Kimberley S van Schooten1, Morag E Taylor2, Jacqueline C T Close2, Jennifer C Davis3, Serena S Paul4, Colleen G Canning4, Mark D Latt5, Phu Hoang6, Nicole A Kochan7, Perminder S Sachdev8, Henry Brodaty9, Catherine M Dean10, Femke Hulzinga11, Stephen R Lord1, Kim Delbaere12. 1. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. 2. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, Australia. 3. Faculty of Management, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. 4. Faculty of Health Sciences, University of Sydney, Sydney Lidcombe, Sydney, New South Wales, Australia. 5. Geriatric Medicine Department, University of Sydney, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia. 6. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia. 7. Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia. 8. Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. 9. Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. 10. Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, Sydney, New South Wales, Australia. 11. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Department of Rehabilitation Sciences, Biomedical Sciences Group, KU Leuven University, Leuven, Belgium. 12. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. Electronic address: k.delbaere@neura.edu.au.
Abstract
OBJECTIVE: To determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations. DESIGN: We pooled data from 5 studies for this observational analysis of prospective falls. SETTING: Community or low-level care facility. PARTICIPANTS: Older people (N=1090; 74.0±9.4y; 579 female); 500 neurologically intact (NI) older people and 3 groups with neurologic disorders (cognitive impairment, n=174; multiple sclerosis (MS), n=111; Parkinson disease, n=305). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sensorimotor function was assessed with the Physiological Profile Assessment, cognitive function with tests of executive function, affect with questionnaires of depression, and concern about falling with falls efficacy questionnaires. These variables were associated with fall incidence rates, obtained prospectively over 6-12 months. RESULTS: Poorer sensorimotor function was associated with falls (incidence rate ratio [95% CI], 1.46 [1.28-1.66]). Impaired executive function was the strongest predictor of falls overall (2.91 [2.27-3.73]), followed by depressive symptoms (2.07 [1.56-2.75]) and concern about falling (2.02 [1.61-2.55]). Associations were similar among groups, except for a weaker relationship with executive impairment in NI persons and a stronger relationship with concern about falling in persons with MS. Multivariable analyses showed that executive impairment, poorer sensorimotor performance, depressive symptoms, and concern about falling were independently associated with falls. CONCLUSIONS: Deficits in cognition (executive function) and affect (depressive symptoms) and concern about falling are as important as sensorimotor function for fall prediction. These domains should be included in fall risk assessments for older people and clinical groups.
OBJECTIVE: To determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations. DESIGN: We pooled data from 5 studies for this observational analysis of prospective falls. SETTING: Community or low-level care facility. PARTICIPANTS: Older people (N=1090; 74.0±9.4y; 579 female); 500 neurologically intact (NI) older people and 3 groups with neurologic disorders (cognitive impairment, n=174; multiple sclerosis (MS), n=111; Parkinson disease, n=305). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sensorimotor function was assessed with the Physiological Profile Assessment, cognitive function with tests of executive function, affect with questionnaires of depression, and concern about falling with falls efficacy questionnaires. These variables were associated with fall incidence rates, obtained prospectively over 6-12 months. RESULTS: Poorer sensorimotor function was associated with falls (incidence rate ratio [95% CI], 1.46 [1.28-1.66]). Impaired executive function was the strongest predictor of falls overall (2.91 [2.27-3.73]), followed by depressive symptoms (2.07 [1.56-2.75]) and concern about falling (2.02 [1.61-2.55]). Associations were similar among groups, except for a weaker relationship with executive impairment in NI persons and a stronger relationship with concern about falling in persons with MS. Multivariable analyses showed that executive impairment, poorer sensorimotor performance, depressive symptoms, and concern about falling were independently associated with falls. CONCLUSIONS: Deficits in cognition (executive function) and affect (depressive symptoms) and concern about falling are as important as sensorimotor function for fall prediction. These domains should be included in fall risk assessments for older people and clinical groups.
Authors: Jennifer C Davis; Chun Liang Hsu; Cheyenne Ghag; Samantha Y Starkey; Patrizio Jacova; Larry Dian; Naaz Parmar; Kenneth Madden; Teresa Liu-Ambrose Journal: Qual Life Res Date: 2022-07-07 Impact factor: 3.440
Authors: Kimberley S van Schooten; Michele L Callisaya; Bridianne O'Dea; Thomas Lung; Kaarin Anstey; Stephen R Lord; Helen Christensen; Alicia Brown; Jessica Chow; Garth McInerney; Lillian Miles; Michelle Ngo; Amy Perram; Kim Delbaere Journal: BMJ Open Date: 2021-04-15 Impact factor: 2.692