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*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)874-880
Number of pages7
JournalArchives of Physical Medicine and Rehabilitation
Volume102
Issue number5
DOIs
Publication statusPublished - May 2021

Keywords

  • Accidental falls
  • Cognition
  • Depression
  • Rehabilitation

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