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Frailty But Not HIV Tied to Falls in Large Group of Older US Women
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10th International Workshop on HIV and Aging, October 10-11, 2019, New York
Mark Mascolini
Frailty independently predicted recurrent falls in the past 12 months in older US women with or at risk for HIV infection in the Women's Interagency HIV Study [1]. This 1229-woman analysis did not find a higher fall risk with HIV infection, but frailty predicted single falls and recurrent falls in women with HIV, and current antiretroviral therapy (ART) lowered risk of recurrent falls.
Previous work in the WIHS cohort found similar rates of single falls (15% to 18%) and recurrent falls (20% to 25%) over 2 years in women with or without HIV infection [2]. Frailty independently predicted recurrent falls in that analysis, and unintentional weight loss (1 of 5 frailty components) independently predicted a single fall.
The new analysis presented at the Aging Workshop involved 897 WIHS women with HIV and 332 HIV-negative women sociodemographically similar to the HIV-positive group. Researchers used the Fried Frailty phenotype to evaluate women for frailty [3]. This method classifies a person as frail if they meet 3 or more of 5 criteria: impaired mobility, reduced grip strength, exhaustion, unintentional weight loss, and low physical activity. Prefrailty means meeting 1 or 2 of the 5 frailty criteria.
WIHS investigators applied stepwise logistic regression to explore associations between the composite frailty assessment, or individual components of the frailty phenotype, and a single fall (1 versus 0) or recurrent falls (2 or more versus 0 or 1) in the past 12 months. Analyses limited to WIHS women with HIV assessed the contribution of HIV disease factors to frailty and falls.
The WIHS study group had a median age of 53 years. A higher proportion of women with than without HIV were white (16% versus 8%), while lower proportions were black (74% versus 80%) or Hispanic/other (10% versus 12%) (P = 0.005). Women with HIV had a higher prevalence of kidney impairment (eGFR below 60 mL/min) (13% versus 7%, P = 0.002) but a lower prevalence of depressive symptoms (27% versus 33%, P = 0.038). Among women with HIV, 93% reported current antiretroviral therapy, and 71% had an undetectable viral load.
Frailty prevalence proved significantly lower in women with than without HIV (9% versus 14%, P = 0.024). Prevalence of prefrailty was marginally higher in women with than without HIV (51% versus 46%). The same proportion of women with and without HIV, 13%, reported single falls. A nonsignificantly lower proportion of women with HIV reported recurrent falls (13% versus 16%).
Multivariate analysis involving all women studied determined that frailty (versus nonfrailty) more than tripled the odds of recurrent falls in the past 12 months (adjusted odds ratio [aOR] 3.61, P < 0.0001) but did not significantly affect chances of single falls. Prefrailty (versus nonfrailty) more than doubled the odds of recurrent falls in the entire group (aOR 2.23, P = 0.008). Every additional 10 years of age boosted odds of recurrent falls 33% (aOR 1.33, P = 0.041).
In an analysis limited to women with HIV, frailty more than tripled the odds of recurrent falls in the past 12 months (aOR 3.50, P = 0.018) and almost tripled the odds of a single fall (aOR 2.88, P = 0.023). In women with HIV, prefrailty doubled the odds of recurrent falls (aOR 2.0, P = 0.42), Current antiretroviral therapy cut chances of recurrent falls about 75% (aOR 0.26, P = 0.0046).
Having HIV infection did not predict single or recurrent falls. But 3 of 5 frailty components independently predicted recurrent falls: reduced grip strength (aOR 1.75, P = 0.025), exhaustion (aOR 1.88, P = 0.0067), and low physical activity (aOR 1.89, 95% CI 1.19 to 2.99, P = 0.0069).
The WIHS team proposed that "evaluating frailty as a risk factor for falls as women age with HIV and a history of advanced HIV disease is clinically warranted."
References
1. Sharma A, Hoover D, Shi Q, et al. Frailty predicts recurrent falls among older women with and without HIV. 10th International Workshop on HIV and Aging, October 10-11, 2019, New York. Abstract 22.
2. Sharma A, Hoover DR, Shi Q, et al. Frailty as a predictor of falls in HIV-infected and uninfected women. Antivir Ther. 2019;24:51-61.
3. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-M156.
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