Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people

Caetano, Maria Joana Duarte; Lord, Stephen R.; Brodie, Matthew A.; Schoene, Daniel; Pelicioni, Paulo Henrique Silva; Sturnieks, Daina L.; Menant, Jasmine C.

doi:10.1016/j.gaitpost.2017.10.017

Cited by 61 publications

(58 citation statements)

References 30 publications

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“…Since tripping is considered one of the most common causes of falls in everyday life [5][6][7], smaller margins of the leading limb during obstacle avoidance were expected. Overall, the ability to make step adjustments, either under time pressure demands or during goal-directed stepping, was impaired in prospective fallers and was associated with falls in [28,29]. This may point at specific underlying gait impairments that can be targeted in falls prevention strategies to reduce fall risk.…”

Section: Discussionmentioning

confidence: 99%

Walking adaptability for targeted fall-risk assessments

et al. 2019

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Background: Most falls occur during walking and are due to trips, slips or misplaced steps, which suggests a reduced walking adaptability. The objective of this study was to evaluate the potential merit of a walkingadaptability assessment for identifying prospective fallers and risk factors for future falls in a cohort of stroke patients, Parkinson's disease patients, and controls (n = 30 for each group).Research question: Does an assessment of walking-adaptability improve the identification of fallers compared to generic fall-risk factors alone?Methods: This study comprised an evaluation of subject characteristics, clinical gait and balance tests, a quantitative gait assessment and a walking-adaptability assessment with the Interactive Walkway. Subjects' falls were registered prospectively with falls calendars during a 6-month follow-up period. Generic and walkingrelated fall-risk factors were compared between prospective fallers and non-fallers. Binary logistic regression and Chi-square Automatic Interaction Detector analyses were performed to identify fallers and predictor variables for future falls.Results: In addition to fall history, obstacle-avoidance success rate and normalized walking speed during goaldirected stepping correctly classified prospective fallers and were predictors of future falls. Compared to the use of generic fall-risk factors only, the inclusion of walking-related fall-risk factors improved the identification of prospective fallers.Significance: If cross-validated in future studies with larger samples, these fall-risk factors may serve as quick entry tests for falls prevention programs. In addition, the identification of these walking-related fall-risk factors may help in developing falls prevention strategies. Methods Subjects30 stroke patients, 30 PD patients and 30 controls participated in this study (Table 1). Groups were age-and sex-matched. Patients were https://doi.

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Section: Discussionmentioning

confidence: 99%

Walking adaptability for targeted fall-risk assessments

et al. 2019

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“…Delayed recall is cognitively more demanding than immediate recall and therefore more sensitive to change in this relatively young and healthy sample. 43 A study among 57 older adults showed that FoF was associated with prolonged anticipatory postural adjustments when initiating walking, particularly under dual-task conditions. 37,38 If the association between FoF and delayed recall is confirmed in future studies, this would strengthen the hypothesis that FoF is a marker for early cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

“…A study in 50 older adults performing a gait adaptability test found that better processing speed was associated with more accurate foot placement 42 and that the association between gait speed and fall risk was partly explained by executive function and FoF. 43 A study among 57 older adults showed that FoF was associated with prolonged anticipatory postural adjustments when initiating walking, particularly under dual-task conditions. 44 Considering the neuroimaging literature, a cross-sectional study among 281 older adults (70-90 years) found associations between poor falls efficacy and lower brain volumes in areas important for executive functions.…”

Section: Discussionmentioning

confidence: 99%

Fear of falling: A manifestation of executive dysfunction?

Peeters

Feeney

Carey

et al. 2019

Int J Geriat Psychiatry

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Objective Fear of falling (FoF) may be an early marker of decline in global cognitive functioning, but associations with specific domains of cognitive functioning are unclear. The aim was to examine associations between FoF and 4‐year decline in memory, processing speed, and executive functioning in adults aged 50 years and older. Methods Data were from 5174 participants (mean age = 62.6 ± 8.9 years, range = 50‐91, 54.5% female) in The Irish Longitudinal Study on Ageing, a population‐based study. Measurements FoF was self‐reported in 2009 to 2011. Immediate and delayed recall, Colour Trails 1 and 2, choice reaction time, sustained attention to response task, and verbal fluency were measured in 2009 to 2011 and 2014 to 2015. Prospective associations between FoF and domains of cognitive functioning were examined using linear mixed modelling. Adjustment was made for demographic and health factors. Interactions with age were examined. Results In 2009 to 2011, 20.6% of participants reported FoF. No statistically significant interaction of FoF with age was found for any of the associations (P ≥ .06). Participants with FoF had greater decline on delayed recall (B = −0.19; 95% CI, −0.32 to −0.06), verbal fluency (B = −0.52; 95% CI, −0.88 to −0.18); and the ln‐transformed scores for the Colour Trails 1 test (B = −0.04; 95% CI, −0.07 to −0.01) and the Colour Trails 2 test (B = −0.04; 95% CI, −0.06 to −0.02) than participants without FoF. No statistically significant associations were found for any of the other outcomes. Conclusions FoF may be an indicator of decline in domains of cognitive functioning, particularly those related to executive function and processing speed. However, studies with longer follow‐up and/or higher average age are required to confirm this.

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“…The high cognitive abilities named executive functions (EF) are responsible for the individual's controlled, goal-oriented behavior [14]. Thus, EF are essential for motor function, emotional regulation, for daily activity performance and for maintaining an active lifestyle [15,16]. Attention problems and uncontrolled goal-oriented behavior may signi cantly impair postural control and the maneuver around obstacles in the environment [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…Brain imaging studies showed that the increased connectivity within the executive network mediated between the caudate head gray matter volume and fall risk via attentional changes among people with Parkinson's Disease (PD) [19]. Other studies found that EF deteriorate prior to, or at the same time as physical performance [15,20] suggesting that EF are also associated with fall risk in the older adults with no PD.…”

Section: Introductionmentioning

confidence: 99%

The Relationships Between Fall Risk, Depression, Executive Dysfunctions and Daily Life of Older Adults

Engel‐Yeger

Zilbershlag

2020

Preprint

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Background: Falling is a major problem in older adults that may significantly reduce health and quality of life (QOL). Body dysfunctions that include depression, cognitive decline and executive dysfunctions may elevate fall risk and impair daily activities and QOL. Yet, most studies evaluate these body dysfunctions using laboratory measures in clinical settings. The present study aimed to: (1) compare these body dysfunctions between high/low risk fallers (2) examine the relationship between these body dysfunctions among the high risk fallers (3) explore the specific contribution of fall risk as a mediator between depression, executive dysfunctions and daily life. Methods: Participants were 123 older adults who live in the community. Depression and cognitive status were measured by the GDS-15 and the MoCA. Fall risk was determined by a questionnaire supported by the Time Up and Go test (TUG). Executive functions (EF) were assessed by the BRIEF-A and the aEFPT medication management assessment. Daily activity performance was measured by the Barthel Index of ADL and the Instrumental ADL Scale. QOL was measured by the World Health Organization Quality of Life Brief Questionnaire. Results: High fall risk was prevalent among 32% of the sample. High risk fallers had significantly lower cognitive level, higher depression, lower EF, lower daily activity performance and lower QOL. Among the high risk group, lower EF as measured in BRIEF-A scales correlated with lower performance of daily activities and lower QOL. SEM model revealed that fall risk mediated between depression, executive dysfunctions and daily life. Conclusions: Depression and executive dysfunctions are more prevalent in older adults with high fall risk and are significantly related to their daily activity performance and to their QOL. Community fall-prevention and rehabilitation programs should screen for fall risk and related body dysfunctions as expressed during daily activity performance and understand their impacts on people’s QOL.

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Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people

Cited by 61 publications

References 30 publications

Walking adaptability for targeted fall-risk assessments

Walking adaptability for targeted fall-risk assessments

Fear of falling: A manifestation of executive dysfunction?

The Relationships Between Fall Risk, Depression, Executive Dysfunctions and Daily Life of Older Adults

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