What Factors Predict Falls in Cognitively Impaired Older Adults?

A significant amount of research has been conducted to identify possible risk factors and causes of falls in older adults as well as implementing interventions in efforts to reduce the incidence of falls in this population. Falls accounted for 2 million non-fatal injuries to adults over the age of 65 in 2007 while over $19 billion is spent annually on direct medical costs. Most of the literature is representative of healthy, community-dwelling adults while a much smaller amount is reserved for the subpopulation of older adults with cognitive impairment. Cognitively impaired adults are twice as likely to fall as healthy older adults. There are several theories that attempt to explain this increased risk including decreased executive function, decreased visual attention, difficulty with dual-task resource allocation, fear of falling and reduced awareness of deficits. The current study examined these theories directly by having cognitively impaired older adults (N=55) complete a cognitive assessment (Mini-Mental State Examination, clock-drawing test, serial 3-retro, categorical naming task and counting dots) as well as using a dual-task paradigm to assess resource allocation using the 10-meter walk test. Awareness of deficits was measured using a modified version of the Anosognosia Questionnaire-Dementia while fear of falling was assessed using the Short Falls Efficacy Scale-International. The number of falls incurred over the last 12 months was used as the criterion variable. Bivariate correlation and multiple linear regression analyses were conducted to identify significant independent predictors of falls as well as the most parsimonious model of predictors in this population of cognitively impaired older adults. No significant relationships were found between falls and the predictor variables of working memory, verbal fluency, visual attention, gait velocity, and awareness of deficits. Dual-task cost was not predictive of falls in this sample. Visual attention measured in the single condition was found to be si