Association of Frailty Status with Risk of Fall among Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

Objectives To investigate the association between frailty status and risk of fall among middle-aged and older Chinese people. Design A nationally representative prospective cohort study. Setting and Participants The study included 13,877 community-dwelling participants aged 45 years and above from the China Health and Retirement Longitudinal Study. Methods Frailty status was identified by the frailty index of health deficit accumulation. 34 variables at baseline were selected to calculate the frailty index. We excluded participants with incomplete information in construction of the frailty index at baseline. Falls were measured based on the respondents' self-report. We used a logistic regression model to estimate the associations between the frailty status and risk of fall, and subgroup analyses and sensitivity analyses were further conducted. Results Of 13,877 participants, 2310 (16.6%) had falls during the observation period. 9027 (65.0%) participants were classified as robust, 4019 (29.0%) participants were classified as pre-frail, and 831 (6.0%) participants were classified as frail. Our results indicated per 0.01 increment in the frailty index was significantly associated with an increased risk of fall among middle-aged and older participants (OR: 1.52, 95%CI: 1.45-1.60). Such association was stronger when frailty was presented as a categorical variable, with an OR of 1.75 (95%CI: 1.59-1.93) for pre-frail and 3.04 (95%CI: 2.60-3.56) for frail. The area under the curve of the logistic model was 0.612 (95%CI: 0.600-0.625). Each 0.01 increment of the frailty index was association with a higher risk of fall among middle-aged (45-59years) participants (OR: 1.44, 95%CI: 1.29-1.60) than among older (>= 60 years) participants (OR: 1.28, 95%CI: 1.16-1.41) at baseline (p=0.015 for interaction). Conclusion Frailty was significantly associated with an increased risk of fall among community-dwelling middle-aged and older people in China. It is necessary to screen and recognize frailty status to prevent falls among middle-aged and older adults.