Comparison of the Clinical-Functional Vulnerability Index and the frailty phenotype for the identification of falls in older individuals: A cross-sectional study

Background: Frailty increases the risk of falls, disability and death in older adults. The Cardiovascular Health Study identified a frailty phenotype (the Fried Phenotype) that was primarily based on physical domains. Instruments that incorporate additional domains (e.g., cognitive, disability or mood) may more accurately identify falls.Objectives: The study aimed i) to evaluate the association between falls and the number of phenotypes identi-fied by the Fried Phenotype and CFVI-20 scores and ii) to compare the strength of the association between falls and each frailty instrument.Methods: This study used the CFVI-20 and the Fried Phenotype and reported falls during the last twelve months. Logistic regression models, odds ratios (ORs), and ROC curves were used to identify associations and perform comparisons (p<0.05). The reporting of the study followed the Strobe guidelines.Results: This study included 1,826 individuals (mean 70.9 (SD 7.3) years old). Prevalence of pre-frailty and low vulnerability was high (72% and 69%) and comparable between frailty instruments. The number of Fried phenotypes increased the odds of having fallen in the past 12 months (OR: 1.5 to 29.5) and the CFVI-20 scores (11% increase/unit change). The CFVI-20 identified falls more accurately than the Fried Phenotype (AUC: 0.68 vs. 0.60, p < 0.001).Conclusions: The number of phenotypes and the CFVI-20 scores were associated with falls; continuous scores identified falls more accurately than categorical classifications. The CFVI-20 was more strongly associated with falls in community-dwelling older adults than the Fried Phenotype.(c) 2022 Elsevier Masson SAS. All rights reserved.

Automated summary

This study aimed to evaluate the association between falls and the number of phenotypes identified by the Fried Phenotype and CFVI-20 scores, and compare the strength of the association between falls and each frailty instrument. The results showed that the number of phenotypes and CFVI-20 scores were associated with falls, and continuous scores identified falls more accurately than categorical classifications. CFVI-20 was more strongly associated with falls in community-dwelling older adults than the Fried Phenotype.