TY - JOUR
T1 - Frailty is strongly associated with increased risk of recurrent falls among older HIV-infected adults
AU - Tassiopoulos, Katherine
AU - Abdo, Mona
AU - Wu, Kunling
AU - Koletar, Susan L.
AU - Palella, Frank J.
AU - Kalayjian, Robert
AU - Taiwo, Babafemi
AU - Erlandson, Kristine M.
N1 - Funding Information:
Funding: This work was supported by the following institutes of the National Institutes of Health: the National Institute of Allergy and Infectious Diseases (NIAID) [AI068636, AI069432, AI068634, AI069423, AI069452, AI067039, AI106701 (and AI069494 to S.L.K.)], the National Institute of Mental Health (NIMH), and the National Institute of Dental and Craniofacial Research (NIDCR), and also by the National Institute of Aging (NIA) [K23AG050260; R01AG054366] to K.M.E. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was also supported by the Veterans Administration: VISN10 Geriatric Research Educational and Clinical Centers, Louis Stokes Cleveland Veterans Administration Medical Center and the CWRU Center for AIDS Research P30 AI036219 to R.C.K. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Funding Information:
R.C.K. receives grant support from Gilead Sciences, and F.J.P. is a consultant and/or on the speakers bureau for Gilead Sciences, Janssen Pharmaceuticals, Merck and Co. and Bristol Myers Squibb. B.T. has received honoraria and/or grant support to Northwestern University from ViiV Healthcare, Gilead Sciences, Glaxo Smith Kline, and Janssen. K.M.E. has received grant support from Gilead Sciences and has served as a consultant for Theratechnologies.
Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc.
PY - 2017/10/23
Y1 - 2017/10/23
N2 - Objective: Both frailty and falls occur at earlier-than-expected ages among HIV-infected individuals, but the contribution of frailty-to-fall risk in this population is not well understood. We examined this association among participants enrolled in AIDS Clinical Trials Group (ACTG) A5322. Design: A prospective, multicenter cohort study of HIV-infected men and women aged at least 40 years. Methods: Frailty assessment included a 4-m walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity. Multinomial logistic regression assessed the association between baseline frailty, grip, and 4-m walk, and single and recurrent (2+) falls over the next 12 months; logistic regression assessed effect modification by several factors on association between frailty and any (1+) falls. Results: Of 967 individuals, 6% were frail, 39% prefrail, and 55% nonfrail. Eighteen percent had at least one fall, and 7% had recurrent falls. In multivariable models, recurrent falls were more likely among frail (odds ratio 17.3, 95% confidence interval 7.03-42.6) and prefrail (odds ratio 3.80, 95% CI 1.87-7.72) than nonfrail individuals. Significant associations were also seen with recurrent falls and slow walk and weak grip. The association between frailty and any falls was substantially stronger among individuals with peripheral neuropathy. Conclusion: Aging HIV-infected prefrail and frail individuals are at significantly increased risk of falls. Incorporation of frailty assessments or simple evaluations of walk speed or grip strength in clinical care may help identify individuals at greatest risk for falls. Peripheral neuropathy further increases fall risk among frail persons, defining a potential target population for closer fall surveillance, prevention, and treatment.
AB - Objective: Both frailty and falls occur at earlier-than-expected ages among HIV-infected individuals, but the contribution of frailty-to-fall risk in this population is not well understood. We examined this association among participants enrolled in AIDS Clinical Trials Group (ACTG) A5322. Design: A prospective, multicenter cohort study of HIV-infected men and women aged at least 40 years. Methods: Frailty assessment included a 4-m walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity. Multinomial logistic regression assessed the association between baseline frailty, grip, and 4-m walk, and single and recurrent (2+) falls over the next 12 months; logistic regression assessed effect modification by several factors on association between frailty and any (1+) falls. Results: Of 967 individuals, 6% were frail, 39% prefrail, and 55% nonfrail. Eighteen percent had at least one fall, and 7% had recurrent falls. In multivariable models, recurrent falls were more likely among frail (odds ratio 17.3, 95% confidence interval 7.03-42.6) and prefrail (odds ratio 3.80, 95% CI 1.87-7.72) than nonfrail individuals. Significant associations were also seen with recurrent falls and slow walk and weak grip. The association between frailty and any falls was substantially stronger among individuals with peripheral neuropathy. Conclusion: Aging HIV-infected prefrail and frail individuals are at significantly increased risk of falls. Incorporation of frailty assessments or simple evaluations of walk speed or grip strength in clinical care may help identify individuals at greatest risk for falls. Peripheral neuropathy further increases fall risk among frail persons, defining a potential target population for closer fall surveillance, prevention, and treatment.
KW - HIV-infected
KW - aging
KW - falls
KW - frailty
KW - peripheral neuropathy
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U2 - 10.1097/QAD.0000000000001613
DO - 10.1097/QAD.0000000000001613
M3 - Article
C2 - 28991026
AN - SCOPUS:85030783412
VL - 31
SP - 2287
EP - 2294
JO - AIDS
JF - AIDS
SN - 0269-9370
IS - 16
ER -