Executive Control Deficits as a Prodrome to Falls in Healthy Older Adults: A Prospective Study Linking Thinking, Walking, and Falling
Talia Herman,Anat Mirelman,Anat Mirelman,Nir Giladi,Nir Giladi,Avraham Schweiger,Jeffrey M. Hausdorff,Jeffrey M. Hausdorff,Jeffrey M. Hausdorff +8 more
TLDR
Among healthy older adults, individuals with poorer EF are more prone to falls, and optimal screening, early detection, and treatment of falls should, apparently, also target this cognitive domain.Abstract:
BACKGROUND: Executive function (EF) deficits may increase fall risk, even among older adults with no overt cognitive impairment. Indeed, the effects of dual tasking (DT) on gait, a challenge to executive control, are more exaggerated in persons with a history of falls. Prospective evidence is, however, lacking. METHODS: We prospectively evaluated whether EF predicts falls over a 2-year period among 262 community-living, healthy, and well-functioning older adults, focusing on the 201 who reported no falls during the previous year. At baseline, participants completed a computerized cognitive battery that generated an index of EF and other cognitive domains. Gait was assessed using performance-based tests and by quantifying walking during single- and dual-task conditions. RESULTS: The 262 participants (mean age: 76.3 +/- 4.3 years, 60.3% women) had intact cognitive function on testing, a low comorbidity index, and good mobility. The EF index predicted future falls. Among those who reported no previous falls, participants in the worst EF quartile were three times more likely to fall during the 2 years of follow-up, and they were more likely to transition from nonfaller to faller sooner. DT gait variability also predicted future falls and multiple falls, whereas other measures of cognitive function, gait, and mobility did not. CONCLUSIONS: Among healthy older adults, individuals with poorer EF are more prone to falls. Higher-level cognitive functions such as those regulated by the frontal lobes are apparently needed for safe everyday navigation that demands multitasking. Optimal screening, early detection, and treatment of falls should, apparently, also target this cognitive domain. Language: enread more
Citations
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Risk factors for falls among older adults: a review of the literature.
TL;DR: The major risk factors identified are impaired balance and gait, polypharmacy, and history of previous falls, which include advancing age, female gender, visual impairments, cognitive decline especially attention and executive dysfunction, and environmental factors.
Journal ArticleDOI
Gait and cognition: a complementary approach to understanding brain function and the risk of falling.
Manuel Montero-Odasso,Manuel Montero-Odasso,Joe Verghese,Olivier Beauchet,Jeffrey M. Hausdorff,Jeffrey M. Hausdorff,Jeffrey M. Hausdorff +6 more
TL;DR: Evidence that gait assessments can provide a window into the understanding of cognitive function and dysfunction and fall risk in older people in clinical practice is presented and a potential complementary approach for reducing the risk of falls by improving certain aspects of cognition through nonpharmacological and pharmacological treatments is presented.
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Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis
TL;DR: The Timed Up and Go test has limited ability to predict falls in community dwelling elderly and should not be used in isolation to identify individuals at high risk of falls in this setting.
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The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis
TL;DR: There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values and the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk.
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Do Learners Really Know Best? Urban Legends in Education
TL;DR: The authors take a critical look at three pervasive urban legends in education about the nature of learners, learning, and teaching and look at what educational and psychological research has to say about them.
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