Coexisting malnutrition risk, frailty, and probable sarcopenia are associated with previous-year falls in community-dwelling older adults: a retrospective cross-sectional real-world evidence study.

Abstract

Background: Falls in older adults are associated with disability, hospitalization, and mortality. Although frailty, malnutrition, and sarcopenia have individually been linked to falls, their combined association with previous-year fall history remains unclear. This study investigated the associations of these conditions and the number of coexisting conditions with self-reported falls during the previous year among community-dwelling older adults attending a geriatric outpatient clinic.

Methods: This retrospective cross-sectional real-world evidence study included 1219 adults aged ≥65 years attending a tertiary geriatric outpatient clinic between 2012 and 2024 who underwent comprehensive geriatric assessment. Frailty was assessed using the FRAIL scale, malnutrition risk using the Mini Nutritional Assessment-Short Form, and probable sarcopenia according to population-specific low handgrip strength based on European Working Group on Sarcopenia in Older People criteria. History of falls was assessed by asking participants whether they had experienced at least one fall during the previous 12 months and was analyzed as a binary outcome. The number of coexisting conditions was categorized as 0, 1, 2, or 3. Multivariable logistic regression models were adjusted for age, sex, and body mass index. A complete-case sensitivity analysis in the subgroup with complete data (n=557) was additionally adjusted for cognitive impairment, depressive symptoms, and polypharmacy.

Results: Mean age was 75.5±6.8 years, 68.3% were female, and 40.3% reported at least one fall during the previous year. Frailty, malnutrition risk, and probable sarcopenia were present in 19.8%, 26.9%, and 42.2% of participants, respectively. Frailty (OR 1.40, 95% CI 1.02-1.92) and malnutrition risk (OR 1.70, 95% CI 1.28-2.26) were associated with previous-year fall history, whereas probable sarcopenia was not (OR 1.28, 95% CI 0.98-1.68). Taking participants with none of the three conditions as the reference group, the adjusted odds of reporting a previous-year fall were higher among those with one condition (OR 1.43, 95% CI 1.09-1.88), two conditions (OR 2.22, 95% CI 1.56-3.16), and three conditions (OR 2.41, 95% CI 1.34-4.34); p for trend <0.001. Participants with two or three conditions had higher odds of reporting a previous-year fall than those with zero or one condition (OR 1.94, 95% CI 1.44-2.63). This association remained significant in the complete-case sensitivity analysis involving 557 participants (OR 1.66, 95% CI 1.06-2.60).

Conclusions: Malnutrition risk and frailty were associated with previous-year fall history, whereas the association with probable sarcopenia was attenuated after multivariable adjustment. A greater number of coexisting conditions was associated with progressively higher odds of reporting a previous-year fall.