Mild cognitive impairment is associated with fall-related injury among adults aged ≥65 years in low- and middle-income countries

Predictive value of the World falls guidelines algorithm within the AGELESS-MELoR cohort

AIM

The World Falls Guidelines (WFG) Task Force published a falls risk stratification algorithm in 2022. However, its adaptability is uncertain in low- and middle-income settings such as Malaysia due to different risk factors and limited resources. We evaluated the effectiveness of the WFG risk stratification algorithm in predicting falls among community-dwelling older adults in Malaysia.

METHODS

Data from the Malaysian Elders Longitudinal Research subset of the Transforming Cognitive Frailty into Later-Life Self-Sufficiency cohort study was utilized. From 2013-2015, participants aged ≥55 years were selected from the electoral rolls of three parliamentary constituencies in Klang Valley. Risk categorisation was performed using baseline data. Falls prediction values were determined using follow-up data from wave 2 (2015-2016), wave 3 (2019) and wave 4 (2020-2022).

RESULTS

Of 1,548 individuals recruited, 737 were interviewed at wave 2, 858 at wave 3, and 742 at wave 4. Falls were reported by 13.4 %, 29.8 % and 42.9 % of the low-, intermediate- and high-risk groups at wave 2, 19.4 %, 25.5 % and 32.8 % at wave 3, and 25.8 %, 27.7 % and 27.0 % at wave 4, respectively. At wave 2, the algorithm generated a sensitivity of 51.3 % (95 %CI, 43.1-59.2) and specificity of 80.1 % (95 %CI, 76.6-83.2). At wave 3, sensitivity was 29.4 % (95 %CI, 23.1-36.6) and specificity was 81.6 % (95 %CI, 78.5-84.5). At wave 4, sensitivity was 26.0 % (95 %CI, 20.2-32.8) and specificity was 78.4 % (95 %CI, 74.7-81.8).

CONCLUSION

The algorithm has high specificity and low sensitivity in predicting falls, with decreasing sensitivity over time. Therefore, regular reassessments should be made to identify individuals at risk of falling.

Effect of chronic pain on the occurrence of falls in older adults with disabilities: a prospective cohort study

BACKGROUND

The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not.

OBJECTIVE

This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities.

METHODS

The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates.

RESULTS

After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057-9.495, p = .04).

CONCLUSION

Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities.

Late Life Cognitive Function Trajectory Among the Chinese Oldest-Old Population-A Machine Learning Approach

Informed by the biopsychosocial framework, our study uses the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset to examine cognitive function trajectories among the oldest-old (80+). Employing K-means clustering, we identified two latent groups: High Stability (HS) and Low Stability (LS). The HS group maintained satisfactory cognitive function, while the LS group exhibited consistently low function. Lasso regression revealed predictive factors, including socioeconomic status, biological conditions, mental health, lifestyle, psychological, and behavioral factors. This data-driven approach sheds light on cognitive aging patterns and informs policies for healthy aging. Our study pioneers non-parametric machine learning methods in this context.

Cognitive and physical declines and falls in older people with and without mild cognitive impairment: a 7-year longitudinal study

OBJECTIVES

We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI).

DESIGN

Prospective cohort study with assessments every 2 years (for up to 6 years).

SETTING

Community, Sydney, Australia.

PARTICIPANTS

Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232).

MEASUREMENTS

Cognitive and physical function measured over 2-6 years follow-up. Falls in the year following participants' final assessment.

RESULTS

In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample.

CONCLUSIONS

Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.

Cross-Lagged Panel Analysis between Physical Frailty, Cognitive Function, and Falls by Sex

OBJECTIVES

This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later.

DESIGN

Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS).

SETTING AND PARTICIPANTS

A total of 2318 community-dwelling older adults aged 70-84 years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men.

METHODS

PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used.

RESULTS

The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β) = 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β = 0.041, 95% CI 0.006-0.076; P = .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β = 0.063, 95% CI 0.012-0.114; P = .015).

CONCLUSIONS AND IMPLICATIONS

Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement and maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.

Increased Parasympathetic Activity as a Fall Risk Factor Beyond Conventional Factors in Institutionalized Older Adults with Mild Cognitive Impairment

PURPOSE

This study aimed to investigate autonomic nervous function during the orthostatic challenge and its relationship with depression and fall, and to elucidate fall-associated factors, including autonomic function, executive function, and depression among institutionalized older adults with mild cognitive impairment (MCI).

METHODS

This study employed a descriptive cross-sectional design. Fall experiences in the current institutions were researched. Heart rate variability (HRV) during the orthostatic challenge was measured. Executive function was evaluated using the semantic verbal fluency test and clock drawing test. Depression was assessed using the Geriatric Depression Scale.

RESULTS

Of the 115 older adults, 17 (14.8%) experienced falls in the current institution. None of the HRV indices during the orthostatic challenge showed any significant changes except for the standard deviation of normal RR intervals (p = .037) in the institutionalized older adults with MCI. None of the HRV indices was significantly related to the depressive symptoms. Multivariate logistic regression analysis showed that normalized high frequency on lying was independently associated with falls (OR = 1.027, p = .049) after adjusting for other conventional fall risk factors although executive function and depressive symptoms were not significant factors for falls.

CONCLUSIONS

Institutionalized older adults with MCI were vulnerable to autonomic nervous modulation, especially to sympathetic modulation, during the orthostatic challenge, which was not associated with depressive symptoms. As increased resting parasympathetic activity seemed to play a key role in association with falls, autonomic nervous function assessment should be considered for fall risk evaluation.

Fall Prevalence and Associated Risk Factors in the Hospitalised Adult Population: A Crucial Step Towards Improved Hospital Care

Background Falls among the adult population are a major global health concern with severe repercussions for individuals and healthcare systems. The purpose of this study was to investigate the prevalence and associated risk factors of falls in hospitalized patients in order to improve hospital care for elderly adults. Materials and methods The research was conducted at two institutions of tertiary care in Abbottabad, Pakistan. After extensive screening and obtaining informed consent, a total of 210 participants aged 50 and older were enrolled in the study. Mental status, history of falls, ambulation/elimination status, vision, gait/balance, systolic blood pressure, medication use, and predisposing diseases were evaluated using the Long Term Care Fall Risk Assessment Form. Additionally, the Dynamic Gait Index was utilized to evaluate various aspects of gait. Results 58.6% of participants reported a history of falls in the previous year, according to the findings. BMI, imbalance, vertigo, and fear of falling were significantly associated with an increased risk of falls in older individuals. The Long-Term Care Fall Risk Assessment, the Montreal Cognitive Assessment (MoCA), the Dynamic Gait Index (DGI), and the Mini-BESTest scores revealed that patients with a history of falls had inferior functional and cognitive outcomes. Falls were more common among individuals with a robust BMI, especially men. Conclusions The study results highlight the multifactorial nature of falls in the adult population and the need for targeted interventions to address modifiable risk factors. To enhance hospital care for high-risk patients, proactive fall prevention strategies, including regular risk assessments and individualized interventions, should be implemented. This study provides important insights into the prevalence and causes of accidents among hospitalized patients, particularly in developing nations such as Pakistan. ​​​​​​.

The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults

Background

Cognitive impairment has been reported to be associated with falls in older adults. However, the complex relationship among falls, cognitive impairment and its associated factors, which could be targeted with specific interventions, remains to be elucidated. This study aimed to examine the direct effects of cognitive impairment on falls, to identify the factors associated with cognitive impairment and to explore the mediation role of cognitive impairment in the association of fall with cognition related factors.

Methods

This 1-year follow-up cohort study enrolled old adults aged 60  years or over. Information about demographic and anthropometric characteristics, fall outcomes, function and nutritional status were collected through face-to-face interview. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Multivariable regression analyses were used to test the association between cognitive impairment and falls and to identify the factors related to cognitive impairment. Additionally, we conduct causal mediation analyses to estimate the mediation effects of cognitive impairment in the pathways of fall occurrence.

Results

Of the 569 participants included in this study, 366 (64.32%) had cognitive impairment, 96 (16.87%) had fall history in the past 1  year, 81 (14.24%) experienced fall and 47 (8.26%) received treatment because of falling during the 1-year follow-up. The association between cognitive impairment and 1-year fall risk was confirmed after adjusting for multiple covariates [odds ratio (OR):2.03, 95% confidence interval (CI): 1.13-3.80]. IADL disability, depression and low grip strength were associated with a higher prevalence of cognitive impairment. While overweight, higher education and higher income level were found to be related to a lower risk of cognitive impairment. Among these associated factors, cognitive impairment mediated the positive association of falling with IADL ability and depression, and a negative relationship with education and income level.

Conclusion

Our study not only confirmed the direct influence of cognitive impairment on fall risk in older adults, but also suggested a mediating role that cognitive impairment played in the pathways of fall occurrence. Our finding could help develop more specific interventions for fall prevention.

Injuries and outcomes resulting due to falls in elderly patients presenting to the Emergency Department of a tertiary care hospital - a cohort study

BACKGROUND

Fall injuries and trauma-related hospitalizations are the most common causes of injury and in-hospital stay amongst the elderly population. After the age of 65, the severity and frequency of fall-related problems increases; the repercussions are challenging for senior citizens, caregivers, and healthcare professionals. This study aims to determine the injuries and outcomes resulting from falls in elderly patients presenting to Emergency Department of a tertiary care hospital.

METHODS

A cohort study design was used. All elderly patients aged ≥ 60 years who visit the Emergency Department with a history of a fall as a primary complaint presenting to the ED of a tertiary care hospital in Karachi, Pakistan were included. A purposive sampling strategy was used to enroll 318 patients from August 2021 to February 2022. The outcome was risk of mortality. Each individual was followed for 90 days to study the outcome. A multivariable logistic regression was applied to check the association between the outcome and covariates. Crude and adjusted risk ratios were reported. A p-value ≤ 0.05 was considered significant.

RESULTS

Of the 318 participants, 265 (83.3%) were fall injury patients with comorbidities. More than half of the patients in both groups were female [32 (60.4%) & 146 (55.1%)]. Eyeglasses were used by most of the fall patients both without and with comorbidities [21 (39.6%) & 152 (57.4%) p 0.018]. There were multiple reasons for a fall including imbalance/dizziness, which was reported by one third of participants in both groups [15 (28.3%) & 77 (29.1%)] followed by a fall from stairs/steps/escalator [15 (28.3%) & 44 (16.6%) p 0.005]. At the end of one month, of those who had a comorbidity 20 (7.5%) expired. The risk of mortality among fall related injuries in elderly patients who were more than 80 years was 1.48 times (95% CI: 1.20-2.10) more likely when compared to those patients who were younger than 80 years.

CONCLUSION

Efforts should be made to improve management of the underlying etiology of falls to prevent them in future. The factors that contribute to falls should be identified. Strategies and interventions should be planned to mitigate this risk of fall in elderly to improve their quality of life.

The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature

BACKGROUND

In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment.

METHODS

According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist.

RESULTS

We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another.

CONCLUSION

It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.

Six-month change in gait speed to discriminate between those with and without falls history in older people with Mild Cognitive Impairment and mild Alzheimer disease

BACKGROUND AND PURPOSE

The purposes of this study were to identify differences in gait speed performance over 6 months between older people with Preserved Cognition (PrC), with Mild Cognitive Impairment (MCI) and with Alzheimer disease (AD) in mild stage; and to verify if the change in gait speed could discriminate fallers in older people with MCI and AD in a mild stage METHODS: A longitudinal study was conducted with community-dwelling older adults, including 40 with PrC, 36 with MCI and 34 with AD in the mild stage. Gait speed (in m/s) changes were captured through a 10-meter walk test. We documented the number of self-reported falls by monthly calendars that were returned after a 6-month follow-up. During this period, the participants received monthly telephone calls to remind them to fill in the calendar RESULTS: There was a significant difference in terms of sex and age between the groups: 23%, 31% and 19% were female and had a mean age of 72.8, 75.9 and 76.9 years in the PrC, MCI and AD groups respectively. During the follow-up, 45%, 52.7% and 52.9% of the PrC, MCI and AD groups fell. The MCI and AD groups presented lower gait speed compared to the PrC Group at both moments. There was no significant difference in the change of gait speed between groups. In the model adjusted by age, the change in gait speed failed to discriminate fallers in older people with MCI and with AD CONCLUSION: Older people with MCI and AD in the mild stage present lower gait speed compared to older people with PrC. Changes in gait speed over a short period of time do not discriminate fallers in older people with MCI or AD in a mild stage.

Analysis of neuropathological comorbid conditions in elderly patients with mild cognitive impairment in a tertiary care center in South India

Introduction:

Mild cognitive impairment (MCI) is a transitional stage in the continuum of cognitive decline. Multiple risk factors may be involved apart from neuropathological states such as Alzheimer’s disease, Parkinson’s disease, and vascular dementia. There is scant data in the literature pertaining to our study population in Kerala, South India that provide associations between suggested risk factors and MCI. Most of the elderly present to family and primary care physicians with complaints of some form of memory impairment.

Objectives:

To find out the significant neuropathological comorbid conditions present in elderly patients with MCI. To assess for other risk factors in the same population- including laboratory parameters, comorbidities, and psychosocial parameters.

Methods:

This retrospective record-based study included a sample of 93 patients with MCI as quantified by the Mini-Mental Status Examination (MMSE). These subjects were compared with controls (n = 97) without MCI, with respect to neuropathological diagnoses, laboratory parameters and psychosocial parameters.

Results:

The findings of our study were that female gender, higher depression scores, a greater number of medications taken, benzodiazepine use, higher alkaline phosphatase levels, positive fall history, loss of a spouse, and lower levels of education were associated with MCI. MCI is negatively associated with positive alcohol history. The most commonly seen proven neuropathological diagnosis was Parkinson’s disease.

Conclusion:

The risk factors that were found in our study should be highlighted in the elderly and preventive measures should be taken to prevent the downward progression through the cognitive continuum. Prospective studies looking into mild cognitive impairment with better screening tools and proper assessment of neuropathological comorbid conditions can further elucidate the findings related to this study.