Sensorimotor, Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study

Kimberley S van Schooten; Morag E Taylor; Jacqueline C T Close; Jennifer C Davis; Serena S Paul; Colleen G Canning; Mark D Latt; Phu Hoang; Nicole A Kochan; Perminder S Sachdev; Henry Brodaty; Catherine M Dean; Femke Hulzinga; Stephen R Lord; Kim Delbaere

doi:10.1016/j.apmr.2020.10.134

Sensorimotor, Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study

Arch Phys Med Rehabil. 2021 May;102(5):874-880. doi: 10.1016/j.apmr.2020.10.134. Epub 2020 Nov 27.

Authors

Affiliations

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.

PMID: 33253696
DOI: 10.1016/j.apmr.2020.10.134

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.

Keywords: Accidental falls; Cognition; Depression; Rehabilitation.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls / statistics & numerical data*
Aged
Aged, 80 and over
Cognitive Dysfunction / physiopathology*
Female
Humans
Male
Middle Aged
Mood Disorders / physiopathology*
Multiple Sclerosis / physiopathology*
Parkinson Disease / physiopathology*
Prospective Studies
Risk Factors
Surveys and Questionnaires