Di-Hua Luo, Roee Holtzer
Worse perceived physical and mental fatigability were associated prospectively with increased fall risk in both OAMS and healthy controls. These findings support the potential clinical utility of fatigability assessment for fall-risk profiling and for informing more tailored fall prevention strategies in normative and MS-related aging.
BACKGROUND: Fatigue and falls are prevalent and disabling in both aging and older adults with multiple sclerosis (OAMS). However, clinically useful, modifiable predictors of fall risk remain insufficiently established. Perceived fatigability has been shown to cross-sectionally correlate with poorer cognitive and mobility outcomes in normative aging and OAMS, but its prospective relationship with falls is unclear. We examined whether baseline perceived fatigability predicts falls during longitudinal follow-up in community-dwelling older adults with and without MS.
METHODS: Participants were 223 older adults aged ≥60 years (109 OAMS; 114 healthy controls). Baseline physical and mental fatigability were assessed using the Pittsburgh Fatigability Scale (PFS). Falls were prospectively tracked using structured monthly telephone interviews during the study period (from September 2019-April 2025). Generalized estimating equations estimated fall risk, adjusting for demographic and clinical covariates, including prior falls.
RESULTS: In the full cohort, higher physical (OR = 1.54, 95%CI=1.25-1.91, p<0.001) and mental fatigability (OR = 1.41, 95%CI=1.12-1.77, p=0.004) were each associated with greater odds of falls after covariate adjustment. Physical fatigability remained significant after accounting for group status (OR = 1.37, 95%CI=1.09-1.71, p=0.006). Mental fatigability was attenuated after inclusion of group status. Group status did not significantly moderate the fatigability-fall risk associations (p-values >0.05 for all interactions between fatigability and group status).
CONCLUSIONS: Worse perceived physical and mental fatigability were associated prospectively with increased fall risk in both OAMS and healthy controls. These findings support the potential clinical utility of fatigability assessment for fall-risk profiling and for informing more tailored fall prevention strategies in normative and MS-related aging.