Examining the relationship between specific cognitive processes and falls risk in older adults: a systematic review

Abstract

Purpose-Recent evidence suggests that impaired cognition increases seniors' risk of falling. The purpose of this review was to identify the cognitive domains that are significantly associated with falls or falls risk in older adults.Methods-We conducted a systematic review of peer-reviewed journal articles published from 1948 to present, focusing on studies investigating different domains of cognitive function and their association with falls or falls risk in adults aged 60 years or older. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we completed a comprehensive search of MEDLINE, Pubmed, and EMBASE databases to identify studies Specific RemarksThis systematic review aims to establish which cognitive domains are associated with falls or falls risk. Twenty-two out of 25 studies report executive functions and/or dual-task to be highly associated with falls or falls risk. Specifically, executive functions are related to falls risk and dual-task is correlated with falls and falls risk. CIHR Author Manuscript CIHR Author Manuscript CIHR Author Manuscriptexamining the association between cognitive function and falls or falls risk. With an expert in the field, we developed a quality assessment questionnaire to rate the quality of the studies included in this systematic review.Results-Twenty-five studies were included in the review. We categorized studies based on two related but distinct cognitive domains: 1) executive functions, or 2) dual-task ability. Twelve studies reported a significant association between executive functions and falls risk. Thirteen studies reported that dual-task performance is a predictor of falls or falls risk in older adults. Three studies did not report an association between cognition and falls risk.Conclusion-Consistent evidence demonstrated that executive functions and dual-task performance were highly associated with falls or falls risk. The results from this review will aid healthcare professionals and researchers in developing innovative screening and treatment strategies for mitigating falls risk by targeting specific cognitive domains.

Altered visual–spatial attention to task-irrelevant information is associated with falls risk in older adults

“…Predicated on the idea that the P300 has been proposed to index attentional resource allocation when memory updating is engaged (e.g., Polich, 1996), those at higher risk of falls may be more immersed in the primary task and less able to distribute attention. This idea certainly fits with the preexisting body of knowledge that has reported poor dualtask performance among fallers (e.g., Hsu et al, 2012). Most notably, these results apply to the low load condition, suggesting that falls risk may be associated with difficulty performing two tasks concurrently, even when the attentional demands of the primary task are low.…”

“…Evidence has consistently implicated cognitive impairment -and more specifically, reduced executive functioning -in falls and falls risk (e.g., Hsu et al, 2012). In our study, task performance and falls risk were only significantly correlated during the more cognitively challenging condition (i.e., high load).…”

“…This relationship is illustrated in older adults who experience falls -a pressing health care issue for our aging society. Fallers have reduced global cognitive functioning (e.g., Tinetti, Speechley, & Ginter, 1988) and perform worse in laboratory tests of higher-level processing (for a review see Hsu, Nagamatsu, Davis, & Liu-Ambrose, 2012). One executive function that is essential for successful navigation through the environment is visual-spatial attention (e.g., Albert, Reinitz, Beusmans, & Gopal, 1999).…”

Geriatric giants – contemporary occurrence in 12,210 in-patients

“…Falls are a frequent cause of morbidity and mortality generally in the elderly and in people suffering from dementia or cognitive impairment with a two to three times higher risk of falling compared with a cognitively healthy person (16)(17)(18)(19)(20). Gillespie (21) depicts signifi cant protection against falling apparent from interventions which targeted multiple identifi ed risk factors in individual patients.…”

Preventing falls in In-Patient Older Adult Mental Health Services: Different Causative Factors in Mental and Neurocognitive Disorders

“…Confusion and disorientation related to dementia has been highlighted to be an overwhelming cause for falls in many studies [12,25,26]. Some suggest that cognitive impairment forms a continuum from mild to severe [27,28] and that falls can be aligned to this trajectory [29][30][31].…”