Identifying Frailty Risk in Older Adults: The Predictive Value of Functional Tests and Center-of-Pressure-Based...

Background/Objectives: Frailty is a multidimensional syndrome characterized by diminished physiological reserves, reduced mobility, and increased fall risk. While clinical assessments are commonly used to screen for frailty, they may not capture minor deficits in postural control. Center-of-pressure (CoP) metrics from force plates provide objective markers of postural control, yet their role in frailty screening remains underexplored. This study aimed to investigate the associations between functional performance measures and CoP-based metrics to identify predictors of frailty among older adults. Methods: Eighty-three adults aged ≥ 55 years with a history of falls were classified as frail or pre-frail based on modified Fried criteria. Functional assessments (Timed Up and Go (TUG), grip strength, Berg Balance Scale [BBS], Falls Efficacy Scale [FES]) and CoP metrics (mean velocity, sway path; eyes open/closed) were evaluated. Both unadjusted and age-adjusted logistic regression models were used to identify independent predictors of frailty. Results: Increased TUG time and number of falls were the strongest risk factors for frailty, while increased sway path and CoP velocity were protective. In particular, sway path under eyes-closed conditions showed the strongest protective association (OR = 0.323, p < 0.001). Additionally, fear of falling (OR = 1.078, p = 0.013) emerged as a significant psychological factor, consistently associated with increased frailty risk regardless of physical performance. Correlation analysis supported these findings, showing that better functional performance was linked to lower frailty risk. Conclusions: CoP sway path and mean velocity independently predict frailty status and offer added value beyond traditional clinical tools. These findings highlight the importance of incorporating instrumented balance assessments into frailty screening to capture nuanced postural control deficits and guide early intervention strategies.