Clinical and Pharmacological Aspects of Falls in Older Women: The Impact of Pre-Frailty and Frailty Syndrome
Clinical and Pharmacological Aspects of Falls in Older Women: The Impact of Pre-Frailty and Frailty Syndrome

Author(s): Zvonimir Bosnić, Ivan Lekić, Dunja Šojat, Ivana Šofić, Hrvoje Pitlović, Tatjana Bačun
Subject(s): Gender Studies, Health and medicine and law, Gerontology
Published by: Sveučilište Josipa Jurja Strossmayera u Osijeku, Ekonomski fakultet u Osijeku
Keywords: accidental falls; multimorbidity; polypharmacy; risk assessment; preventive health services;
Summary/Abstract: Older women are at a markedly increased risk of falls, with frailty syndrome being a central determinant. Frailty is a multidimensional geriatric condition characterized by diminished physiological reserve, sarcopenia, impaired mobility, unintentional weight loss, fatigue, and heightened vulnerability to internal and external stressors. Individuals with frailty exhibit elevated rates of falls, fractures, hospitalizations and mortality. Pre-frailty, a transitional stage, also confers increased susceptibility, highlighting the opportunities for early identification and intervention. A narrative review was conducted using systematic searches of the Web of Science, MEDLINE, and Google Scholar, including clinical guidelines, review articles, and original studies published over the past ten years. Studies focusing on older women, frailty or pre-frailty, falls, and relevant clinical or pharmacological determinants were included in this review. The selection criteria emphasized methodological rigor, relevance, and contributions to understanding fall-susceptibility mechanisms in frail populations. Evidence indicates that multimorbidity, polypharmacy, and chronic low-grade inflammation (inflammaging) substantially exacerbate fall risk in older women. Clinically, challenges include under-recognition of frailty, complex management of comorbid conditions, and difficulties implementing multidisciplinary preventive strategies. The limitations of the literature include heterogeneity in frailty definitions, scarcity of targeted interventional studies, and inconsistent pharmacological data. Although frailty assessment is not yet standard in clinical practice, it is a robust predictor of fall risk. Systematic screening and early intervention, even at the pre-frailty stage, are critical. Optimized pharmacotherapy combined with careful monitoring of clinical characteristics may mitigate this risk. The STOPP/START criteria provide a practical tool for rational medication management and facilitate the integration of frailty assessment into routine clinical workflows. Future research should focus on standardized frailty assessment, longitudinal evaluation of pharmacological and inflammatory risk factors, and the development of integrated clinical and pharmacological strategies to reduce falls and preserve functional independence in older women.

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