BackgroundFalling is common among older people. The Timed-Up-and-Go Test (TUG) is recommended as a screening tool for falls but its predictive value has been challenged. The objectives of this study were to examine the ability of TUG to predict future falls and to estimate the optimal cut-off point to identify those with higher risk for future falls.MethodsThis is a prospective cohort study nested within a randomised controlled trial including 259 British community-dwelling older people ≥65 years undergoing usual care. TUG was measured at baseline. Prospective diaries captured falls over 24 weeks. A Receiver Operating Characteristic curve analysis determined the optimal cut-off point to classify future falls risk with sensitivity, specificity, and predictive values of TUG times. Logistic regression models examined future falls risk by TUG time.ResultsSixty participants (23%) fell during the 24 weeks. The area under the curve was 0.58 (95% confidence interval (95% CI) = 0.49-0.67, p = 0.06), suggesting limited predictive value. The optimal cut-off point was 12.6 seconds and the corresponding sensitivity, specificity, and positive and negative predictive values were 30.5%, 89.5%, 46.2%, and 81.4%. Logistic regression models showed each second increase in TUG time (adjusted for age, gender, comorbidities, medications and past history of two falls) was significantly associated with future falls (adjusted odds ratio (OR) = 1.09, 95% CI = 1.00-1.19, p = 0.05). A TUG time ≥12.6 seconds (adjusted OR = 3.94, 95% CI = 1.69-9.21, p = 0.002) was significantly associated with future falls, after the same adjustments.ConclusionsTUG times were significantly and independently associated with future falls. The ability of TUG to predict future falls was limited but with high specificity and negative predictive value. TUG may be most useful in ruling in those with a high risk of falling rather than as a primary measure in the ascertainment of risk.

BackgroundFalling is common among older people. The Timed-Up-and-Go Test (TUG) is recommended as a screening tool for falls but its predictive value has been challenged. The objectives of this study were to examine the ability of TUG to predict future falls and to estimate the optimal cut-off point to identify those with higher risk for future falls.MethodsThis is a prospective cohort study nested within a randomised controlled trial including 259 British community-dwelling older people ≥65 years undergoing usual care. TUG was measured at baseline. Prospective diaries captured falls over 24 weeks. A Receiver Operating Characteristic curve analysis determined the optimal cut-off point to classify future falls risk with sensitivity, specificity, and predictive values of TUG times. Logistic regression models examined future falls risk by TUG time.ResultsSixty participants (23%) fell during the 24 weeks. The area under the curve was 0.58 (95% confidence interval (95% CI) = 0.49-0.67, p = 0.06), suggesting limited predictive value. The optimal cut-off point was 12.6 seconds and the corresponding sensitivity, specificity, and positive and negative predictive values were 30.5%, 89.5%, 46.2%, and 81.4%. Logistic regression models showed each second increase in TUG time (adjusted for age, gender, comorbidities, medications and past history of two falls) was significantly associated with future falls (adjusted odds ratio (OR) = 1.09, 95% CI = 1.00-1.19, p = 0.05). A TUG time ≥12.6 seconds (adjusted OR = 3.94, 95% CI = 1.69-9.21, p = 0.002) was significantly associated with future falls, after the same adjustments.ConclusionsTUG times were significantly and independently associated with future falls. The ability of TUG to predict future falls was limited but with high specificity and negative predictive value. TUG may be most useful in ruling in those with a high risk of falling rather than as a primary measure in the ascertainment of risk.

BackgroundEvidence on longitudinal associations between smoking and frailty is scarce. The objective of this study was to systematically review the literature on smoking as a predictor of frailty changes among community-dwelling middle-aged and older population.MethodsA systematic search was performed using three electronic databases: MEDLINE, Embase and Scopus for studies published from 2000 through May 2015. Reference lists of relevant articles, articles shown as related citations in PubMed and articles citing the included studies in Google Scholar were also reviewed. Studies were included if they were prospective observational studies investigating smoking status as a predictor and subsequent changes in frailty, defined by validated criteria among community-dwelling general population aged 50 or older. A standardised data collection tool was used to extract data. Methodological quality was examined using the Newcastle-Ottawa Scale for cohort studies.ResultsA total of 1020 studies were identified and systematically reviewed for their titles, abstracts and full-text to assess their eligibilities. Five studies met inclusion criteria and were included in this review. These studies were critically reviewed and assessed for validity of their findings. Despite different methodologies and frailty criteria used, four of the five studies consistently showed baseline smoking was significantly associated with developing frailty or worsening frailty status at follow-up. Although not significant, the other study showed the same trend in male smokers. It is of note that most of the estimate measures were either unadjusted or only adjusted for a limited number of important covariates.ConclusionsThis systematic review provides the evidence of smoking as a predictor of worsening frailty status in community-dwelling population. Smoking cessation may potentially be beneficial for preventing or reversing frailty.

BackgroundCurrent research has established obesity as one of the main modifiable risk factors for cognitive impairment. However, evidence on the relationships of total and regional body composition measures as well as sarcopenia with cognitive functioning in the older population remains inconsistent.MethodsData are based on 1,570 participants from the British Regional Heart Study (BRHS), a cohort of older British men from 24 British towns initiated in 1978–80, who were re-examined in 2010–12, aged 71–92 years. Cognitive functioning was assessed with the Test-Your-Memory cognitive screening tool. Body composition characteristics assessed using bioelectrical impedance analysis included total fat mass (FM), central FM, peripheral FM, and visceral fat level. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People (EWGSOP) definition of severe sarcopenia and the Foundation for the National Institutes of Health (FNIH) sarcopenia project criteria.ResultsAmong 1,570 men, 636 (41 %) were classified in the mild cognitive impairment (MCI) and 133 (8 %) in the severe cognitive impairment (SCI) groups. Age-adjusted multinomial logistic regressions showed that compared with participants in the normal cognitive ageing group, those with SCI were more likely to have waist circumference >102 cm, BMI >30 kg/m2, to be in the upper quintile of total FM, central FM, peripheral FM and visceral fat level and to be sarcopenic. The relationships remained significant for total FM (RR = 2.16, 95 % CI 1.29–3.63), central FM (RR = 1.85, 95 % CI 1.09–3.14), peripheral FM (RR = 2.67, 95 % CI 1.59–4.48), visceral fat level (RR = 2.28, 95 % CI 1.32–3.94), BMI (RR = 2.25, 95 % CI 1.36–3.72) and waist circumference (RR = 1.63, 95 % CI 1.05–2.55) after adjustments for alcohol, smoking, social class, physical activity and history of cardiovascular diseases or diabetes. After further adjustments for interleukin-6 and insulin resistance, central FM, waist circumference and sarcopenia were no longer significantly associated with SCI.ConclusionsIncreased levels of peripheral FM, visceral fat level, and BMI are associated with SCI among older people. Distinct pathophysiological mechanisms link regional adipose tissue deposition and cognitive functioning.

BackgroundAlthough population-based studies have shown frailty predicted future falls, their follow-up periods were one year or longer and short-term fall risks associated with frailty are unknown.MethodsA prospective cohort study nested within a randomised controlled trial was conducted to examine associations between frailty and short-term incident future falls among community-dwelling older people. Two hundred forty eight community-dwelling people > =65 years without history of > =three falls and allocated to a usual care arm of exercise intervention trial were prospectively monitored for falls over 24 weeks. Frailty index (FI) was constructed from 40 deficits at baseline. The future fall risks according to frailty status was examined using logistic regression models.ResultsOf 248 participants, 46 were classified as frail and 57 had one or more falls during follow-up. Both each 0.01 increase in FI and frailty defined as FI > =0.25 were significantly associated with higher risks of future falls in multivariate logistic regression models adjusted for age, gender and history of two falls in the previous year (odds ratio (OR) = 1.05, 95 % confidence interval (95 % CI) = 1.02–1.07, p < 0.001; OR = 3.04, 95 % CI = 1.53–6.02, p = 0.001, respectively). Receiver operating characteristic (ROC) curve analysis showed FI predicted future falls with fair accuracy with area under ROC curve of 0.62 (95 % CI = 0.53–0.71, p < 0.01).ConclusionsFrailty was a significant and independent predictor of short-term future falls among community-dwelling older people who had volunteered for a physical activity study. It is important for healthcare practitioners to recognise frailty as a risk factor of imminent future falling even in older people who appear to be ageing well.

BackgroundAlthough population-based studies have shown frailty predicted future falls, their follow-up periods were one year or longer and short-term fall risks associated with frailty are unknown.MethodsA prospective cohort study nested within a randomised controlled trial was conducted to examine associations between frailty and short-term incident future falls among community-dwelling older people. Two hundred forty eight community-dwelling people > =65 years without history of > =three falls and allocated to a usual care arm of exercise intervention trial were prospectively monitored for falls over 24 weeks. Frailty index (FI) was constructed from 40 deficits at baseline. The future fall risks according to frailty status was examined using logistic regression models.ResultsOf 248 participants, 46 were classified as frail and 57 had one or more falls during follow-up. Both each 0.01 increase in FI and frailty defined as FI > =0.25 were significantly associated with higher risks of future falls in multivariate logistic regression models adjusted for age, gender and history of two falls in the previous year (odds ratio (OR) = 1.05, 95 % confidence interval (95 % CI) = 1.02–1.07, p < 0.001; OR = 3.04, 95 % CI = 1.53–6.02, p = 0.001, respectively). Receiver operating characteristic (ROC) curve analysis showed FI predicted future falls with fair accuracy with area under ROC curve of 0.62 (95 % CI = 0.53–0.71, p < 0.01).ConclusionsFrailty was a significant and independent predictor of short-term future falls among community-dwelling older people who had volunteered for a physical activity study. It is important for healthcare practitioners to recognise frailty as a risk factor of imminent future falling even in older people who appear to be ageing well.