Beyond CFS 4: Defining Clinically Meaningful Risk Groups for Falls Using Fear of Falling and Nutritional Assessments

INTRODUCTION

Clinical Frailty Scale (CFS) is a validated 9-point scale for assessing frailty, with higher scores associated increased risk of injurious falls, morbidity, prolonged hospitalization and death. Individuals with CFS 4 represent a heterogenous pre-frail group, making risk stratification challenging. Falls are a key adverse outcome that often precedes functional decline. This study aimed to identify predictors of falls in community-dwelling older adults with CFS 4. 

METHODOLOGY

A retrospective study included community-dwelling adults aged ≥65 with CFS4. Demographic, nutritional, and physical performance variables(SPPB) were compared between fallers and non-fallers using univariate analyses, followed by multivariate logistic regression to identify independent predictors of fall. Model performance was evaluated using the area under the receiver operating characteristic curve(AUC) and the Hosmer-Lemeshow test. A weighted risk score was then developed to classify participants into low, intermediate, and high-risk groups.

RESULTS 

Among 202 community-dwelling adults with CFS 4, 23(11.4%) experienced falls. Age, gender, AMT, grip strength, and SPPB did not differ between groups. Fallers had poorer nutritional status(MNA-SF), smaller calf circumference, slower gait speed and greater fear of falling. 

In univariate logistic regression, impaired nutritional status(OR 5.27, 95% CI 1.94-14.32;p=0.001) and greater fear of falling(OR 27.09, 95% CI 6.13–119.80;p<0.001) significantly predicted falls. Multivariable analysis confirmed both MNA-SF(adjusted OR 5.67, 95% CI 1.61-20.05;p=0.007) and FES-I(adjusted OR 31.52, 95% CI 6.76-147.86;p<0.001) as independent predictors. A weighted risk score assigning 1point for impaired MNA-SF and 2points for impaired FES-I(total score 0-3) demonstrated good discrimination, with fall risk increasing from 1.7%(score 0) to 72.7%(score 3), effectively stratifying low-, intermediate-, and high-risk groups. 

CONCLUSION

Poor nutritional status and fear of falling independently predicted falls in older adults with CFS 4.

A simple weighted score incorporating MNA-SF and FES-I improved risk stratification beyond CFS alone and may support targeted fall prevention. External validation in larger prospective cohorts is warranted.