Citation

Fischer BL, Gleason CE, Gangnon RE, Janczewski J, Shea T, Mahoney JE. Phys. Ther. 2014; 94(3): 355-362.

Affiliation

B.L. Fischer, PsyD, Geriatric Research, Education, and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terr, Madison, WI 53705 (USA).

Copyright

(Copyright © 2014, American Physical Therapy Association)

DOI

10.2522/ptj.20130195

PMID

24231226

Abstract

BACKGROUND: Declining cognition is a risk factor for falls among older adults. The extent to which impaired judgment in performance of daily activities increases falls risk is unclear. OBJECTIVE: To determine if engagement in mobility activities in a risky manner explains the association between declining cognition and rate of falls. DESIGN: Secondary analysis of baseline and prospective data from subjects enrolled in the intervention arm of a randomized clinical trial. METHODS: Two hundred forty five community-dwelling older adults (79% female, mean age 79, SD 8.0) at-risk for falls received physical, cognitive, and functional evaluations. Cognition was assessed with the Short Portable Mental Status Questionnaire (SPMSQ). Using interview and in-home assessment data, physical therapists determined whether participants were at-risk when performing mobility-related Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs). Falls were measured prospectively for one year using monthly falls diaries. RESULTS: Declining cognition was associated with increased number of mobility activities designated as risky (1.5% of mobility activities performed in a risky manner per SPMSQ point) and with increased rate of falls (rate ratio 1.16 for each unit change in SPMSQ score. Risky performance of mobility activities mediated the relationship between cognition and rate of falls. LIMITATIONS: Risk assessment was based on clinical judgment of experienced physical therapists. Cognition was measured with a relatively insensitive instrument, and only selected mobility activities were evaluated. CONCLUSIONS: Engagement in mobility ADL's/IADL's in a risky manner emerged as a link between declining cognition and increased number of falls, suggesting a mechanism through which rate of falls may increase. Specifically, declining cognition is associated with performance of mobility activities in an unsafe manner, thereby increasing risk for falls.

Language: en