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Frailty is associated with declines in physiological capacity across sensory, neurological, and musculoskeletal systems. An underlying assumption is that the frailer an individual, the more likely they are to experience falls and fractures. We examined whether grades of frailty can assess the long-term risk of hospitalized falls, fractures, and all-cause mortality in 1261 community-dwelling older women (mean age [SD] of 75.1 [2.7] yr) over 14.5 yr. Frailty was operationalized using a frailty index (FI) of cumulative deficits from 33 variables across multiple health domains (physical, mental, comorbidities) at baseline. The total score across these variables was summed and divided by 33 to obtain the FI. Participants were graded as fit (FI ≤ 0.12), mildly frail (FI > 0.12–0.24), moderately frail (FI > 0.24–0.36), or severely frail (FI > 0.36). Fall-related (n  = 498), any fracture-related (n  = 347), and hip fracture–related hospitalizations (n  = 137) and deaths (n  = 482) were obtained from linked health records. Associations between FI grades and clinical outcomes were analyzed using multivariable-adjusted Cox-proportional hazard models including age, treatment (calcium/placebo), BMI, smoking history, socioeconomic status, plasma vitamin D (25OHD) status plus season obtained, physical activity, self-reported prevalent falls in the last 3 mo, and self-reported fractures since the age of 50 yr. At baseline, 713 (56.5%), 350 (27.8%), 163 (12.9%), and 35 (2.8%) of women were classified as fit, mildly frail, moderately frail, and severely frail, respectively. Women with mild, moderate, and severe frailty had significantly higher hazards (all P  < .05) for a fall-related (46%, 104%, 168%), any fracture-related (88% for moderate, 193% for severe frailty), hip fracture–related hospitalizations (93%, 127%, 129%), and all-cause mortality (47%, 126%, 242%). The FI identified community-dwelling older women at risk for the most serious falls and fractures and may be incorporated into risk assessment tools to identify individuals with poorer clinical prognosis. [ABSTRACT FROM AUTHOR]

Abdominal aortic calcification (AAC), a recognized measure of advanced vascular disease, is associated with higher cardiovascular risk and poorer long‐term prognosis. AAC can be assessed on dual‐energy X‐ray absorptiometry (DXA)‐derived lateral spine images used for vertebral fracture assessment at the time of bone density screening using a validated 24‐point scoring method (AAC‐24). Previous studies have identified robust associations between AAC‐24 score, incident falls, and fractures. However, a major limitation of manual AAC assessment is that it requires a trained expert. Hence, we have developed an automated machine‐learning algorithm for assessing AAC‐24 scores (ML‐AAC24). In this prospective study, we evaluated the association between ML‐AAC24 and long‐term incident falls and fractures in 1023 community‐dwelling older women (mean age, 75 ± 3 years) from the Perth Longitudinal Study of Ageing Women. Over 10 years of follow‐up, 253 (24.7%) women experienced a clinical fracture identified via self‐report every 4–6 months and verified by X‐ray, and 169 (16.5%) women had a fracture hospitalization identified from linked hospital discharge data. Over 14.5 years, 393 (38.4%) women experienced an injurious fall requiring hospitalization identified from linked hospital discharge data. After adjusting for baseline fracture risk, women with moderate to extensive AAC (ML‐AAC24 ≥ 2) had a greater risk of clinical fractures (hazard ratio [HR] 1.42; 95% confidence interval [CI], 1.10–1.85) and fall‐related hospitalization (HR 1.35; 95% CI, 1.09–1.66), compared to those with low AAC (ML‐AAC24 ≤ 1). Similar to manually assessed AAC‐24, ML‐AAC24 was not associated with fracture hospitalizations. The relative hazard estimates obtained using machine learning were similar to those using manually assessed AAC‐24 scores. In conclusion, this novel automated method for assessing AAC, that can be easily and seamlessly captured at the time of bone density testing, has robust associations with long‐term incident clinical fractures and injurious falls. However, the performance of the ML‐AAC24 algorithm needs to be verified in independent cohorts. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). [ABSTRACT FROM AUTHOR]

Background: Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study. Methods: This was a non‐randomized trial (pilot study) including NH staff and residents from five facilities. Long‐stay residents at high‐risk for injurious falls were identified using a validated risk calculator and staff referral. A remote team reviewed the electronic health record (EHR) and provided recommendations as Injury Prevention Plans (IPP). A research nurse served as a care coordinator focused on resident engagement and shared decision‐making. Outcomes included implementation measures, as identified in the EHR, and surveys and interviews with staff. Results: Across five facilities, 274 residents were screened for eligibility, and 46 residents (16.8%) were enrolled. Most residents were female (73.9%) and had dementia (63.0%). An IPP was completed for 45 residents (97.8%). The nurse made a total of 93 deprescribing recommendations in 36 residents (80% of residents had one or more deprescribing recommendation; mean 2.2 recommendations/resident). Twenty of 45 residents (44.4%) had a recommendation for osteoporosis treatment. Among residents with recommendations, 21/36 (58.3%) had one or more deprescribing orders written and 6/20 (30.0%) had an osteoporosis medication prescribed. At 4 months, most medication changes persisted. Adverse side effects were rare. Staff members identified several areas for program refinement, including aligning recommendations with provider workflow and engaging consultant psychiatrists. Conclusions: A remote injury prevention service is safe and feasible to enhance deprescribing and osteoporosis treatment in long‐stay NH residents at risk for injury. Additional investigation is needed to determine if this model could reduce injurious falls when deployed across NH chains. [ABSTRACT FROM AUTHOR]

Background: The dose–response relationship of vitamin D status and the risk of serious falls requiring hospitalization in older women is unclear. We examined the association between plasma 25‐hydroxyvitamin D (25OHD) with falls‐related hospitalizations over 14.5 years in a large cohort of older women. Methods: In 1348 community‐dwelling Australian women aged ≥70 years, plasma 25OHD concentrations were assessed at baseline (1998) using LC–MS/MS. Fall‐related hospitalizations were obtained from linked data systems. Baseline grip strength and timed‐up‐and‐go (TUG) were assessed as measures of muscle strength and physical function, respectively. Results: Mean plasma 25OHD was 66.9 ± 28.2 nmol/L. The number of women in the low (LOW; <50 nmol/L), medium (MED; 50 to <75 nmol/L), and higher 25OHD (HIGH; ≥75 nmol/L) categories were 384 (28.5%), 491 (36.4%), and 473 (35.1%), respectively. In the multivariable‐adjusted analysis, compared to LOW, women in HIGH had significantly lower hazards for a falls‐related hospitalization (HR 0.76 95%CI 0.61–0.95). Restricted cubic spline regression models highlight increasing gradient of risk for a falls‐related hospitalization with decreasing 25OHD levels. Generalized additive modeling highlighted higher 25OHD to be associated with better TUG performance. Including TUG into the multivariable‐adjusted models did not alter the relationship between 25OHD and injurious falls (HIGH vs. LOW HR 0.76 95%CI 0.60–0.95). Conclusions: In community‐dwelling older Australian women, maintaining plasma 25OHD at 75 nmol/L or above may confer benefits to muscle function and long‐term prevention of injurious falls requiring hospitalization. This relationship appears to be independent of better physical function observed in women with higher 25OHD levels. [ABSTRACT FROM AUTHOR]

Objectives Cardiovascular disorders are recognized as important modifiable risk factors for falls. However, the association between falls and orthostatic hypotension ( OH) remains ambivalent, particularly because of poor measurement methods of previous studies. The goal was to determine for the first time to what extent OH (and variants) are risk factors for incident falls, unexplained falls ( UF), injurious falls ( IF) and syncope using dynamic blood pressure ( BP) measurements in a population study. Design Nationally representative longitudinal cohort study-The Irish Longitudinal Study on Ageing ( TILDA)-wave 1 (2009-2011) with 2-year follow-up at wave 2 (2012-2013). Setting Community-dwelling adults. Participants Four thousand one hundred twenty-seven participants were randomly sampled from the population of older adults aged ≥50 years resident in Ireland. Measurements Continuous BP recordings measured during active stands were analyzed. OH and variants (initial OH and impaired orthostatic BP stabilization OH(40)) were defined using dynamic BP measurements. Associations with the number of falls, UF, IF, and syncope reported 2 years later were assessed using negative binomial and modified Poisson regression as appropriate. Results Participants had a mean age of 61.5 (8.2) years (54.2% female). OH(40) was associated with increased relative risk of UF ( RR: 1.52 95% CI: 1.03-2.26). OH was associated with all-cause falls ( IRR: 1.40 95% CI: 1.01-1.96), UF( RR: 1.81 95% CI: 1.06-3.09), and IF( RR: 1.58 95% CI: 1.12-2.24). IOH was not associated with any outcome. Conclusion With the exception of initial orthostatic hypotension, beat-to-beat measures of impaired orthostatic BP recovery (delayed recovery OH (40) or sustained orthostatic hypotension OH) are independent risk factors for future falls, unexplained falls, and injurious falls. [ABSTRACT FROM AUTHOR]

Although multifactorial fall prevention interventions have been shown to reduce falls and injurious falls, their translation into clinical settings has been limited. This article describes a hospital-based fall prevention clinic established to increase availability of preventive care for falls. Outcomes for 43 adults aged 65 and older seen during the clinic's first 6 months of operation were compared with outcomes for 86 age-, sex-, and race-matched controls; all persons included in analyses received primary care at the hospital's geriatrics clinic. Nonsignificant differences in falls, injurious falls, and fall-related healthcare use according to study group in multivariate adjusted models were observed, probably because of the small, fixed sample size. The percentage experiencing any injurious falls during the follow-up period was comparable for fall clinic visitors and controls (14% vs 13%), despite a dramatic difference at baseline (42% of clinic visitors vs 15% of controls). Fall-related healthcare use was higher for clinic visitors during the baseline period (21%, vs 12% for controls) and decreased slightly (to 19%) during follow-up; differences in fall-related healthcare use according to study group from baseline to follow-up were nonsignificant. These findings, although preliminary because of the small sample size and the baseline difference between the groups in fall rates, suggest that being seen in a fall prevention clinic may reduce injurious falls. Additional studies will be necessary to conclusively determine the effects of multifactorial fall risk assessment and management delivered by midlevel providers working in real-world clinical practice settings on key outcomes, including injurious falls, downstream fall-related healthcare use, and costs. [ABSTRACT FROM AUTHOR]