And mortality in older Chinese adults: Results from the Beijing longitudinal study of aging

Objectives: Falls are well known to be associated with adverse health outcomes, especially when complicated by fracture. Falls are more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficit accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation. Design: Representative cohort study, with 8 year follow-up. Setting: The Beijing Longitudinal Study of Aging (BLSA). Participants: 3,257 Chinese people aged 55+ years at baseline. Measurements: A frailty index (FI) was constructed using 33 health deficits, but excluding falls and fractures. The rates of falls, fractures and death as a function of age and the FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants' health records. Results: Of 3,257 participants at baseline (1992), 360 people (11.1%) reported a history of falls, and 238 (7.3%) reported fractures. By eight years, 1,155 people had died (35.3%). The FI was associated with an increased risk of recurrent falls (OR=1.54; 95% confidence interval (CI)=1.34-1.76), fractures (OR=1.07; 95% CI=0.94-1.22), and death (OR=1.50, 95% CI=1.41-1.60). The FI showed a significant effect on mortality in a multivariate Cox regression model (Hazard Rate=1.29, 95% CI=1.25-1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality. Conclusion: Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death.