Dear Editor,
Falls have become a public serious issue among older people, according to the data, falls influence over 20% of older adults worldwide. When older people suffer from falls, they usually have serious consequences, such as hospitalization, fractures, and even mortality (1, 2). Therefore, identifying the risk factors of falls was very important. Frailty is a very common geriatric syndrome among older adults. Over the last decades, several studies have explored the association between frailty and falls among older people and some systematic reviews and meta-analysis have summarized the evidence and confirmed that frailty can lead to a higher risk of falls compared to those without frailty (3, 4).
With great interest, we read the recently updated systematic review and meta-analysis by Yang and his colleague who conducted a meta-analysis of the association between frailty and falls among older people (5). They performed a great study by systematically searching internet databases worldwide and found that older people with frailty had a greater risk of falling than older people without frailty. In addition, subgroup analysis also found men, in developed countries and Oceania had a higher risk of falling than their counterparts. This meta-analysis had many strengths and emphasized the importance of early screening frailty and intervention to reduce frailty, preventing fall risk among older adults. Apart from the strengths, some other questions need more discussion.
Firstly, we think the author might need to provide more information about the methods for pooling the effect size between the association between frailty and falling. In the original study, two studies present the effect size of the association as “HR”, twenty studies present the effect size as “OR” and seven studies present the effect size as “RR”. Therefore, the authors must have used some methods to convert OR and HR to RR. We think the authors need to display this information in the methods, which can help the reader to better understand.
Secondly, we believe that the older people from the hospital and community are different. Usually, older people living in the hospital often suffer from acute or chronic diseases, therefore they are more vulnerable to frailty. Thus, conducting a subgroup by setting was very important. We performed the subgroup analysis by setting and the results found that older people with frailty had higher fall risk in hospital compared to older people with frailty from the community or population-based setting, the results (pooled RR=1.79,95CI:1.29–2.46; versus pooled RR=1.40,95%CI:1.22–1.62; versus pooled RR=1.30,95%CI:1.22–1.38) showed in Figure 1. Therefore, nurses and doctors need to pay more attention to frailty in hospitals. As several studies found that the prevalence of frailty in hospital are higher than community, more preventive strategy should be performed in hospital by the clinic manager.
Figure 1.
Subgroup analysis for the association between frailty and falls among older people based on setting
Thirdly, the original study explored the association between frailty and falls by controlling different confounding factors. Different studies had adjusted different variables; therefore, the effect size for the association between frailty and falls might be overestimated or underestimated, which could not be avoided due to the different study designs. To provide overall information, the authors can provide the fully adjusted variable in each original study and perform the subgroup analysis based on different adjusted models (unadjustment versus adjustment), if the results of association between frailty and falls in this subgroup analysis were similar, which can show the results were relatively robust.
To sum up, the authors performed an excellent updated meta-analysis and the finding had many clinical implications not only for policymakers to implement a strategy to reduce falls among older people but also to bring great attention from clinicians and geriatric comprehensive teams to take intervention for treating frailty among older people. We believe that fully figure out these mentioned problems can provide the true prognostic value of frailty for falls among older people.
Conflict of interest:
the authors have no conflicts of interest to declare.
Ethical approval:
Not applicable.
Patient consent:
Not applicable.
Authors contributions:
ZXM is responsible for design and writing, MFG and SDH are responsible for data analysis.
References
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