Examining links between anxiety, reinvestment and walking when talking by older adults during adaptive gait

Abstract

Falls by older adults often result in reduced quality of life and debilitating fear of further falls. Stopping walking when talking (SWWT) is a significant predictor of future falls by older adults and is thought to reflect age-related increases in attentional demands of walking. We examine whether SWWT is associated with use of explicit movement cues during locomotion, and evaluate if conscious control (i.e. movement specific reinvestment) is causally linked to fall-related anxiety during a complex walking task. We observed whether twenty-four older adults stopped walking when talking when asked a question during an adaptive gait task. After certain trials, participants completed a visuospatial recall task regarding walkway features, or answered questions about their movements during the walk. In a subsequent experimental condition, participants completed the walking task under conditions of raised postural threat. Compared to a control group, participants who SWWT reported higher scores for aspects of reinvestment relating to conscious motor processing but not movement self-consciousness. The higher scores for conscious motor processing were preserved when scores representing cognitive function were included as a covariate. There were no group differences in measures of general cognitive function, visuospatial working memory or balance confidence. However, the SWWT group reported higher scores on a test of external awareness when walking, indicating allocation of attention away from task-relevant environmental features. Under conditions of increased threat, participants self-reported significantly greater state anxiety and reinvestment and displayed more accurate responses about their movements during the task. SWWT is not associated solely with age-related cognitive decline or generic increases in age-related attentional demands of walking. SWWT may be caused by competition for phonological resources of working memory associated with consciously processing motor actions and appears to be causally linked with fall-related anxiety and increased vigilance.

Gazing into Thin Air: The Dual-Task Costs of Movement Planning and Execution during Adaptive Gait

“…The experimental set up described below is highly comparable to that previously used by Young and colleagues [37]. Participants walked at a comfortable pace over a 6 by 5 grid of 19 black and 11 white wooden blocks (stepping surface of each block = 40cm x 40cm, height of each block = 30cm, total length of the walking path = 4.4m).…”

“…In addition to disrupting the automaticity of motor performance, researchers have indicated that reinvestment can influence the allocation of attention during gait. Much in the same way as performing a cognitive dual-task while walking can reduce an individual's ability to perceive environmental cues [34,35], researchers have demonstrated that conscious monitoring and control of movement may similarly impair the perception of external information during locomotion [36,37]. Masters and colleagues [33] argued that cognitive resources are required to consciously attend to the process of moving.…”

“…This process in turn limits the resources available for other processes, which may include the visual search necessary to attend to information in the external environment [16]. It has also been suggested that an internal focus of attention may impair the retention of an environmental ‘spatial map’ [16], with older adults who ‘stop walking when talking’ displaying both greater propensity to consciously control their movements and poorer retention of visuo-spatial information [37]. Yet, little is known about how reinvestment influences visual search behavior.…”

“…Therefore, we expected a reduction in both the number of task-relevant ‘inside’ fixations (those within the walking path) while walking under cognitive load. As literature demonstrates how a propensity to consciously control movements is associated with a reduction in the ability to allocate attention between concurrent tasks during locomotion [36,37], we predicted that changes in visual search behavior under cognitive load would be most pronounced in high-trait-reinvesters. Finally, researchers have demonstrated that walking while simultaneously performing a cognitive dual-task can impair performance in both the motor- and cognitive-task in younger adults, relative to a single-task baseline condition [24].…”

Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality

“…Blyth et al [21] studied older men and found a strong association between pain and worries about health and overall anxiety status, independently of comorbid depression. There is also evidence of an association between anxiety and falls among older adults [22]. In contrast, a study of cancer patients and their risk of depression and anxiety showed that older adults (over 60 years) with a cancer history had a decreased risk for anxiety and depressive disorders compared to younger adults with cancer [23].…”