Frailty and fall risk in schizophrenia: Which components drive the risk of falls?

Frailty is increasingly recognized in schizophrenia and is linked to adverse outcomes such as fall. However, mechanisms connecting body composition to frailty and fall risk in psychiatric inpatients remain insufficiently understood. This study aimed to examine (1) the association between fat-free mass and frailty; (2) the relationship between frailty and fall in the past 12 months; and (3) which frailty components most strongly relate to fall among inpatients with schizophrenia.

In this cross-sectional study, 195 hospitalized adults (≥40 years; mean age 65.9 years) with schizophrenia or schizoaffective disorder were assessed. Frailty was defined using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. Body composition was measured by bioelectrical impedance analysis to compute fat-free mass index (FFMI) and fat mass index (FMI).

Frailty prevalence was 32.8% (prefrail 54.9%; robust 12.3%). Higher FFMI was independently associated with lower odds of being frail. Frailty was strongly associated with fall history (OR = 9.85 vs. prefrail/robust). Across individual frailty components, slowness (reduced gait speed) showed the strongest relationship with fall.

Frailty is highly prevalent among inpatients with schizophrenia and strongly predicts fall risk. Among the individual frailty components, slowness was the key driver of fall, pointing to gait impairment as a critical focus for intervention. Routine gait assessment, combined with physiotherapy, nutritional support, and careful medication review, may help reduce frailty and prevent fall in this population. Prospective studies are needed to confirm these associations and to establish effective strategies for fall prevention in schizophrenia.