The association of falls with loneliness and social exclusion: evidence from the DEAS German Ageing Survey

Prevalence and burden of loneliness in COPD: A systematic review and meta-analysis

BACKGROUND

Loneliness poses significant public health concerns on a global scale. Being alone and lacking social connections have been proven to impact prognosis and response to treatment in different diseases, including COPD. Yet, the prevalence and burden of loneliness on COPD outcomes remain unclear.

METHODS

Various relevant databases were systematically searched in March 2024. The quality of the studies included was assessed using a modified Newcastle-Ottawa Scale. The random effect model was used to compute the pooled prevalence and associated 95 % confidence intervals (95%CI) of loneliness and living alone in COPD patients.

RESULTS

After reviewing 256 studies, 11 studies, including 4644 COPD patients, met the inclusion criteria and were included in the systematic review. Of the included studies, 5/11 (45.5%) reported the prevalence of loneliness or lone living among COPD patients and were included in the meta-analysis. The prevalence of loneliness and lone living among COPD patients was 32% (95% CI = 16%-48%) and 29% (95% CI = 16%-41%), respectively. The Three-item UCLA loneliness scale was the most often used loneliness assessment tool (5/11, 45.5%). Loneliness and lone living were associated with poor outcomes, including emergency department visits, readmissions, depression, and reduced pulmonary rehabilitation response.

CONCLUSION

Despite one-third of COPD patients experiencing loneliness, researchers have not consistently documented its impact on COPD outcomes. More studies are needed to assess the impact of loneliness on COPD and how to mitigate the negative effects on patients' outcomes.

Moving the needle on implementing fall prevention programs in Saudi Arabia: assessing knowledge and perceptions of fall risk among community-dwelling older women

BACKGROUND

Saudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia.

METHODS

A cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms.

RESULTS

Nearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls.

CONCLUSION

Multidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

Factors associated with loneliness among individuals aged 80 years and over: Findings derived from the nationally representative "Old Age in Germany (D80+)" study

OBJECTIVES

To clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex).

METHODS

Data from the nationally representative "Old Age in Germany (D80+)" were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire).

RESULTS

Higher loneliness was significantly associated with not being married (e.g., widowed compared to being married, β=0.37, p<.001), being institutionalized (β=0.33, p<.001), low education (high education compared to low education, β=-0.07, p<.01), a higher number of chronic conditions (β=0.02, p<.001), poor self-rated health (β=-0.19, p<.001) and greater functional impairment (β=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex).

CONCLUSION

Several sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels.

Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019-2020

BACKGROUND

Older adults' engagement on social media may be a resource to reduce loneliness and improve mental health.

PURPOSE

This study aimed to examine loneliness and social media use and its association with severe psychological distress among older adults and whether social media use moderated the association of loneliness on severe psychological distress among older adults.

METHODS

This study is a secondary analysis of the 2019-2020 California Health Interview Survey. The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with a K6 score ≥ 13 associated with severe mental illness. Loneliness was measured using a revised Three Item Loneliness Scale (TILS) score. Multiple regression analyses were conducted to examine associations between loneliness and severe psychological distress.

RESULTS

Loneliness, health status, and identification as Asian, remained strong predictors of severe psychological distress among older adults when adjusting for other factors. In bivariate analysis, high-frequent social media users, but did not remain significant when accounting for covariates. Social media use did not moderate the association between loneliness and severe psychological distress.

CONCLUSION

This study underscores the significant impact of loneliness on poor mental health among older adults, emphasizing that while frequent social media use correlates with severe psychological distress, it may not alleviate the association of loneliness on poor mental health, thus highlighting the urgent need to address social isolation and promote genuine social connectedness, particularly among Asian older adults.

German population norms of the preference to solitude scale and its correlates

AIM

Our first aim was to present norm values for the Preference for Solitude Scale by sex, age, and other sociodemographic groups. Our second aim was to evaluate the correlates of preference for solitude.

METHODS

Data were collected in August/September 2023 from a sample of individuals (N = 5000) living in Germany aged 18 to 74 years (ensuring representativeness in terms of sex, age group and federal state for the German general adult population). The established and valid Preference for Solitude Scale (range 0 to 12, with higher values reflecting a stronger preference for solitude) was used to quantify the preference for solitude. Norm values were provided by sex and age groups. Multiple linear regressions were used to examine the correlates of preference for solitude.

RESULTS

Average preference for solitude score was 7.6 (SD = 3.0; 0 to 12). The average score was 7.3 (SD = 3.0) among males and 7.9 (SD = 2.9) among females. Regressions showed that a stronger preference for solitude was associated with being female (β = .51, p < .001), being older (e.g., being 40 to 49 years compared to 18 to 29 years, β = .85, p < .001), being single (e.g., divorced compared to being single, β = -.78, p < .01), higher level of education (secondary education compared to primary education, β = .43, p < .01), never been a smoker (e.g., daily smoker compared to never smokers, β = -.61, p < .001), absence of alcohol consumption (e.g., drinking once a week compared to never drinking, β = -1.09, p < .001), no sports activity (e.g., 2-4 hours per week compared to no sports activity, β = -.60, p < .001), poorer self-rated health (β = .28, p < .001) and more depressive symptoms (β = .05, p < .001). Sex-stratified regressions yielded similar results.

CONCLUSION

Norm values provided in this study can be used as a benchmark for comparison with other countries and can guide further research dealing with preferences for solitude. We demonstrated the importance of several sociodemographic factors (e.g., marital status), lifestyle-related factors (e.g., sports activity), and health-related factors (e.g., depressive symptoms) for the preference for solitude. Such knowledge about the correlates of preference for solitude may help to characterize them. This is essential to ensure a good balance between social interaction and being alone. This is important because preference for solitude is associated with poor self-rated health and depression, but also with healthy behaviors such as abstaining from smoking and drinking.

Protocol of a 12-week eHealth programme designed to reduce concerns about falling in community-living older people: Own Your Balance randomised controlled trial

INTRODUCTION

Concerns about falling (CaF) are common in older people and have been associated with avoidance of activities of daily life. Exercise designed to prevent falls can reduce CaF, but the effects are usually short-lived. Cognitive behavioural therapy (CBT) can reduce CaF for longer but is not readily available in the community and unlikely to prevent falls. A multidomain intervention that combines CBT, motivational interviewing and exercise could be the long-term solution to treat CaF and reduce falls in older people with CaF. This paper describes the design of a randomised controlled trial to test the effectiveness of two different 12 week self-managed eHealth programmes to reduce CaF compared with an active control.

METHODS

A total of 246 participants (82 per group) aged 65 and over, with substantial concerns about falls or balance will be recruited from the community. They will be randomised into: (1) myCompass-Own Your Balance (OYB) (online CBT programme) intervention or (2) myCompass-OYB plus StandingTall intervention (an eHealth balance exercise programme), both including motivational interviewing and online health education or (3) an active control group (online health education alone). The primary outcome is change in CaF over 12 months from baseline of both intervention groups compared with control. The secondary outcomes at 2, 6 and 12 months include balance confidence, physical activity, habitual daily activity, enjoyment of physical activity, social activity, exercise self-efficacy, rate of falls, falls health literacy, mood, psychological well-being, quality of life, exercise self-efficacy, programme adherence, healthcare use, user experience and attitudes towards the programme. An intention-to-treat analysis will be applied. The healthcare funder's perspective will be adopted for the economic evaluation if appropriate.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the South Eastern Sydney Local Health District Human Research Ethics Committee (2019/ETH12840). Results will be disseminated via peer-reviewed journals, local and international conferences, community events and media releases.

TRIAL REGISTRATION NUMBER

ACTRN12621000440820.

The relationship between fall and loneliness among older people in China: the mediating role of personality trait

Aims

We aimed to explore the role of personality traits between fall and loneliness.

Methods

A questionnaire survey was used to investigate falls, the big five personality traits, and loneliness among older people (≥ 60 years old) in China mainland.

Results

A total of 4,289 older people participated in the survey. There are significant differences in age, marital status, education level, residence, solitariness, and fall in relation to loneliness among older people. Falls, especially when they occurred one time increase the loneliness of older people. Agreeableness, conscientiousness, and neuroticism were significant mediating effects between falls and loneliness.

Conclusion

This study implied that agreeableness, conscientiousness, and neuroticism were meditating factors between falls and loneliness. In the future, we should consider the big five personality traits more to understand loneliness and offer older people interventions for reducing their loneliness. The study design was cross-sectional, so the temporal precedence of mediators and causality could not be tested. Because the data were collected retrospectively, current loneliness is likely to have confounding effects on retrospective recall.

The perceived control model of falling: developing a unified framework to understand and assess maladaptive fear of falling

BACKGROUND

fear of falling is common in older adults and can have a profound influence on a variety of behaviours that increase fall risk. However, fear of falling can also have potentially positive outcomes for certain individuals. Without progressing our understanding of mechanisms underlying these contrasting outcomes, it is difficult to clinically manage fear of falling.

METHODS

this paper first summarises recent findings on the topic of fear of falling, balance and fall risk-including work highlighting the protective effects of fear. Specific focus is placed on describing how fear of falling influences perceptual, cognitive and motor process in ways that might either increase or reduce fall risk. Finally, it reports the development and validation of a new clinical tool that can be used to assess the maladaptive components of fear of falling.

RESULTS

we present a new conceptual framework-the Perceived Control Model of Falling-that describes specific mechanisms through which fear of falling can influence fall risk. The key conceptual advance is the identification of perceived control over situations that threaten one's balance as the crucial factor mediating the relationship between fear and increased fall risk. The new 4-item scale that we develop-the Updated Perceived Control over Falling Scale (UP-COF)-is a valid and reliable tool to clinically assess perceived control.

CONCLUSION

this new conceptualisation and tool (UP-COF) allows clinicians to identify individuals for whom fear of falling is likely to increase fall risk, and target specific underlying maladaptive processes such as low perceived control.

Factors associated with falls among hospitalized and community-dwelling older adults: the APPCARE study

Background

Falls are a leading cause of disability. Previous studies have identified various risk factors for falls. However, contemporary novel research is needed to explore these and other factors associated with falls among a diverse older adult population. This study aims to identify the factors associated with falls among hospitalized and community-dwelling older adults.

Methods

Cross-sectional data from the 'Appropriate care paths for frail elderly people: a comprehensive model' (APPCARE) study were analyzed. The study sample consisted of hospitalized and community-dwelling older adults. Falling was assessed by asking whether the participant had fallen within the last 12 months. Multivariable logistic regression models were used to evaluate associations between socio-demographic characteristics, potential fall risk factors and falls.

Results

The sample included 113 hospitalized (mean age = 84.2 years; 58% female) and 777 community-dwelling (mean age = 77.8 years; 49% female) older adults. Among hospitalized older adults, loneliness was associated with an increased risk of falls. Associations between female sex, secondary education lever or lower, multimorbidity, a higher score on limitations with activities of daily living (ADL), high risk of malnutrition and falling were found among community-dwelling participants.

Conclusion

The results of this study confirm the multi-factorial nature of falling and the complex interaction of risk factors. Future fall prevention programs could be tailored to the needs of vulnerable subpopulations at high risk for falls.

Social exclusion in people with diabetes: cross-sectional and longitudinal results from the German Ageing Survey (DEAS)

As social exclusion can be linked to worse health and overall reduced quality of life, we describe social exclusion in people with diabetes and assess whether diabetes can be considered as a risk factor for social exclusion. We analyzed two waves (2014, 2017, N = 6604) from a survey of community-dwelling people aged > 40 using linear regression, group comparison and generalized estimating equations to explore the association between diabetes, social exclusion, socioeconomic, physical and psychosocial variables. In the entire cohort, diabetes was cross-sectionally associated with social exclusion after adjusting for covariates (p = 0.001). In people with diabetes, social exclusion was further associated with self-esteem (p < 0.001), loneliness (p =  < 0.001), income (p = 0.017), depression (p = 0.001), physical diseases (p = 0.04), and network size (p = 0.043). Longitudinal data revealed that higher levels of social exclusion were already present before the diagnosis of diabetes, and future social exclusion was predicted by self-esteem, loneliness, depression, and income, but not by diabetes (p = .221). We conclude that diabetes is not a driver of social exclusion. Instead, both seem to co-occur as a consequence of health-related and psychosocial variables.

Frailty, falls and poor functional mobility predict new onset of activity restriction due to concerns about falling in older adults: a prospective 12-month cohort study

PURPOSE

Concerns about falling are common in older adults and often cause activity restriction. This can lead to physical deconditioning, falls and social isolation. However, not every concerned older adult will restrict their activities. This 12-month longitudinal study investigated the physical and psychosocial factors that predict the new onset of activity restriction due to concerns about falling in older people.

METHODS

Participants were 543 older adults (M_age = 80.3 ± 4.4 years, range: 75-98) who did not report activity restriction due to concerns about falling at Timepoint-1 (negative response to the following question: "Do concerns about falling stop you going out-and-about?"). Participants completed a battery of physical and psychological assessments at Timepoint-1. Using binary logistic regression, we then assessed which of these variables predicted whether participants reported having started restricting their activity due to concerns about falling at the 12-month follow-up (Timepoint 2).

RESULTS

10.1% of the sample started to restrict activity due to concerns about falling at Timepoint 2. Three key predictors significantly predicted activity restriction group status at 12-month follow-up: greater frailty at Timepoint-1 (Fried Frailty Index; OR = 1.58, 95% CI 1.09-2.30), experiencing a fall between Timepoint-1 and 2 (OR = 2.22, 95% CI 1.13-4.38) and poorer functional mobility at Timepoint-1 (Timed up and Go; OR = 1.08, 95% CI 1.01-1.15).

CONCLUSIONS

Frailty, experiencing a fall and poorer functional mobility all predicted the onset of activity restriction due to concerns about falling. Clinicians working in balance and falls-prevention services should regularly screen for frailty, and patients referred to frailty services should likewise receive tailored treatment to help prevent the development of activity restriction due to concerns about falling.

Global evidence on falls and subsequent social isolation in older adults: a scoping review

BACKGROUND

Falls are a leading cause of injury-related hospitalizations among adults aged 65 years and older and may result in social isolation.

OBJECTIVE

To summarise evidence on falls and subsequent social isolation and/or loneliness in older adults through a scoping review.

ELIGIBILITY CRITERIA

Studies were eligible for inclusion if the population had a mean age of 60 years or older, they examined falls and subsequent social isolation, loneliness, fear of falling or risk factors and were primary studies (eg, experimental, quasi-experimental, observational and qualitative).

SOURCES OF EVIDENCE

MEDLINE, CINAHL, Embase, Ageline and grey literature from inception until 11 January 2021.

CHARTING METHODS

A screening and charting form was developed and pilot-tested. Subsequently, two reviewers screened citations and full-text articles, and charted the evidence.

RESULTS

After screening 4993 citations and 304 full-text articles, 39 studies were included in this review. Participants had a history of falling (range: 11% to 100%). Most studies were conducted in Europe (44%) and North America (33%) and were of the cross-sectional study design (66.7%), in the community (79%). Studies utilised 15 different scales. Six studies examined risk factors for social isolation and activity restriction associated with fear of falling. Six studies reported mental health outcomes related to falls and subsequent social isolation.

CONCLUSIONS

Consistency in outcome measurement is recommended, as multiple outcomes were used across the included studies. Further research is warranted in this area, given the ageing population and the importance of falls and social isolation to the health of older adults.

SCOPING REVIEW REGISTRATION NUMBER

10.17605/OSF.IO/2R8HM.

Sentinel fall presenting to the emergency department (SeFallED) - protocol of a complex study including long-term observation of functional trajectories after a fall, exploration of specific fall risk factors, and patients' views on falls prevention

BACKGROUND

Falls are a leading cause for emergency department (ED) visits in older adults. As a fall is associated with a high risk of functional decline and further falls and many falls do not receive medical attention, the ED is ideal to initiate secondary prevention, an opportunity generally not taken. Data on trajectories to identify patients, who would profit the most form early intervention and to examine the impact of a fall event, are lacking. To tailor interventions to the individual's needs and preferences, and to address the whole scope of fall risks, we developed this longitudinal study using an extensive assessment battery including dynamic balance and aerobic fitness, but also sensor-based data. Additionally, participative research will contribute valuable qualitative data, and machine learning will be used to identify trips, slips, and falls in sensor data during daily life.

METHODS

This is a mixed-methods study consisting of four parts: (1) an observational prospective study, (2) a randomized controlled trial (RCT) to explore whether a diagnostic to measure reactive dynamic balance influences fall risk, (3) machine learning approaches and (4) a qualitative study to explore patients' and their caregivers' views. We will target a sample size of 450 adults of 60 years and older, who presented to the ED of the Klinikum Oldenburg after a fall and are not hospitalized. The participants will be followed up over 24 months (within four weeks after the ED, after 6, 12 and 24 months). We will assess functional abilities, fall risk factors, participation, quality of life, falls incidence, and physical activity using validated instruments, including sensor-data. Additionally, two thirds of the patients will undergo intensive testing in the gait laboratory and 72 participants will partake in focus group interviews.

DISCUSSION

The results of the SeFallED study will be used to identify risk factors with high predictive value for functional outcome after a sentinel fall. This will help to (1) establish a protocol adapted to the situation in the ED to identify patients at risk and (2) to initiate an appropriate care pathway, which will be developed based on the results of this study.

TRIAL REGISTRATION

DRKS (Deutsches Register für klinische Studien, DRKS00025949 ). Prospectively registered on 4^th November, 2021.

Interventions for social isolation in older adults who have experienced a fall: a systematic review

OBJECTIVES

The objective of our systematic review was to identify the effective interventions to prevent or mitigate social isolation and/or loneliness in older adults who experienced a fall.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Ageline were searched (from inception to February 2020).

METHODS

Studies were eligible if they described any intervention for social isolation in older adults living in a community setting who experienced a fall, and reported outcomes related to social isolation or loneliness.Two independent reviewers screened citations, abstracted data and appraised risk of bias using the Cochrane risk of bias tool. The results were summarised descriptively.

RESULTS

After screening 4069 citations and 55 full-text articles, four studies were included. The four studies varied in study design, including a randomised controlled trial, non-randomised controlled trial, an uncontrolled before-after study and a quasiexperimental study. Interventions varied widely, and included singing in a choir, a patient-centred, interprofessional primary care team-based approach, a multifactorial assessment targeting fall risk, appropriate medication use, loneliness and frailty, and a community-based care model that included comprehensive assessments and multilevel care coordination. Outcome measures varied and included scales for loneliness, social isolation, social interaction, social networks and social satisfaction. Mixed results were found, with three studies reporting no differences in social isolation or loneliness after the intervention. Only the multifactorial assessment intervention demonstrated a small positive effect on loneliness compared with the control group after adjustment (B=-0.18, 95% CI -0.35 to -0.02).

CONCLUSIONS

Few studies examined the interventions for social isolation or loneliness in older adults who experienced a fall. More research is warranted in this area.

PROSPERO REGISTRATION NUMBER

CRD42020198487.

Subjective well-being among male veterans in later life: the enduring effects of early life adversity

OBJECTIVES

This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively.

METHODS

Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships.

RESULTS

Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being.

DISCUSSION

Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.

Social support and health-related quality of life among the oldest old - longitudinal evidence from the multicenter prospective AgeCoDe-AgeQualiDe study

PURPOSE

The aim of this study was to examine the longitudinal within-association between social support and health-related quality of life among the oldest old.

METHODS

Longitudinal data (follow-up waves 7 to 9) were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85 +)" (AgeQualiDe). n = 648 individuals were included in the analytical sample. At FU wave 7, mean age was 88.8 years (SD: 2.9 years, from 85 to 99 years). Social support was quantified using the Lubben Social Network Scale (6-item version). Health-related quality of life was assessed using the EQ-5D-3L including problems in five health dimensions, and its visual analogue scale (EQ VAS). It was adjusted for several covariates in conditional logistic and linear fixed effects regressions.

RESULTS

Intraindividual decreases in social support were associated with an increased likelihood of developing problems in 'self-care', 'usual activities', 'pain/discomfort' and 'anxiety/depression' (within individuals over time). In contrast, intraindividual changes in social support were not associated with intraindividual changes in the EQ VAS score.

CONCLUSION

Findings indicate a longitudinal intraindividual association between social support and problems, but only in some health dimensions. Further research in this area based on longitudinal studies among the oldest old (from different countries) is required.

Comorbidities and psychosocial factors as correlates of self-reported falls in a nationwide sample of community-dwelling people aging with HIV in Germany

BACKGROUND

Falls are a frequent health problem with potentially severe consequences among the elderly. Due to the aging HIV population, there is a growing interest in falls as a geriatric syndrome in HIV research and clinical practice. Previous studies found rather high prevalences of falls in this population and focused on biomedical and demographic risk factors for falls. Psychosocial risk factors like stigma, social support or loneliness were not previously assessed as correlates of fall events in this population.

METHODS

We assessed self-reported fall frequency in the past 12 months in a nationwide sample of 897 community-dwelling people aged 50 years or older living with HIV in Germany using a cross-sectional study design. We calculated odds of any fall for sociodemographic and HIV-related variables in bivariate analyses and for comorbidities, and psychosocial variables in bivariate and adjusted analyses.

RESULTS

Eighteen percent of our participants reported at least one fall in the preceding 12 months, 12 % reported recurring falls. A lower socioeconomic status, being single and living alone were significantly associated with a higher risk for falling. An AIDS diagnosis was related to fall risk, but time since diagnosis and a detectable viral load were not. Reporting at least one comorbidity increased fall risk in our sample 2.5 times (95% CI: 1.59; 3.97). The strongest association with fall risk was found for diseases of the central nervous system, heart disease, rheumatism, osteoporosis, and chronic pain. Experienced HIV stigma (AOR: 2.11; 95% CI: 1.58; 2.83) and internalized HIV stigma (AOR: 1.43; 95% CI: 1.12; 1.85), as well as social support (AOR: .92; 95% CI: .86; .99) and loneliness (AOR: 1.51; 95% CI: 1.22; 1.87) were significantly related to fall risk in bivariate and adjusted analyses.

CONCLUSIONS

We found a low prevalence of falls in our sample of community-dwelling people aging with HIV. Our results show evidence for a strong association between comorbidity and falling, and between psychosocial factors and falling. Especially the strong association between experienced HIV stigma and fall risk is noteworthy and adds falls to the list of health outcomes affected by HIV stigma.

Perceived social isolation, social disconnectedness and falls: the mediating role of depression

OBJECTIVES

to estimate the association of social disconnectedness and perceived social isolation with the risk of falls and also investigate whether depression mediated this association.

METHOD

Biennial longitudinal survey data from 2006 to 2012 waves of the U.S. Health and Retirement Study of adults aged 65 and older (N = 22,153 observations) were examined. The outcome variable was number of self-reported falls over the observation period. Independent variables included social isolation (social disconnectedness, perceived social isolation) and number of depressive symptoms. Generalized Estimating Equation regressions were performed to address the research questions.

RESULTS

Regression models indicated that social disconnectedness is associated with a 5% increase in the risk of falls. Perceived social isolation (lack of perceived social support and loneliness combined) was associated with a 33% increase in falls risk. For each increase in the number of depressive symptoms, the risk of falls increased by 13%. Also, the number of depressive symptoms mediated the association between perceived social isolation and risk of falls.

CONCLUSION

Our findings were suggestive of the need to consider social isolation when designing falls prevention programs. More research is needed with research designs that address potential endogeneity bias.

[COVID-19 in old age-The geriatric perspective]

Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.

Association of Loneliness With Falls: A Study of Older US Adults Using the National Social Life, Health, and Aging Project

Objectives: Falls represent a significant cause of morbidity and mortality in older adults, and are more common among those living alone. We aimed to determine if there is an association between loneliness and falls. Methods: Participants were surveyed in three waves separated by 5 years. We used the three-item UCLA Loneliness Scale to measure loneliness. Results: Data from 2337 respondents, with both loneliness and fall data in at least two consecutive waves, were included. Over three waves, 51% respondents reported a fall and 23% reported ≥ two falls. In multivariate analysis, the odds of having ≥ one fall 5 years later increased by a factor of 1.11 per one point increase on the loneliness scale (OR = 1.11, 95% CI 1.04, 1.19; p < .01). Discussion: Lonely older adults have increased odds of future falls. Strategies for combating loneliness in older adults may help reduce fall-related morbidity and mortality.

Falls and life-space mobility: longitudinal analysis from The International Mobility in Aging Study

OBJECTIVES

To investigate a 4-year longitudinal relationship between falls, recurrent falls, and injurious falls, according to different levels of life-space mobility (LSM).

METHODS

Longitudinal analysis of an international cohort study. The participants were older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline. Three waves of data (2012, 2014, 2016) were used. Fall history during the past year was recorded. Recurrent fallers were identified as those who fell at least twice and injurious fallers as participants who required medical attention. LSM measurements included Total Life-Space (LS-C), Maximal Life-Space (LS-M), Assisted Life-Space (LS-A), Independent Life-Space (LS-I) and Restricted Life-space (LS-ID) scores. Generalized estimation equation (GEE) models were used to determine whether life-space mobility measures and their change over time differed between recurrence of falls and injurious falls.

RESULTS

At baseline, the prevalence of falls in the last year was 28%. 11.8% reported recurrent falls and 2.6% had serious injurious falls in the last year preceding the assessments. Recurrent fallers were more likely to be female, with insufficient income and, with comorbidities. GEE models showed that life-space mobility was lower among those with recurrent falls or serious injurious falls compared to those who never fell, but the rate of change did not differ over the 4-year follow-up except for the LS-A and LS-I scores, where some improvements were observed over time.

CONCLUSIONS AND IMPLICATIONS

Falls were independently associated with a decrease in LSM over 4 years. Targeting older adults with recurrent and injurious falls with appropriate interventions may improve community mobility and social participation.

[Who Feels Excluded? On the Use of the Concept of Social Exclusion to Analyze Current Societal Trends]

The concept of social exclusion has had an astonishing career in the social sciences. The focus of this paper is an empirical investigation of the use of this concept to analyze current societal trends. From this theoretical perspective we derive four theses, which are empirically tested in this paper with a focus on the perception of exclusion: First, that because of the processes of economic structural change, larger population groups are affected by social exclusion in several dimensions (unemployment, poverty, social isolation), culminating in a subjective sense of exclusion among them. Thus, it is assumed that social exclusion has become the main social cleavage in contemporary society. Second, it is assumed that social exclusion cannot be clearly located in classical sociostructural categories but has diffused into broad segments of society. Third, socioeconomic precariousness and social isolation are thought to play a central role in the emergence of a subjective sense of exclusion. Here, and fourth, it is assumed, however, that this impacts on the sense of exclusion via the subjective perception of the objective life conditions. We test these theses derived from this theoretical perspective on the basis of survey data, using the sense of exclusion as a dependent variable. It becomes clear that, first, social exclusion has not diffused into large parts of society and thus can by no means be regarded as the main social cleavage in society; and second, an increased sense of exclusion can be found in different but clearly identifiable social groups. Moreover, our analyses show that the subjective sense of exclusion is rooted in both social isolation and socioeconomic precariousness, albeit clearly mediated by their subjective perception.

The Onset of Falls Reduces Subjective Well-Being. Findings of a Nationally Representative Longitudinal Study

Introduction: The prevalence of older individuals experiencing a fall is high. Moreover, falls can have deleterious effects on health status. Additionally, falls can affect the subjective well-being of individuals. However, there is a lack of studies examining the link between falls and subjective well-being. Therefore, the objective of this study was to investigate whether the onset of falling is associated with (intraindividual) decreases in subjective well-being in men and women. Materials and Methods: Longitudinal data (from wave 5 to wave 6) were taken from a population-based sample of individuals residing in private households in Germany [in our analytical sample: 3,906 observations (men), and 3,718 observations (women)]. Positive and negative affect were quantified using the Positive and Negative Affect Schedule (PANAS). Life satisfaction was assessed using the Satisfaction with Life Scale (SWLS). Results: Adjusting for various potential confounders, fixed effects regressions showed that the onset of falls was associated with a decrease in positive affect (β = 0.08, p < 0.01), and an increase in negative affect (β = 0.07, p < 0.01) among men. While the onset of falls was not associated with changes in positive affect in women, it was associated with a decrease in negative affect in women (β = 0.06, p < 0.05). Sex differences were significant. The onset of falls was not associated with decreases in life satisfaction in men, nor in women. Discussion: The present study particularly highlights the link between the onset of falls and reduced affective well-being among men. Avoiding falls may contribute to maintaining affective well-being among middle-aged and older men.

A longitudinal analysis of loneliness, social isolation and falls amongst older people in England

Loneliness and social isolation have been identified as important predictors of various health outcomes, but little research has investigated their influence on falls. This study aimed to investigate the longitudinal association between loneliness, social isolation and falls amongst older adults in England, looking at both self-reported falls and falls that require hospital admissions. This study drew on large scale, nationally representative data from the English Longitudinal Study of Ageing linked with Hospital Episode Statistics. Data were analysed using survival analysis, with self-reported falls (total sample = 4013) and falls require hospital admission being modelled separately (total sample = 9285). There was a 5% increase in the hazard of self-reported falls relative to one point increase in loneliness independent of socio-demographic factors (HR: 1.05, 95% CI: 1.02–1.08), but the association was explained away by individual differences in health and life-style measures (HR: 1.03, 95% CI: 1.00–1.07). Both living alone (HR: 1.18, 95% CI: 1.07–1.32) and low social contact (HR: 1.04, 95% CI: 1.01–1.07) were associated with a greater hazard of self-reported falls even after controlling for socio-demographic, health and life-style differences. Similar results were also found for hospital admissions following a fall. Our findings were robust to a variety of model specifications.

Falls in older people with diabetes: Identification of simple screening measures and explanatory risk factors

AIMS

To identify risk factors for falls in older people with diabetes mellitus (DM) and to develop a low-cost fall risk screening tool.

METHODS

Older adults with DM (n = 103; age = 61.6 + 6.0 years) were recruited from diabetic clinics. Demographic, DM specific factors, lower limb strength and sensation, cognition, fear of falling, hand reaction time, balance, mobility and gait parameters were assessed using validated methods. Falls were prospectively recorded over six months.

RESULTS

Past falls and female gender were identified as significant predictors of falls: history of falls and female gender increased fall rates by 4.62 (95% CI = 2.31-9.27) and 2.40 (95% CI = 1.04-5.54) respectively. Fall rates were significantly associated with Diabetic Neuropathy scores, HbA1c level, contrast sensitivity, quadriceps strength, postural sway, tandem balance, stride length and Timed Up and Go Test times. A multi-variable fall risk tool derived using five measures, revealed that absolute risk for multiple falls increased from 0% in participants with zero or one factor to 83% in participants with all five risk factors.

CONCLUSIONS

Simple screening items for fall risk in people with DM were identified, with parsimonious explanatory risk factors. These findings help guide tailored interventions for preventing falls in DM.

Depressive Symptoms and Frailty Among the Oldest Old: Evidence from a Multicenter Prospective Study

OBJECTIVE

There is a lack of studies disentangling whether changes in frailty are associated with subsequent changes in depressive symptoms or vice versa among the oldest old. Consequently, we aimed to disentangle this link.

DESIGN

Three waves [follow-up (FU) wave 7 to FU wave 9; n = 423 individuals in the analytical sample] were used from the multicenter prospective cohort study "Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)" (AgeQualiDe).

SETTING AND PARTICIPANTS

Primary care patients aged 85 years and older.

METHODS

The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to quantify frailty, and the Geriatric Depression Scale was used to measure depressive symptoms. It was adjusted for several covariates (sociodemographic and health-related factors) in regression analysis.

RESULTS

Multiple linear regressions with first differences showed that initial increases in depressive symptoms (from FU wave 7 to FU wave 8) were associated with subsequent increases in frailty (from FU wave 8 to FU wave 9; β = 0.06, P < .05), whereas initial increases in frailty (from FU wave 7 to FU wave 8) were not associated with subsequent increases in depressive symptoms (from FU wave 8 to FU wave 9).

CONCLUSIONS AND IMPLICATIONS

The study findings suggest the relevance of increases in depressive symptoms for subsequent increases in frailty. Treatment of depressive symptoms may also be beneficial to postpone frailty.

Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness

OBJECTIVES

In response to the lack of longitudinal evidence, this study aims to disentangle time sequence and directionality between the severity of geriatric conditions (GCs) and loneliness.

DESIGN

Longitudinal panel study.

SETTING AND PARTICIPANTS

The working sample had 4680 participants of 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS). All participants were at least 65 years old at baseline. Proxy responded cases and individuals who suffered from moderate to severe cognitive impairment were excluded from the analysis.

METHODS

Loneliness was measured with the 3-item UCLA loneliness scale. Five GCs were included: falls, incontinence, vision impairment, hearing impairment, and pain. Severity indicators were the number of times fallen in the past 2 years, number of days experiencing loss of bladder control in the past month, self-rated eyesight, self-rated hearing, and participants' perceived level of pain.

RESULTS

Random-intercept cross-lagged panel models were run to analyze the relationship between the severity of each individual GC and loneliness. All models were controlled for baseline demographics, social isolation, self-rated health, physical function, comorbidities, and hospitalization. The longitudinal association between loneliness and fall was bidirectional: a higher loneliness score predicted an increased number of falls and vice versa. Incontinence, vision impairment, hearing impairment, and pain were not significantly associated with loneliness longitudinally. The association between the random intercept of loneliness and some GCs (vision and pain) were significant, indicating the severity of these GCs were related to loneliness at the between-person level at baseline.

CONCLUSION AND IMPLICATIONS

Findings of the longitudinal analysis suggest a reciprocal relationship between fall and loneliness. Fall prevention programs could be integrated with social service for addressing loneliness, and alleviating loneliness might be beneficial for preventing falls. Results of this study highlight the importance of integrating clinical management of falls with social services addressing loneliness in long term care.

Which factors contribute to loneliness among older Europeans? Findings from the Survey of Health, Ageing and Retirement in Europe: Determinants of loneliness

BACKGROUND

While previous studies have examined the determinants of loneliness (i) using a longitudinal approach and (ii) using data from nationally representative samples, only few studies have done both at once. Hence, the purpose of our study was to clarify which factors are associated with loneliness longitudinally based on nationally representative data.

METHODS

Data were taken from wave 5 to 7 of the "Survey of Health Ageing, and Retirement in Europe "(SHARE; covering 27 European countries and Israel in total) (in our analytical sample, n = 101,909 observations). Loneliness was assessed using the three-item loneliness scale. As explanatory variables, we included age, marital status, income, self-rated health, depressive symptoms, functional decline, cognitive functioning and chronic diseases. Exploiting the features of panel data and mitigating the problem of unobserved heterogeneity, linear FE regressions were used.

RESULTS

FE regressions showed that loneliness increased with increasing age (β = .02, p < .001), changes from married and living together with spouse/registered partnership to another marital status (β=-.71, p < .001), decreases in log income (β=-.01, p < .05), worsening self-rated health (β = .04, p < .001), functional decline (β = .09, p < .001), increases in depressive symptoms (β = .13, p < .001) and decreases in cognitive functioning (β=-.01, p < .001), whereas it was not associated with changes in chronic diseases.

CONCLUSION

Our longitudinal study based on nationally representative SHARE data contributed to identify the determinants of loneliness among older Europeans using panel data methods. Tackling the identified risk factors may assist in avoiding loneliness in older adults living in Europe.

The link between falls, social isolation and loneliness: A systematic review

BACKGROUND

The chances of experiencing a fall among those aged 60 years and older increase as risk factors accumulate. In the last few decades, several studies have identified different risk factors for falls in older people, including the role of social isolation and loneliness. This systematic review provides an overview of published literature that analyzes the bidirectional relation between falls and social isolation or loneliness.

MATERIAL AND METHODS

Two databases (PubMed and Europe PMC) were used to search for publications investigating the relationship between falls, social isolation and/or loneliness in older people. Similar articles and references were screened against the inclusion criteria.

RESULTS

17 studies met the inclusion criteria and were included. Only a few studies assessed the association between falls and social isolation/loneliness among older people. Therefore, articles examining the association between falls and living alone status among people aged 60 and older were included as well. In all studies loneliness, social isolation, and living alone were significantly associated with falls in older people.

CONCLUSIONS

The findings emphasize the importance of the relationship between falls and social isolation, loneliness and living alone among older people. As there are only a few studies assessing the relationship between falls and loneliness or social isolation, further research in this field should be conducted. In particular, longitudinal studies that utilize standardized measurement instruments should be carried out.

Associations between the measures of physical function, risk of falls and the quality of life in haemodialysis patients: a cross-sectional study

BACKGROUND

Impaired physical function due to muscle weakness and exercise intolerance reduces the ability to perform activities of daily living in patients with end-stage kidney disease, and by consequence, Health-Related Quality of Life (HRQoL). Furthermore, the risk of falls is an aggregate of physical function and, therefore, could be associated with HRQoL as well. The present study examined the associations between objective and subjective measures of physical function, risk of falls and HRQoL in haemodialysis patients.

METHODS

This cross-sectional multicentre study included patients on maintenance haemodialysis. Physical function (quadriceps force, handgrip force, Sit-to-Stand, and six-minute walking test), the risk of falls (Tinetti, FICSIT-4, and dialysis fall index) and HRQoL (PROMIS-29 and EQ-5D-3 L) were measured and analysed descriptively, by general linear models and logistic regression.

RESULTS

Of the 113 haemodialysis patients (mean age 67.5 ± 16.1, 57.5% male) enrolled, a majority had impaired quadriceps force (86.7%) and six-minute walking test (92%), and an increased risk of falls (73.5%). Whereas muscle strength and exercise capacity were associated with global HRQoL (R² = 0.32) and the risk of falls, the risk of falls itself was related to psycho-social domains (R² = 0.11) such as depression and social participation, rather than to the physical domains of HRQoL. Objective measures of physical function were not associated with subjective fatigue, nor with subjective appreciation of health status.

CONCLUSIONS

More than muscle strength, lack of coordination and balance as witnessed by the risk of falls contribute to social isolation and HRQoL of haemodialysis patients. Mental fatigue was less common than expected, whereas, subjective and objective physical function were decreased.

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components

AIMS

To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain.

DESIGN

Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach.

METHODS

The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis.

RESULTS

Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care.

CONCLUSIONS

Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care.

IMPACT

Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care.

TRIAL REGISTRATION

ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

Chemotherapy-Induced Peripheral Neuropathy: Association With Increased Risk of Falls and Injuries

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and degenerative side effect of many commonly used chemotherapy agents. Symptoms manifest as sensory and motor neuropathies. CIPN may necessitate chemotherapy dose reduction or discontinuation.

OBJECTIVES

This review intends to summarize literature linking CIPN to an increased risk of falls and injuries and provides recommendations to help maintain patient safety and maximize physical function.

METHODS

A literature search was conducted using MEDLINE®, PubMed®, and ScienceDirect.

FINDINGS

Assessment of CIPN and CIPN-related falls and injuries is vital in preventing related complications, and proper education of oncology nursing staff on CIPN assessment and management is necessary.

Self-Rated Health and Social Exclusion: Does Gardening Moderate This Relation? Evidence from the German Ageing Survey

The aim of the present study was to examine whether the association between self-rated health and social exclusion can be moderated by the frequency of gardening in the total sample and stratified by sex. Cross-sectional data employed in this study came from the fifth wave of the German Ageing Survey (n = 5048), a nationally representative sample comprising non-institutionalized individuals aged 40 and above. A single-item measure was used to quantify self-rated health (ranging from 1 = very good to 5 = very bad). An established scale developed by Bude and Lantermann was used to assess social exclusion. Moreover, individuals reported the frequency of work in the garden (daily; several times a week; once a week; 1-3 times a month; less often; never). Poorer self-rated health was associated with feelings of social exclusion. The frequency of gardening significantly moderated the association between these factors in women. This cross-sectional study emphasizes the moderating role of gardening in the relation between self-rated health and social exclusion in women. Longitudinal studies are required to validate the present findings.

The association between use of online social networks sites and perceived social isolation among individuals in the second half of life: results based on a nationally representative sample in Germany

BACKGROUND

To date, little is known about the association between the use of online social network sites and social isolation among individuals in the second half of life. Therefore, the aim of the present study was to examine this association among older adults.

METHODS

Cross-sectional data was drawn from a nationally representative sample of non-institutionalized individuals aged 40 and above (n = 7837) in Germany (German Ageing Survey). Online social network use was assessed using the frequency of social network use (e.g., Facebook) in the preceding 12 months (daily; several times a week; once a week; 1-3 times a month; less often; never). Perceived social isolation was measured using an established scale created by Bude and Lantermann.

RESULTS

Adjusting for covariates, linear regressions revealed that daily online social network users reported lower social isolation scores compared with those with less frequent or no social media use.

CONCLUSIONS

Data suggest that daily users of online social networks aged 40 and over tend to feel less socially isolated than less frequent users or non-users. Future research should concentrate on identifying the direction of this association. Moreover, the reasons underlying this finding should be examined.

Falls Are Associated With Decreased Autonomy, and Self-Efficacy Moderates This Relation: Results From a National Study

The first aim of this study was to examine the association between falls and perceived autonomy. The second aim was to investigate whether this association is moderated by self-efficacy. Cross-sectional data were drawn from the German Ageing Survey-a nationally representative sample of individuals living in private households aged 40 and above (n = 7,746) in Germany. Perceived autonomy was quantified according to Schwarzer. Self-efficacy was assessed using a widely established scale by Schwarzer and Jerusalem. With covariates being adjusted, linear regressions revealed that experiencing a fall in the past 12 months was associated with lower perceived autonomy (β = -.09, p < .001). General self-efficacy moderated this association (β = .08, p = .02). Findings emphasized the association between falls and perceived autonomy as well as the moderating role of self-efficacy. Future longitudinal studies are required to gain insights into the temporal relationship between these variables.

Dual-task Interference Disrupts Parkinson's Gait Across Multiple Cognitive Domains

Gait dysfunction, a hallmark of Parkinson's disease, contributes to a relatively high incidence of falling. Gait function is further diminished during the performance of a motor-cognitive task (i.e., dual-task). It is unclear if Parkinson's disease-related dual-task deficits are related to a specific area of cognitive function or are the result of a more global decline in executive function. The aim of this project was to systematically evaluate gait performance to determine if gait dysfunction is restricted to certain types of executive function or a global phenomenon in individuals with Parkinson's disease. Twenty-three individuals with mild-moderate Parkinson's disease completed a series of dual-task conditions in which gait was paired with cognitive tasks requiring: working memory (0, 1, and 2-back), attention and problem solving (serial-7 subtraction), verbal memory (digit recall), semantic memory (Controlled Oral Word Association) and information processing speed (visual Stroop test). The results demonstrate that individuals with mild-moderate Parkinson's disease have a generalized worsening of spatial-temporal gait parameters regardless of the specific cognitive demand being performed concurrently. Overall, gait velocity decreased (p < 0.01) and stride and stance time both increased (p < 0.01) across all cognitive conditions. The attention and problem solving task resulted in the greatest number of gait parameter decrements. Results indicated that performance on cognitive tasks remained unchanged from single-task to dual-task conditions. Diminished gait performance under dual-task conditions across different cognitive function domains suggests a global Parkinson's disease-related deficit in information processing and regulation of gait.