of independence, hospitalization, and institutionalization. Factors associated with falls are poorly understood in this population. We hypothesized that insights derived from studies of the elderly might apply to adults of all ages undergoing hemodialysis; we focused on frailty, a phenotype of physiological decline strongly associated with falls in the elderly.
  
  
  METHODS
  In this prospective, longitudinal study of 95 patients undergoing hemodialysis (1/2009-3/2010), the association of frailty with future falls was explored using adjusted Poisson regression. Frailty was classified using the criteria established by Fried et al., as a combination of five components: shrinking, weakness, exhaustion, low activity, and slowed walking speed.
  
  
  RESULTS
  Over a median 6.7-month period of longitudinal follow-up, 28.3% of study participants (25.9% of those under 65, 29.3% of those 65 and older) experienced a fall. After adjusting for age, sex, race, comorbidity, disability, number of medications, marital status, and education, frailty independently predicted a 3.09-fold (95% CI: 1.38-6.90, P=0.006) higher number of falls. This relationship between frailty and falls did not differ for younger and older adults (P=0.57).
  
  
  CONCLUSIONS
  Frailty, a validated construct in the elderly, was a strong and independent predictor of falls in adults undergoing hemodialysis, regardless of age. Our results may aid in identifying frail hemodialysis patients who could be targeted for multidimensional fall prevention strategies.
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.forename: Sunitha
authors.initials: S
authors.lastname: Suresh
authors.forename: Andrew
authors.initials: A
authors.lastname: Law
authors.forename: Megan L
authors.initials: ML
authors.lastname: Salter
authors.forename: Luis F
authors.initials: LF
authors.lastname: Gimenez
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Walston
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dorry@jhmi.edu.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000058:Accidental Falls / Q000401:mortality* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000401:mortality*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome