Abstract
OBJECTIVE: To compare the association of glaucoma and glaucoma suspect diagnoses with frailty, quantified via an electronic frailty index (eFI), and to evaluate whether a glaucoma diagnosis moderates the association between frailty and the cumulative risk of acute healthcare encounters for incident falls or fractures. DESIGN: Retrospective study of electronic health record (EHR) data. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults ≥65 years old with an ICD-10 diagnosis code for glaucoma or glaucoma suspect who had a calculable eFI score as of 10/1/2017. METHODS: Ordinal logistic regression was used to examine the cross-sectional association between glaucoma (predictor) and frailty status (outcome) based on the eFI. The relationship of glaucoma and frailty with the cumulative incidence of hospital or emergency room visits for injurious falls or fractures over time was modeled using cause-specific recurrent event survival models that account for censoring and the competing risk of death. MAIN OUTCOME MEASURES: Frailty status based on the eFI and cumulative incidence of falls or fractures. RESULTS: Glaucoma patients were significantly more likely to be frail compared to glaucoma suspects (adjusted odds ratio=1.36, 95 % CI(1.16, 1.60)). Both pre-frailty and frailty were associated with an increased risk of incident falls/fractures in older adults: prefrail (hazard ratio=2.07, 95 % CI (1.40, 3.06)), frail (hazard ratio=3.35, 95 % CI (2.24, 5.03)), but there was no interaction of frailty with glaucoma status on falls/fractures risk. Also, the risk of incident falls/fractures did not significantly differ between glaucoma versus glaucoma suspects. CONCLUSIONS: Glaucoma patients were more likely to be frail or pre-frail based on an EHR-derived index than glaucoma suspects. Both pre-frailty and frailty were associated with increased cumulative risk of injurious falls or fractures but there was no interaction of frailty with glaucoma. Frailty based on the eFI was better at discriminating who is at risk of acute healthcare utilization for falls/fractures than a glaucoma diagnosis.