Prevalence of falls, physical performance, and dual-task cost while walking in older adults at high risk of falling with and without cognitive impairment

Abstract

Purpose: To compare the prevalence of falls, physical performance, and dual-task cost during walking between cognitively healthy and impaired older adults at high risk of falling. Methods: A cross-sectional analysis of 670 community-dwelling older adults who were considered at high risk of falling, operationalized as 1) having fallen at least once in the preceding 12 months and having a health-care practitioner’s referral indicating that the participant was at risk of falls or 2) having impaired mobility as evidenced by a Timed Up and Go (TUG) result ≥13.5 s. Participants (mean age = 77.7 years, SD = 5.6) were divided into cognitively healthy (n = 461) or cognitively impaired (n = 209) groups using a cutoff score of <23 on the Montreal Cognitive Assessment test. Assessment included self-reported number of falls over the previous 12 months, functional reach, TUG, Short Physical Performance Battery (SPPB), and single-and dual-task walk performance. Data were analyzed using Poisson regression to estimate the prevalence ratios of falls and analysis of variance to examine between-group differences on physical performance and dual-task cost during walking performance. Results: In the analysis, 82.3% of older adults with cognitive impairment and 69.4% of unimpaired older adults reported 1 or more falls in the previous 12 months. Compared with cognitively healthy participants, those with cognitive impairment were 2.57 (95% confidence interval [CI] = 2.17 to 3.05) times more likely to have any fall and 2.33 (95% CI = 1.95 to 2.78) times more likely to have multiple falls. Older adults with cognitive impairment performed worse on functional reach (mean difference [MD] = −2.33 cm, 95% CI = −3.21 to −1.46), TUG (MD = 3.05 s, 95% CI = 2.22 to 3.88), and SPPB (MD = −1.24 points, 95% CI = −1.55 to −0.92) and showed increase in dual-task costs (MD = 6.59%, 95% CI = 4.19 to 9.03) compared to those without cognitive impairment. Conclusion: Older adults at high risk for falls and who have cognitive impairment are associated with a greater risk for falls and decrements in physical and dual-task performance.