Order of Onset of Physical Frailty and Cognitive Impairment and Risk of Repeated Falls in Community-Dwelling Older Adults.

This was an observational study, so it cannot show that frailty or cognitive impairment caused the falls, only that they occurred together. Falls were measured by asking about the past 12 months, and the study did not record how many falls occurred, so frequent minor falls may have been missed. The analysis looked only at the year after new frailty or cognitive impairment, so longer-term fall risk was not assessed. 328 people were excluded because fall information was missing; they were older and had more disease burden, so the analysed sample may not represent all older adults. Some people excluded because of death or drop-out were sicker than those analysed, which may make the observed associations conservative. The authors note that the co-occurrence pattern may be linked to dementia, but they did not establish that dementia caused the falls.

The authors declared no conflicts of interest. The paper lists NIH and non-U.S. government research support.

Do not read the higher repeated-fall rate in the co-occurrence group as proof that treating frailty or cognitive impairment prevents falls. This study did not test an intervention, and the frailty-first versus cognitive-impairment-first difference did not reach statistical significance after adjustment.