Biomarkers explained.

Biomarker

What it measures

Why it matters

What this may help prevent

Grip strength (dynamometer)

Muscle strength reserve

Strong predictor of frailty and mortality

Falls, disability, hospital admissions, early need for rest home care

Standing balance (4-stage test)

Postural stability

Balance decline precedes falls

Falls, low impact (osteoporotic) fractures, emergency presentations, loss of confidence

Vitamin D (blood)

Bone and neuromuscular function

Deficiency increases weakness and falls

Fractures, falls, hospital admissions

Biomarker

What it measures

Why it matters

What this may help prevent

Falls history (past 12 months)

Falls frequency and circumstances

A previous fall strongly predicts future falls and injury

Recurrent falls, fractures, hospital admissions

Chair rise test (standing without hands)

Functional lower limb strength

Difficulty rising is linked to higher fall, fracture and frailty risk

Mobility loss, increasing dependence, early residential care

Osteoporosis risk profile (risk factors and history)

Clinical fracture risk (e.g., prior fracture, steroid exposure, family history)

Hip and spine fractures are major drivers of disability in later life

Fragility fractures, long-term disability, residential care entry

Vitamin D (blood test)

Bone and muscle support

Deficiency increases falls and fracture risk

Fragility fractures, recurrent falls

Serum calcium (blood test)

Calcium balance

Abnormal levels may signal metabolic contributors to bone weakness

Bone weakness, fracture risk

Biomarker

What it measures

Why it matters

What this may help prevent

Mini-Addenbrooke’s Cognitive Examination (Mini-ACE) score

Cognitive performance across memory, attention, fluency and visuospatial skills

Early cognitive changes may impact independence and daily function

Medication errors, unsafe driving, financial vulnerability, avoidable hospital admissions and delirium during acute illness or hospital admission

Functional cognition questions (impact on hobbies, daily tasks, family feedback)

Real-world cognition and day-to-day functioning

Functional decline often appears before formal diagnosis

Safety risks at home, financial vulnerability

Vitamin B12 (blood test)

Nerve and brain health

Low B12 can mimic cognitive decline and cause neuropathy

Reversible confusion, falls from neuropathy

Thyroid stimulating hormone (TSH) (blood test)

Thyroid balance affecting energy and cognition

Thyroid dysfunction can present as memory issues

Treatable cognitive symptoms

Glycated haemoglobin (HbA1c) (blood test)

Long-term blood sugar exposure

Higher levels increase cardiovascular and cerebrovascular risk

Stroke and vascular dementia

Biomarker

What it measures

Why it matters

What this may help prevent

Social connection frequency (contact pattern)

How often a person connects with others

Isolation is linked to poorer health outcomes and faster decline

Depression, accelerated cognitive decline, avoidable admissions

Loneliness Indicator

How lonely a person feels regardless of contacts

Loneliness is a strong predictor of decline

Depression, functional decline, early residential care

Purpose and Quality of Life Indicator

Overall wellbeing trajectory

Purpose and wellbeing correlate with resilience and health behaviours

Loss of motivation, reduced activity, decline

Biomarker

What it measures

Why it matters

What this may help prevent

Sleep quality

Difficulty falling or staying asleep

Poor sleep and sedative medications increase falls risk, mood symptoms and cognitive strain

Falls, hospital admissions, daytime impairment

Daytime sleepiness

Daytime alertness and fatigue

Daytime sleepiness affects driving and safety

Accidents, falls, reduced function

Biomarker

What it measures

Why it matters

What this may help prevent

Nutritional Assessment

Malnutrition risk

Malnutrition increases frailty, infection risk and poor recovery

Hospital admissions, infections, early residential care

Body mass index (BMI)

Body size relative to height

Both low BMI and high BMI increase health risk in ageing

Frailty, diabetes, heart disease

Recent weight loss / reduced intake

Catabolic risk and appetite change

Unintentional weight loss can signal illness and increases frailty risk

Frailty progression, hospital admissions

Serum albumin (blood test)

Protein reserve and illness burden and liver synthetic function

Low levels predict poorer recovery and resilience

Hospitalisation risk, delayed recovery

Iron studies (blood test: ferritin, transferrin saturation and iron)

Iron stores and availability

Low iron status contributes to fatigue, weakness and reduced exercise tolerance

Falls risk, functional decline

Folate (blood test)

Nutrient supporting red blood cells and brain

Low folate can contribute to fatigue and cognitive symptoms

Functional decline

Vitamin B12 (blood test)

Nerve and brain health

Deficiency can cause neuropathy and cognitive symptoms

Falls (via neuropathy), cognitive impairment

Biomarker

What it measures

Why it matters

What this may help prevent

Hearing difficulty

Hearing function in daily life

Hearing loss is linked to isolation and cognitive strain

Depression, cognitive decline, safety issues

Snellen visual acuity test

Distance vision clarity

Vision loss increases falls and driving risk

Falls, driving accidents

Functional vision questions

Everyday vision capability

Functional impairment predicts medication and safety errors

Medication errors, falls

Oral health status (pain, dentures fit, last dental visit)

Oral comfort, chewing and dental care access

Oral health affects nutrition and infection risk

Weight loss, infections, poor nutrition

Biomarker

What it measures

Why it matters

What this may help prevent

Polypharmacy count (regular medicines)

Medication burden

Higher medication burden increases side effects and interactions

Falls, delirium, avoidable hospital admissions

High-risk medication exposure (e.g., sedatives, strong pain medicines)

Medication-related harm risk

Certain medicines increase falls, confusion and bleeding risk

Falls, delirium, admissions to hospital and residential care

Adherence and medication system reliability

Ability to take medicines correctly

Missed doses or double dosing can cause harm or deterioration

Avoidable admissions, treatment failure

Glomerular Filtration Rate (GFR) (blood test)

Kidney filtration for safe dosing

Kidney function changes with age and affects medication safety

Drug toxicity, hospital admissions

Creatinine (blood test)

Kidney function marker used to calculate eGFR

Supports safe prescribing

Drug toxicity

Liver function tests (ALT, AST, GGT, Albumin) (blood test)

Liver enzymes and synthetic function

Liver function influences medication metabolism and overall health

Medication-related harm, broader health risk

Biomarker

What it measures

Why it matters

What this may help prevent

Blood pressure (lying and standing)

Blood pressure control and postural drop

Major driver of stroke and dizziness-related falls

Stroke, fainting (syncope), hospital admissions

Pulse rate and rhythm check

Heart rate and rhythm regularity

Irregular rhythm can indicate atrial fibrillation (AF)

Stroke, heart failure exacerbations

Glycated haemoglobin (HbA1c) (blood test)

Long-term glucose exposure

Higher levels accelerate vascular ageing

Diabetes complications, vascular events

Total cholesterol (blood test)

Overall cholesterol level

High levels contribute to plaque build-up

Heart attack, stroke

Low-density lipoprotein cholesterol (LDL) (blood test)

“Bad” cholesterol

Key driver of atherosclerosis

Heart attack, stroke

High-density lipoprotein cholesterol (HDL) (blood test)

“Good” cholesterol

Low levels associated with higher risk

Vascular events

Triglycerides (blood test)

Blood fat linked to insulin resistance

Elevated levels increase cardiometabolic risk

Vascular events

Biomarker

What it measures

Why it matters

What this may help prevent

Bowel function pattern (frequency, stool form, straining)

Constipation/diarrhoea pattern and severity

Bowel issues impact comfort, appetite, sleep and function, urinary function.

Delirium from constipation, avoidable hospital admissions, bladder dysfunction

Blood in stool or change in bowel habit (red flags)

Warning symptoms for bowel disease

Early identification improves outcomes

Advanced bowel disease, delayed diagnosis

Faecal incontinence frequency and impact

Bowel control and quality-of-life impact

Major driver of social withdrawal and care needs

Loss of independence, early residential care

Biomarker

What it measures

Why it matters

What this may help prevent

Urinary symptoms (women: leakage frequency/type and bother)

Bladder control and symptom impact

Incontinence increases falls risk and social withdrawal

Falls, sleep disruption, depression

Urinary symptoms (men: lower urinary tract symptoms and nocturia)

Flow and night-time urination burden

Nocturia contributes to falls and daytime fatigue

Falls, functional decline related to poor sleep

Pad use (24 hours)

Practical severity marker

Helps quantify impact and need for support

Skin irritation, social withdrawal

Biomarker

What it measures

Why it matters

What this may help prevent

Pain severity and impact assessment

Pain burden and functional limitation

Persistent pain drives inactivity, frailty and mood decline

Mobility loss, falls, avoidable admissions

Morning stiffness duration and pattern

Inflammatory vs mechanical pain signals

Inflammatory arthritis needs early identification to prevent joint damage

Progressive joint damage, disability

Biomarker

What it measures

Why it matters

What this may help prevent

Driving exposure and pattern (how often, where, day/night)

Driving frequency and complexity

Higher exposure increases risk if function declines

Accidents, injury, loss of licence crisis

Driving concerns (self and family) and near-misses

Perceived safety and recent warning signs

Concerns often precede incidents

Accidents, injury-related admissions

Biomarker

What it measures

Why it matters

What this may help prevent

Home safety

Environmental fall and safety hazards

Home hazards are a common, modifiable contributor to falls

Falls, fractures, hospital admissions