Meta‐analysis of type and complexity of a secondary task during walking on the prediction of elderly falls

Abstract

Aim: Dual‐tasking probes divided attention and causes performance changes that are associated with an increased risk for falls in the elderly. There is no systematic review investigating the effect of task type and complexity on the prediction of elderly falls. This article synthesizes research evidence regarding this issue on the contents of dual‐tasking walking. Methods: Relevant studies were systematically identified from electronic databases of Medline, PubMed, CINAHL, Cochrane CENTRAL and PsycINFO, and the reference lists of identified articles. The selection criteria were defined a priori. Two independent reviewers classified task types based on properties for cognitive demand, assessed the methodological quality with a customized checklist, and calculated the odds ratio of fall prediction. Results: There was one study of reaction time, one of discrimination and decision‐making, 10 of mental tracking, three of verbal fluency and five of manual tasks. The methodological heterogeneity was manifested in the selection criteria, faller classification, tasks and measures, resulting in substantial heterogeneity (I2 87–92%). Meta‐analyses resulted in a significant pooled odds ratio 1.33 (95% CI 1.18–1.50). The mental tracking task was the only type that yielded a significant odds ratio 3.30 (95% CI 2.00–5.44). Running meta‐analyses separately for simple and difficult mental tracking task showed similar odds ratios. Conclusion: The mental tracking task yielded significant dual‐task‐related changes for fall prediction. Most studies successively used an appropriate level of task complexity specific to the specified population of interest. More research is required for definite conclusions regarding the effect of task type and complexity. Geriatr Gerontol Int 2013; 13: 289–297.

The division of visual attention affects the transition point from level walking to stair descent in healthy, active older adults

“…Such multi-tasking is, of its own right, a source of risk for falls in older adults (Hsu et al (2012) Beauchet et al (2009) Chu et al (2012) Herman et al (2010) ) and older adults generally show greater dual task effects that are environment and task dependent, whether due to increased caution, decreased physical and cognitive function or both (Woollacott and Shumway-Cook (2002) ). Yet, to our knowledge, few studies have used the dual task paradigm with stair gait and particularly for decent where inattention from everyday stimuli has a heighten risk of leading to serious injury or even death.…”

“…Stair gait is a frequent daily activity with great potential risk for falls and injuries (Bridenbaugh and Kressig (2011) ) Chu et al (2012) ). Stair descent particularly poses a great risk for falling for older adults (Bosse et al (2012) Hamel and Cavanagh (2004) Startzell et al (2000) Verghese et al (2008 ) and nearly sixty percent of falls on stairs occur during transition on the first or last two steps (Jackson and Cohen (1995) ).…”

Association of increased gait variability while dual tasking and cognitive decline: results from a prospective longitudinal cohort pilot study

“…First, an association has been identified with the changes in gait performance while dual tasking (Zijlstra et al 2008;Chu et al 2013;Montero-Odasso et al 2012). The principle of dual task gait paradigm is to compare performance under routine conditions (i.e., walking without distractions) with performance under a challenging dual task condition (i.e., simultaneously executing an attention-demanding task) (Zijlstra et al 2008).…”

“…Dual task-related changes in gait are considered as a sensitive and a specific marker of adverse effects of cognitive impairment on the highest levels of gait control (Zijlstra et al 2008;Chu et al 2013;Montero-Odasso et al 2012;Beauchet et al 2009). Increased stride time (i.e., gait cycle duration) variability is also considered as the best biomarker to detect the consequences of cognitive impairment on the highest levels of gait control, high variability reflecting abnormal control and gait instability (Montero-Odasso et al 2012;Beauchet et al 2014;Montero-Odasso et al 2014).…”

Muscle Activation of Older Adults With and Without Parkinson’s Disease During Street Crossing Simulations

“…The gait during simulated street crossing with reduced time resulted in higher mean values of muscle activation in both groups. Stimulus competition occurs in situations involving multiple tasks, dividing the attention, impairing gait performance [19]. Older adults with and without PD had to adopt a gait speed that is significantly higher than their preferred speed; for this they increase cadence and muscle activation.…”