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Executive function and falls in older adults: New findings from a five-year prospective study link fall risk to cognition
Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk...
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Published in: | PloS one 2012-06, Vol.7 (6), p.e40297-e40297 |
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description | Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk.
We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74-.98, p = .021), the attention index (RR: .84; CI: .75-.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01-1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p |
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We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74-.98, p = .021), the attention index (RR: .84; CI: .75-.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01-1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p<0.02).
These findings demonstrate that among community-living older adults, the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screening EF will likely enhance fall risk assessment, and that treatment of EF may reduce fall risk.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0040297</identifier><identifier>PMID: 22768271</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accidental Falls ; Adult ; Adults ; Age ; Aged ; Biology ; Calendars ; Cognition ; Cognition & reasoning ; Cognition - physiology ; Cognition Executive Function Executive Function Gait ; Cognitive ability ; Cognitive therapy ; Communities ; Community ; Dementia ; Dementia disorders ; Engineering ; Executive function ; Executive Function - physiology ; Falls ; Female ; Follow-Up Studies ; Gait ; Gait - physiology ; Health risks ; Humans ; Information processing ; Laws, regulations and rules ; Male ; Medical research ; Medicine ; Memory ; Neurology ; Older people ; Prospective Studies ; Regression analysis ; Risk assessment ; Risk Factors ; Survival Analysis ; Time Factors ; Walking</subject><ispartof>PloS one, 2012-06, Vol.7 (6), p.e40297-e40297</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Mirelman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Mirelman et al. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c781t-15ab756764356c8f67c2dc3040b8019e7adc8d3b490fd6c4946066cf321187823</citedby><cites>FETCH-LOGICAL-c781t-15ab756764356c8f67c2dc3040b8019e7adc8d3b490fd6c4946066cf321187823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1325036434/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1325036434?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25731,27901,27902,36989,36990,44566,53766,53768,74869</link.rule.ids><backlink>$$Uhttp://igdc.huji.ac.il/home/Maagar/Details.aspx?AN=3291$$D View record in IGDC$$Hfree_for_read</backlink><backlink>$$Uhttp://dx.doi.org/10.1371/journal.pone.0040297$$D View full text (Access may be restricted)$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22768271$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Laks, Jerson</contributor><creatorcontrib>Mirelman, Anat</creatorcontrib><creatorcontrib>Herman, Talia</creatorcontrib><creatorcontrib>Brozgol, Marina</creatorcontrib><creatorcontrib>Dorfman, Moran</creatorcontrib><creatorcontrib>Sprecher, Elliot</creatorcontrib><creatorcontrib>Schweiger, Avraham</creatorcontrib><creatorcontrib>Giladi, Nir</creatorcontrib><creatorcontrib>Hausdorff, Jeffrey M</creatorcontrib><title>Executive function and falls in older adults: New findings from a five-year prospective study link fall risk to cognition</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk.
We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74-.98, p = .021), the attention index (RR: .84; CI: .75-.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01-1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p<0.02).
These findings demonstrate that among community-living older adults, the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screening EF will likely enhance fall risk assessment, and that treatment of EF may reduce fall risk.</description><subject>Accidental Falls</subject><subject>Adult</subject><subject>Adults</subject><subject>Age</subject><subject>Aged</subject><subject>Biology</subject><subject>Calendars</subject><subject>Cognition</subject><subject>Cognition & reasoning</subject><subject>Cognition - physiology</subject><subject>Cognition Executive Function Executive Function Gait</subject><subject>Cognitive ability</subject><subject>Cognitive therapy</subject><subject>Communities</subject><subject>Community</subject><subject>Dementia</subject><subject>Dementia disorders</subject><subject>Engineering</subject><subject>Executive function</subject><subject>Executive Function - physiology</subject><subject>Falls</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gait</subject><subject>Gait - 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Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mirelman, Anat</au><au>Herman, Talia</au><au>Brozgol, Marina</au><au>Dorfman, Moran</au><au>Sprecher, Elliot</au><au>Schweiger, Avraham</au><au>Giladi, Nir</au><au>Hausdorff, Jeffrey M</au><au>Laks, Jerson</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Executive function and falls in older adults: New findings from a five-year prospective study link fall risk to cognition</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2012-06-29</date><risdate>2012</risdate><volume>7</volume><issue>6</issue><spage>e40297</spage><epage>e40297</epage><pages>e40297-e40297</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk.
We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74-.98, p = .021), the attention index (RR: .84; CI: .75-.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01-1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p<0.02).
These findings demonstrate that among community-living older adults, the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screening EF will likely enhance fall risk assessment, and that treatment of EF may reduce fall risk.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22768271</pmid><doi>10.1371/journal.pone.0040297</doi><tpages>e40297</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Accidental Falls Adult Adults Age Aged Biology Calendars Cognition Cognition & reasoning Cognition - physiology Cognition Executive Function Executive Function Gait Cognitive ability Cognitive therapy Communities Community Dementia Dementia disorders Engineering Executive function Executive Function - physiology Falls Female Follow-Up Studies Gait Gait - physiology Health risks Humans Information processing Laws, regulations and rules Male Medical research Medicine Memory Neurology Older people Prospective Studies Regression analysis Risk assessment Risk Factors Survival Analysis Time Factors Walking |
title | Executive function and falls in older adults: New findings from a five-year prospective study link fall risk to cognition |
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