Abstract

OBJECTIVE

To analyze the prevalence of falls and frailty syndrome and the association between these two syndromes in the elderly population.

METHOD

Systematic review, without restriction of dates, in English, Portuguese and Spanish languages, in the databases PubMed, CINAHL, LILACS and in the SciElo virtual library. The association between both variables was extracted from the studies (Odds Ratio and 95% Confidence Intervals).

RESULTS

The review included 19 studies published between 2001 and 2015. The prevalence of falls in the frail elderly population was between 6.7% and 44%; in the pre-frail, between 10.0% and 52.0%, and in the non-frail, between 7.6% and 90.4%. The association between both variables presented a value of OR 1.80 (95% CI 1.51-2.13).

CONCLUSION

There is evidence that falls are associated to the frailty in the elderly. Other factors may influence this association, such as age, sex, data collection instrument of the studies, place where they live and the process of senescence.

Descriptors
Aged; Accidental Falls; Frail Elderly; Geriatric Nursing; Review

Resumen

OBJETIVO

Analizar la prevalencia de caídas y el síndrome de la fragilidad y la asociación entre ambos síndromes en la población mayor.

MÉTODO

Revisión sistemática, sin restricción de fechas, en los idiomas inglés, portugués y español, en las bases de datos PubMed, CINAHL, LILACS y en la biblioteca virtual SciElo. La asociación entre ambas variables fue extraída de los propios artículos (Odds Ratio y los Intervalos de Confianza del 95%).

RESULTADOS

Fueron incluidos en la revisión 19 artículos publicados entre 2001 y 2015. La prevalencia de caída en el anciano frágil estuvo entre el 6,7% y el 44%; en los pre frágiles, entre el 10,0% y el 52,0%; y en los no frágiles, entre el 7,6% y el 90,4%. La asociación entre ambas variables presentó el valor de OR 1,80 (IC 95% 1,51-2,13).

CONCLUSIÓN

Hay evidencias de que la caída está asociada con la fragilidad del anciano. Otros factores pueden influenciar dicha asociación, tales como edad, sexo, instrumento de recolección de datos de los estudios, sitio en donde vive y el proceso mismo de ancianidad.

Descriptores
Anciano; Accidentes por Caídas; Anciano Frágil; Enfermería Geriátrica; Revisión

Resumo

OBJETIVO

Analisar a prevalência de quedas e da síndrome da fragilidade e a associação entre essas duas síndromes na população idosa.

MÉTODO

Revisão sistemática, sem restrição de datas, nos idiomas inglês, português e espanhol, nas bases de dados PubMed, CINAHL, LILACS e na biblioteca virtual SciElo. A associação entre ambas as variáveis foi extraída dos próprios artigos (Odds Ratio e os Intervalos de Confiança de 95%).

RESULTADOS

Foram incluídos na revisão 19 artigos publicados entre 2001 e 2015. A prevalência de queda no idoso frágil esteve entre 6,7% e 44%; nos pré-frágeis, entre 10,0% e 52,0%, e nos não frágeis, entre 7,6% e 90,4%. A associação entre ambas as variáveis apresentou o valor de OR 1,80 (IC 95% 1,51-2,13).

CONCLUSÃO

Há evidências de que a queda está associada à fragilidade do idoso. Outros fatores podem influenciar essa associação, como idade, sexo, instrumento de coleta de dados dos estudos, local onde vive e o próprio processo de senescência.

Descritores
Idoso; Acidentes por Queda; Idoso Fragilizado; Enfermagem Geriátrica; Revisão

Introduction

The number of people aged 60 years and over has been increasing in many countries. World demographic data show that people over 65 in 1980 were 378 million; In 2010, this number reached 759 million, and in 2050, almost two billion people are expected¹1 United Nations. Current status of the social situation, well-being, participation in development and rights of older people worldwide. New York: Department of Economic and Social Affairs; 2011..

During the aging process, the body undergoes systemic changes in organs and tissues, with decreased activity, reduced flexibility, loss of nerve cells, thickening of blood vessels and decreased muscle tone, leading to different geriatric syndromes among them, fall and frailty²2 Landinez PNS, Contreras VK, Castro VA. Proceso de envejecimiento, ejercicio y fisioterapia. Rev Cub Salud Pública. 2012;38(4):542-80..

The World Health Organization (WHO) defines fall as an involuntary event occurring loss-of-balance bringing the body to the ground or other surface. The highest mortality rates are for people over 60 years³3 Organización Mundial de la Salud. Caídas: nota descriptiva [Internet]. Ginebra: OMS; 2016 [citado 2016 out. 14]. Disponible en: Disponible en: http://www.who.int/mediacentre/factsheets/fs344/es/
http://www.who.int/mediacentre/factsheet... .

The incidence of falls can affect approximately 20% to 30% of the population aged 60 years or over, annually⁴4 Kojima S, Furuna T, Ikeda N, Nakamura M, Sawada Y. Falls among community-dwelling elderly people of Hokkaido, Japan. Geriatr Gerontol Int. 2008;8(4):272-7.. The elderly living in the community may suffer 0.7 falls per year, with a range of 0.2-1.6. On the other hand, institutionalized and hospitalized elderly have a higher prevalence of falls⁵5 Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002;18(2):141-58.. The fall is associated with frailty due to loss of muscle mass, called sarcopenia. In addition to chronic diseases, the consumption of different drugs, especially diuretics or beta-blockers, simultaneously, cognitive deficit and delirium increase the risk of falls⁶6 Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-7..

There is no consensus on the concept of frailty syndrome, but it is known to be a state of vulnerability with a poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes such as muscle weakness, bone frailty, malnutrition, risk of falls, vulnerability to trauma and infections, unstable blood pressure and decreased functional capacity⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.^-88 Allore HG, Tinetti ME, Gill TM, Peduzzi PN. Experimental designs for multicomponent interventions among persons with multifactorial geriatric syndromes. Clin Trials. 2005;2(1):13-21..

Thus, considering the importance of the topic and several concepts, a meeting of researchers in the area was held to discuss the concept of frailty, which was defined as “a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death”⁶6 Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-7..

Frailty can also be understood as a multidimensional syndrome, which must be holistically assessed, determined or modified by biological, psychological and social factors of complex etiology. It is considered an uncomfortable condition, multifactorial and dynamic in nature related to the history or life trajectory of the elderly⁹9 Rockwood K, Howlett SE, MacKnight C, Beattle BL, Bergman H, Hébert R, et al. Prevalence, attributes and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian Study of health and aging. J Gerontol A Biol Sci Med Sci. 2004;59(12):1310-7.

10 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722-7.^-1111 Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526-9..

The prevalence of frailty, according to the phenotype⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56., is from 6.9% to 21%. Research showed that, for females, this state was higher, from 6.8% to 22%, and for males, from 4% to 19.2%¹²12 Tribes S, Oliveira RJ. Síndrome da fragilidade biológica em idosos: revisão sistemática. Rev Salud Pública. 2011;13(5):853-64.. Measuring this syndrome, using different models used in Primary Health Care, a prevalence of 4% to 59.1% was found, with populations in Southeastern Europe, Hispanics and African-Americans being the most affected¹³13 Sieliwonczyk E, Perkisas S, Vandewoude M. Frailty indexes, screening instruments and their application in Belgian primary care. Acta Clín Belq. 2014; 69(4):223-39..

The association of fall and frailty syndromes deserves to be highlighted, since both have been studied and measured with similar tools, which leads to the development of research for the health professional to make a plan to prevent adverse outcomes, such as functional dependence, hospitalization and death, with the purpose of improving the condition and life expectancy of the elderly. It is understood that fall and frailty syndromes provide the elderly with more risk of vulnerability in their life. In this sense, the scientific evidence may promote a more adequate evaluation for the elderly population.

In this systematic review, the following guiding question was formulated, based on the PICO strategy, that maximizes the retrieval of evidence in the databases and avoids unnecessary searches¹⁴14 Akobeng AK. Principles of evidence based medicine. Arch Dis Child. 2005;90 (8):837-40.: What is the scientific evidence in the prevalence of falls and its association with frailty syndrome in the elderly?

Thus, in view of these first considerations, the objective of the study was to analyze the prevalence of fall and frailty syndrome in the elderly population and the association between these two syndromes.

Method

This is a systematic review of literature, which aims to synthesize the scientific knowledge produced on a specific research topic, with a view to generate new knowledge on the results presented by published research¹⁵15 Botelho LLR, Cunha CCA, Macedo M. O método da revisão integrativa nos estudos organizacionais. Gestão Soc. 2011;5(11):121-36.^-1616 Galvão CM, Sawada NO, Trevizan MA. Revisão sistemática: recurso que proporciona a incorporação das evidências na prática da Enfermagem. Rev Latino Am Enfermagem. 2004;12(3):549-56..

In order to prepare the review, the following steps were taken: 1) Preparation of the protocol; 2) Definition of the question; 3) Search for studies; 4) Selection of studies; 5) Critical appraisal of the studies; 6) Data extraction and 7) Synthesis of studies¹⁷17 Joanna Briggs Institute. Reviewers’ manual [Internet]. Adelaide: JBI; 2014 [cited 2015 Oct 14]. Available from: Available from: http://joannabriggs.org/assets/docs/sumari/reviewersmanual-2014.pdf
http://joannabriggs.org/assets/docs/suma... .

In order to include studies in the review, the following criteria were defined: the search was carried out in September 2015, without restriction of dates in Portuguese, English and Spanish; who studied the elderly, 60 years old or older, of both gender, who lived in different contexts. Qualitative, cross-sectional studies, theses, dissertations, book chapters, technical reports, editor’s letters and review articles were excluded.

The search was conducted in the National Center for Biotechnology Information (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Latin American and Caribbean Literature in Health Sciences (LILACS) and the Scientific Electronic Library Online (SciELO), using the following Portuguese descriptors: Idoso AND Idoso fragilizado OR Fragilidade OR Frágil AND Acidentes por quedas OR Quedas; and English, Aged AND 80 and over OR Elderly OR Older people AND Frail elderly OR Frail OR Frailty AND Accidental falls OR Falls and in Spanish Anciano OR adulto mayor AND Anciano frágil OR Frágil OR Fragilidad AND Accidentes por caídas OR caídas.

The collection of information followed the recommendations of the Pre-requisite Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, in order to increase the number of publications and to provide more complete and transparent information¹⁸18 Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. Ann Inter Med. 2009;151(4):264-9.. There were 496 studies in PubMed, 175 in CINAHL, 39 in LILACS, and nine in SciELO, therefore, 719 publications. Two studies that met the inclusion criteria were added manually, totaling 721 articles.

The titles and abstracts of the studies were then read. The sample was selected by two reviewers, independently and blindly. When there was doubt or disagreement, a meeting with a third reviewer was needed. Thus, 668 studies were removed, as they did not meet the inclusion and exclusion criteria, and a total of 53 studies were read in full.

At this stage of the review, an instrument was used to extract information from the studies including the following items: identification, study setting, type of publication, methodological characteristics of the study and methodological quality assessment¹⁹19 Ursi ES, Galvão CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. Rev Latino Am Enfermagem. 2006;14(1):124-31.. After the analysis, 25 studies were excluded because they did not affect the association between fall and the frailty syndrome in the elderly, and nine, because they were cross-sectional studies, therefore, 19 studies were selected.

To analyze the information, the statistical package R 3.3.0 was used, from which the prevalence of fall and frailty were extracted, respectively. The analysis and the association figures were performed using Odds Ratio (OR) and 95% Confidence Intervals (CI), associating fall and frailty variables, being analyzed using the Metafor module with a Restricted Maximum Likelihood Estimate (REML), in order to estimate the components of the variance and then to calculate the least squares generalized by the fixed effects of the parameters.

Results

Identification and selection of studies

After being selected, 19 studies met the inclusion criteria for this systematic review (Figure 1).

The 19 studies analyzed were published between 2001 and 2015 - four in 2013²⁰20 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.

21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.

22 de Vries OJ, Peeters GMEE, Lips P, Deeg JH. Does frailty predict increased risk of falls and fratures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397-403.^-2323 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... ; four in 2012²⁴24 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.

25 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74.

26 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.^-2727 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.; three in 2014²⁸28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1....

29 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.^-3030 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32.; two in 2011³¹31 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.^-3232 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5. and in 2007³³33 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51.^-3434 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4.; and one in 2015³⁵35 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9., 2009³⁶36 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8., 2008³⁷37 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9. and 2001⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56..

As far as the language is concerned, 18 studies were in English⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.^,2020 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.

21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.

22 de Vries OJ, Peeters GMEE, Lips P, Deeg JH. Does frailty predict increased risk of falls and fratures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397-403.

23 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... ^-2424 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.^,2626 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.

27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.

28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1....

29 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.

30 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32.

31 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.

32 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5.

33 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51.

34 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4.

35 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9.

36 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9. and one in Spanish²⁵25 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74.. According to the country of publication, nine studies were carried out in North America⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.^,2020 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.^,2424 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.^-2525 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74.^,3131 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.^,3333 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51.^-3434 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4.^,3636 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9.; In Europe, seven²¹21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.

22 de Vries OJ, Peeters GMEE, Lips P, Deeg JH. Does frailty predict increased risk of falls and fratures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397-403.^-2323 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... ^,2626 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.

27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.^-2828 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... ^,3232 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5. and in Asia and Australia, three²⁹29 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.^-3030 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32.^,3535 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9.. As for the publication period, 14 different journals were identified, most notably the Archives of Gerontology and Geriatrics, with three publications²⁶26 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.^-2727 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.^,3232 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5., and Archives of Internal Medicine³¹31 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.^,3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9., BMC Geriatrics²³23 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... ^,2828 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... and Journal of Gerontology⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.^,3333 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51., with two studies each, and the others, one article²⁰20 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.

21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.^-2222 de Vries OJ, Peeters GMEE, Lips P, Deeg JH. Does frailty predict increased risk of falls and fratures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397-403.^,2424 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.^-2525 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74.^,2929 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.^-3030 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32.^,3434 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4.

35 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9.

36 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9..

In relation to the method used, 19 studies were longitudinal - 14 prospective studies⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.^,2020 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.

21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.

22 de Vries OJ, Peeters GMEE, Lips P, Deeg JH. Does frailty predict increased risk of falls and fratures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397-403.^-2323 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... ^,2525 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74.

26 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.

27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.^-2828 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... ^,3131 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.

32 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5.^-3333 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51.^,3636 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9.⁾ and four retrospective²⁴24 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.^,3030 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32.^,3434 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4.^-3535 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9. - and one randomized case-control study²⁹29 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.. From the studies that composes the review, 15 (78.9%) had the lowest mean age of the general elderly sample - 68.33 (SD=6.73)²⁵25 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74. - and the highest, 84.88 (SD=7.3)²¹21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6. years old.

The mean number of participants in the studies was 33,260 and ranged from 40²¹21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6. to 6,724³³33 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51.. The prevalence of falls ranged from 11.0%³³33 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51. to 50.0%³⁴34 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4. and frailty from 2.3%²⁰20 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83. to 51.4%³⁴34 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4. in North America. The prevalence of falls was 8.2%²⁸28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... to 93.0%³²32 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5. and frailty between 8.1%²³23 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... and 75.0%²¹21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.⁾ in Europe. The prevalence of falls was 22.0%³⁰30 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32., and the prevalence of frailty was 12.5%³⁵35 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9. to 50.5%³⁰30 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32.⁾ in Asia and Australia.

The study also pointed out that 17 (89.4%)⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.^,2020 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.

21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.

22 de Vries OJ, Peeters GMEE, Lips P, Deeg JH. Does frailty predict increased risk of falls and fratures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397-403.

23 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132...

24 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.

25 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74.

26 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.^-2727 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.^,2929 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.

30 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32.^-3131 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.^,3333 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51.

34 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4.

35 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9.

36 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9. used the self-report of the elderly in relation to fall; one study (5.3%) used the hospital registry²⁸28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... , and another (5.3%), the instrument The Downton Fall Risk Index³²32 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5.. With regard to the evaluation of frailty, nine authors (39.2%) used the CHS Index⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.^,2121 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.^,2323 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... ^-2424 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.^,2828 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... ^-2929 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.^,3333 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-51.^,3636 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9., five (21.7%) the SOF Index at large²⁶26 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.

27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.^-2828 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... ^,3636 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9., two (8.7%) the Edmonton Frail Scale²⁰20 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.^,3030 Bennet A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy and drugs-drug interactions in robust versus frail hospitalized falls patients: a prospective cohort study. Drugs Aging. 2014;31(3):225-32., two (8.7%), the FRAIL index²⁵25 León GED, Tamez PHE, Gutiérrez HH, Cedillo RJA, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Med Clin. 2012;138(11):468-74.^,3535 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9., other instruments, such as the handgrip strength³¹31 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21., the LASA Frailty Instrument²¹21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6., the CSBA Index²⁷27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20. and SNAC Instrument³²32 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5.. On the other hand, it was observed that four (21.1%) authors used more than one instrument to evaluate the frailty in the elderly, namely: the CHS Index, the SOF Index and the CSBA Index²⁷27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.^-2828 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... ^,3636 Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures and mortality in older men. J Am Geriatr Soc. 2009;57(3):492-8.^-3737 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9. (Table 1).

From the 19 studies, 13 (68.4%) of them used different instruments to evaluate falls and frailty. Among the frail elderly, the lowest prevalence was 6.7%²³23 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... , and the highest was 44.0%²⁶26 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8.. In the pre-frail category, the lowest prevalence was 10.0%³⁷37 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9., and the highest was 52.0%²⁴24 Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2012;24(4): 641-53.. On the other hand, the elderly who fell and were categorized as non-frail, the study showed that the lowest prevalence was 7.6%²⁸28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... , and the highest was 90.4%²⁷27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20.. On the other hand, six studies did not highlight the association between the instruments²⁰20 Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013; 21(3):775-83.

21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.^-2222 de Vries OJ, Peeters GMEE, Lips P, Deeg JH. Does frailty predict increased risk of falls and fratures? A prospective population-based study. Osteoporos Int. 2013;24(9):2397-403.^,2929 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22.^,3131 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.^-3232 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5. (Table 2).

The variation of the estimates between the fall and the frailty of the elderly was broad, the lowest, with OR 1.40 (95% CI, 1.16-1.69)²³23 Sheehan KJ, O’Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr. 2013;13:132. doi: 10.1186/1471-2318-13-132.
https://doi.org/10.1186/1471-2318-13-132... , and the highest, with OR 4.68 (95% CI, 1.71-12.84)²⁸28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... . In the evaluation of the research included in the review, there was an association between fall and frailty syndrome (OR 1.80, 95% CI, 1.51-2.13), as can be seen in Figure 2. However, some researchers used more than one analysis, so there was a repetition of the citations in the respective figure. It should be noted that there was a variation in the association between fall and frailty between studies, 95% CI, 1.51% -2.13%, and the highest confidence interval was 95% CI, 1.71% 12.84%²⁸28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... , using the CHS Index scale, and the lowest, 95% CI, 0.77% -1.62%²⁹29 Fairhall N, Sherrington C, Lord SR, Kurrle SE, Langron C, Lockwood K, et al. Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomized controlled trial. Age Ageing. 2014;43(5):616-22., also with the CHS Index. Confidence intervals varied between publications, depending on the population and instruments used in each study.

On the other hand, three researchers²¹21 Crehan F, O´Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J. 2013;106(6):173-6.^,3232 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5.^,3434 Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55(12):2041-4. used different tests to verify the association between these two variables, but did not report the confidence interval, as shown in Table 3.

Discussion

Fall leads the elderly to suffer, in addition to physical injuries, psychological changes that can lead to isolation, hospitalization and death. The number of falls has been increasing considerably due to the increase in life expectancy and biological changes associated with aging³3 Organización Mundial de la Salud. Caídas: nota descriptiva [Internet]. Ginebra: OMS; 2016 [citado 2016 out. 14]. Disponible en: Disponible en: http://www.who.int/mediacentre/factsheets/fs344/es/
http://www.who.int/mediacentre/factsheet... . This WHO statement can be confirmed in the findings of this study, where, out of the 19 studies evaluated, the highest prevalence of falls was in prospective longitudinal study of 315 elderly people from 11 communities in three Swedens’ counties. The results revealed that 93% fell, and 58.8% were frail³²32 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5..

In the 19 studies, the highest occurrence of falls was in female, ranging from 55.4%²⁷27 Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G. A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr. 2012;54(1):16-20. to 85.4%³⁵35 Woo J, Yu R, MPhil MW, Yeung F, Wong M, Lum C. Frailty screening in the community using the FRAIL scale. J Am Med Dir Assoc. 2015;16(5):412-9., depending on the type of study, setting, population, sample, age group and evaluation instruments. The study by Bilotta et al.²⁶26 Bilotta C, Nicolini P, Casè A, Pina G, Rossi S, Vergani C. Frailty syndrome diagnosed according to the study of osteoporotic fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Arch Gerontol Geriatr. 2012;54(2):23-8. showed that, in multiple linear regression, frailty was associated with a high risk of falling (OR 2.01, 95% CI, 1.05-3.83; p = 0.035), but the authors did not report its prevalence. One of the studies³¹31 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21. reports that one of the hypothesis of data from longitudinal studies with women shows that functional capacity declines with aging. Thus, older women are more likely to become frail and fall more.

Falling is the second leading cause of death from unintentional accidental injury, and an estimated 37.3 million people who fall every year need medical attention. This generates cost with hospitalization and rehabilitation and consequent increase of resources for the family and the elderly. In addition, the groups that are at greater risk of falling are those older than 65 years of age and female³3 Organización Mundial de la Salud. Caídas: nota descriptiva [Internet]. Ginebra: OMS; 2016 [citado 2016 out. 14]. Disponible en: Disponible en: http://www.who.int/mediacentre/factsheets/fs344/es/
http://www.who.int/mediacentre/factsheet... . With the aging process, the body undergoes physiological changes, such as joint deformity or swelling, which causes limitation and instability in the range of movement of the lower limbs, changes the balance and walking in the elderly³⁸38 Salzman B. Gait and balance disorders in older adults. Am Fam Physician. 2010; 82(1):61-8.. There is also a decrease in reflexes, automated rhythmic movements and voluntary movements, as well as impairment in the ability of the nervous system to process vestibular, visual and proprioceptive signals responsible for maintaining stability³⁹39 Lemos LFC, Teixeira CS, Mota CB. Uma revisão da gravidade e equilíbrio corporal. Rev Bras Ci Mov. 2009;17(4):83-90..

Approximately 30% of people over 65 years old have walking difficulties, and 20% need help devices⁴⁰40 Centers for Disease Control and Prevention (CDC). Prevalence and most common causes of disability among adults--United States, 2005. MMWR Morb Mortal Wkly Rep. 2009;58(16):422-52.. Problems such as vision impairment, orthostatic hypotension, cardiac and pulmonary diseases, and the use of drugs that cause adverse effects contribute to the elderly fall are also highlighted³⁸38 Salzman B. Gait and balance disorders in older adults. Am Fam Physician. 2010; 82(1):61-8..

On the other hand, it was observed that the prevalence of falls ranged from 8.2%²⁸28 Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. doi: 10.1186/1471-2318-14-1.
https://doi.org/10.1186/1471-2318-14-1.... to 93.0%³²32 Bravell ME, Westerlind B, Midlov P, Ostgren CJ, Borgquist L, Lannering C, et al. How to assess frailty and the need for care? Report from the study of health and drugs in the elderly (SHADES) in community dwelling in Sweden. Arch Gerontol Geriatr. 2011;53(1):40-5.. It should be noted that frailty was measured with different measurement instruments, since it is a great challenge for researchers to obtain an instrument that can be considered as a “gold standard” to accurately compare the results¹²12 Tribes S, Oliveira RJ. Síndrome da fragilidade biológica em idosos: revisão sistemática. Rev Salud Pública. 2011;13(5):853-64..

Frailty was evaluated with eight instruments: the CSBA Index⁴¹41 Ravaglia G, Forti P, Lucicesare A, Pisacane N, Rietti E, Patterson C. Development of an easy prognostic score for frailty outcomes in the aged. Age Ageing. 2008;37(2):161-6., with nine items; The SOF Index³⁷37 Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med. 2008;168(4):382-9. with three; The CHS Index⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56., with five; The LASA Frailty Instrument⁴²42 Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ Lips P. Comparison of the LASA physical activity questionnaire with a 7- day diary and pedometer. J Clin Epidemiol. 2004;57(3):252-8., with nine; The FRAIL Index⁴³43 Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-8., with five; The Edmonton Frail Scale¹¹11 Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526-9. with nine; The VES-13⁴⁴44 Saliba S, Elliott M, Rubenstein LA, Solomon DH, Young RT, Kamberg CJ, et al. The vulnerable elders survey: a tool for identifying vulnerable elders in the community. J Am Geriatr Soc. 2001;49(12):1691-9., with 13; and SNAC Instrument⁴⁵45 The Swedish National Study on Aging and Care (SNAC). Analyser av olika strukturalternativ för äldreomsorgen [Internet]. [cited 2015 Nov 14]. 2014. Available from: Available from: http://www.snac.org
http://www.snac.org... , with three domains. All scales evaluate the physical aspect, but the LASA Frailty Instrument⁴²42 Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ Lips P. Comparison of the LASA physical activity questionnaire with a 7- day diary and pedometer. J Clin Epidemiol. 2004;57(3):252-8. and SNAC Instrument⁴⁵45 The Swedish National Study on Aging and Care (SNAC). Analyser av olika strukturalternativ för äldreomsorgen [Internet]. [cited 2015 Nov 14]. 2014. Available from: Available from: http://www.snac.org
http://www.snac.org... assess the cognitive aspect, and the Edmonton Frail Scale¹¹11 Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526-9., the social aspect. The lack of consensus on the definition of frail leads researchers to use different instruments to identify the clinical features of this syndrome.

Molecular changes, including genetic variations expressed in oxidative stress with mitochondrial losses, shortening of telomeres, DNA damage and cellular aging, cause a physiological imbalance that leads to a vicious cycle, reducing energy and manifesting itself in the body in slowness, weakness, weight loss, decreased activity and fatigue⁴⁶46 Walston J, McBrnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities results from the Cardiovascular Health Study. Arch Interm Med. 2002;162(20):2333-41.^-4747 Walston J, Hadley EC, Ferruci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in older adults. J Am Geriatr Soc. 2006;54(6):991-1001..

Likewise, frailty is often related to the presence of anemia, orthostatic hypotension, congestive heart failure, chronic kidney disease, diabetes mellitus, osteopenia, decreased vitamin D and testosterone, altered cognitive status, falls and fractures, HIV infection, ocular diseases, Parkinson’s, depression, besides weight loss, sarcopenia, anorexia, polypharmacy and inflammation with increased cytosine production⁴⁸48 van Kan GA, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Direct Assoc. 2008;9(2):71-2.^-4949 Roschelle AH. The frailty syndrome: a comprehensive review. J Nutr Gerontol Geriatr. 2001;30(4):315-68..

It was verified that frail category presented relevant percentages in different studies. Although these two syndromes are considered important for the evaluation of the functional dependence of the elderly, there are several challenges to be considered in the systematic review on the subject. One of them refers to the type of self-report instrument, and the evaluation of frailty is more related to the physical aspects. The instruments have different cut-off points and definitions, which may present different data regarding the question of each research.

Most studies were conducted by American and European researchers. Thus, the lack of research with elderly people in other countries makes it difficult to compare the prevalence of falls and their association with frailty among groups of different ages, sex and ethnicity.

In the analysis of the prevalence of falls, most authors used longitudinal design, which allows a more realistic follow-up of the occurrence of fall and frailty syndromes and determines the relationship between cause and effect. It is also verified that the publications can be considered recent and come from the frailty model that was initially described in a study⁷7 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56. and that was associated with physiological indicators, such as unintentional weight loss, exhaustion, energy deficit, slowness and the potential to interact and cause a higher level of frailty in the elderly.

Frailty is a clinical syndrome that leads the elderly to a state of vulnerability, which increases the risk of adverse effects, such as dependence, disability, falls, injuries, acute illnesses, slow recovery, hospitalization, institutionalization in nursing homes and increased mortality³¹31 Xue QL, Walston JD, Fried LP, Beaner BA. Prediction of risk of falling, physical disability and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119-21.^,5050 Clegg A. The frailty syndrome. Clin Med. 2011;11(1):72-5..

After a fall, the elderly stay indoors for a long period of recovery and rehabilitation, which denotes costs for themselves and the health system. On the other hand, some authors⁵¹51 Bates DW, Pruess K, Souney P, Platt R. Serious falls in hospitalized patients: correlates and resource utilization. Am J Med. 1995;99(2):137-43. report that frailty increases with age, characterized as reserve loss and consequent increase in the risk of distinct events in the health of the most vulnerable population. Stressing events in the elderly in a frail state, such as impaired balance and cognitive status, are strongly associated with falling and delirium⁵⁰50 Clegg A. The frailty syndrome. Clin Med. 2011;11(1):72-5..

With the demographic transition and the consequent increase in life expectancy, the elderly may present several syndromes resulting from the process of senescence and senility and should have a more detailed evaluation of the health-disease process.

Regarding the limitation of the study, it was verified that the authors used different instruments, but that the researchers were able to identify the fall and its characteristics, to measure frailty and to make the association between them and the other sociodemographic variables in the elderly, besides describing health conditions of the study population. Another aspect to be highlighted is that most of the researches on fall were made through self-report of the elderly, unlike frailty, which was evaluated with different scales of measures, with validity and feasibility to predict cases of frailty.

Conclusion

The objective of the study was to analyze the prevalence of falls and the frailty syndrome and the association between them in the elderly population, through a systematic review. Data from the 19 included studies showed a population of 40 to 6,724 elderly, aged over 65 years. The prevalence of falls in the frail elderly ranged from 6.7% to 44%. There was evidence that the fall is associated with the presence of frailty in the elderly. In this review, there was an association of 1.80 (95% CI, 1.51-2.13).

This association between the two variables depends on multiple factors, such as age, sex, data collection instrument, setting, and the elderly senescence process itself. It should be noted that the two syndromes are important to be evaluated and monitored by health professionals, to prevent possible health problems, besides hospitalization and death.

The data of this review contribute to the advancement of the knowledge of the area of Geriatrics, with the longevity of the human being. Therefore, it is necessary to develop proposals for risk prevention for this population.

References

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