Frailty is strongly associated with increased risk of recurrent falls among older HIV-infected adults

Abstract

Objective Both frailty and falls occur at earlier than expected ages among HIV-infected individuals, but the contribution of frailty to fall risk in this population is not well understood. We examined this association among participants enrolled in AIDS Clinical Trials Group (ACTG) A5322. Design A prospective, multi-center cohort study of HIV-infected men and women ≥40 years. Methods Frailty assessment included a 4-meter walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity. Multinomial logistic regression assessed the association between baseline frailty, grip, and 4-meter walk and single and recurrent (2+) falls over the next 12 months; logistic regression assessed effect modification by several factors on association between frailty and any (1+) falls. Results Of 967 individuals, 6% were frail, 39% pre-frail, and 55% non-frail. Eighteen percent had ≥1 fall, and 7% had recurrent falls. In multivariable models, recurrent falls were more likely among frail (OR=17.3; 95% CI=7.03-42.6) and pre-frail (OR=3.80; 95% CI=1.87-7.72) than non-frail individuals. Significant associations were also seen with recurrent falls and slow walk and weak grip. The association between frailty and any falls was substantially stronger among individuals with peripheral neuropathy. Conclusions Aging HIV-infected pre-frail and frail individuals are at significantly increased risk of falls. Incorporation of frailty assessments or simple evaluations of walk speed or grip strength in clinical care may help identify individuals at greatest risk for falls. Peripheral neuropathy further increases fall risk among frail persons, defining a potential target population for closer fall surveillance, prevention, and treatment.

Gender differences for frailty in HIV-infected patients on stable antiretroviral therapy and with an undetectable viral load

“…In our first analysis, we observed that people with pre-frailty/frailty had more frequently hearing or visual impairment or falls, suggesting that it is necessary to incorporate geriatric principles for the management of theses patients. In this regards, Tassiopoulos et al [20] observed that falls were more common among pre-frail/frail men. We also observed the same but the reasons are not well known.…”

“…Erlandson et al [21] notes that multiple potential factors (including tobacco use, comorbidities, medications) could be implicated in falls. Against what one would suppose, neither gait speed nor grip strength were associated with falls [20].…”

Polypharmacy, Hazardous Alcohol and Illicit Substance Use, and Serious Falls Among PLWH and Uninfected Comparators

“…Falls are associated with fractures, traumatic brain injury, 1 disability, 2 and death and are a growing concern for people aging with HIV. [4][5][6][7][8] Of particular importance are falls that cause a patient to seek health care (serious falls). Previous research has provided conflicting evidence about fall risk factors among persons living with HIV (PLWH) and whether or not these risk factors differ for PLWH and uninfected comparators.…”

Can Biomarkers Advance HIV Research and Care in the Antiretroviral Therapy Era?

“…Frailty is a geriatric syndrome of vulnerability to adverse health outcomes, characterized by impairment in mobility, balance, strength, cognition, nutrition, endurance, and physical activity [26]. Frailty contributes to and is exacerbated by other geriatric syndromes [27]. Many studies suggest that frailty occurs earlier and more often among HIV-infected individuals [28].…”