Thigh Circumference as a Simple Marker of Falls and Frailty in Older Adults: A Scoping Review

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Aarthy Aravind 1 Abhishek Aravind 2 ; Nurul Iman Athirah Ahmad Fauz 3 ; Jenifer Vasanthakumar 4

1 Year 3 Medical student ,University of Buckingham Medical school ; 2 Medical Volunteer Countess of Chester Hospital ; 3 , 4 Resident Doctors Royal Liverpool University Hospital

Scientific Research

SP - Falls

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Abstract

Introduction

Falls and frailty are major causes of morbidity and loss of independence in older adults, with low lower-limb muscle mass contributing to both. Although calf circumference (CC) is established as a simple anthropometric marker of muscle mass, the potential value of thigh circumference (TC) is less well defined. We reviewed evidence examining TC in relation to falls, frailty and associated functional outcomes.

Method

A focused scoping search of literature identified studies assessing TC or thigh muscle thickness in older adults in relation to falls and frailty. Thirteen studies across North America, Europe and Asia were identified and categorised by population, thigh assessment and clinical outcome.

Results

Evidence relating TC to falls was limited current literature. In a prospective Japanese cohort, TC predicted fall injury, with thresholds of 44.6 cm in men and 37.2 cm in women, although discrimination was modest (Area under curve-AUC 0.625). Among 199 older emergency-department patients, greater ultrasound-measured thigh muscle thickness was independently associated with lower odds of previous falls (adjusted OR 0.59, 95% CI 0.38–0.91). TC was also associated with trip and falls risk. Evidence correlating with frailty was inconsistent and limited, including a Spanish cohort of 564 older adults where TC did not directly associate with frailty (p=0.411). On the other hand, associations with sarcopenia were more consistent in 2 studies. A Chinese cohort of 1,000 participants demonstrated AUCs of 0.873 in men and 0.861 in women, while reported TC thresholds varied substantially between populations.

Conclusion(s)

TC appears to be a promising, inexpensive, accessible marker of lower-limb muscle health. However, evidence for predicting clinical falls and frailty remains limited and heterogeneous. Prospective studies are required to establish age- and sex-specific thresholds and determine whether TC adds value to existing falls and frailty assessment as it is a simple reproducible clinical measurement.