How Probable Cognitive Impairment Shapes Fall Risk and Physical Function After 12 Months

TL;DR

Older adults with cognitive impairment have more falls and worse outcomes after a severe fall compared to those without cognitive issues, even if their physical function remains stable.

Contribution

The study identifies cognitive impairment as a key factor in increased fall risk and suggests the need for cognitive-focused interventions.

Findings

Cognitively impaired older adults had significantly more recurrent falls over 12 months.

Both groups showed cognitive improvement, but physical function like gait speed remained stable.

Attention or executive function deficits may be more closely linked to fall risk than physical function.

Abstract

Older adults with cognitive impairment (OACI) experience more severe fall-related sequelae and have a higher risk of recurrent falls than cognitively healthy older adults (OACH). Despite the high risk of decline in physical function following fall-related emergency department (ED) visits, targeted falls prevention interventions remain limited. Therefore, this study examines the trajectories of physical function and recurrent falls in OACH and OACI. Older adults (≥60 years) were recruited shortly after a severe fall that required an ED visit and were followed up for 12 months. Follow-up included monthly telephone calls and three home visits to assess recurrent falls, functional performance measured by self-preferred, three-meter overground gait speed (m/s), and cognition (MoCA). After twelve months, 116 OACI (mean age 77.1± 8.4; MoCA: 21.8±1.9) experienced more recurrent falls (n = 61/116, p = 0.01) compared to 126 OACH (mean age 70.7±7.8; MoCA: 26.8±1.4; recurrent falls 46/126). ANCOVA indicated a significant difference between the groups with worse performance in OACI (p < 0.001), although both groups showed cognitive improvement over time (p < 0.001). Physical function including gait speed remained stable, with both groups demonstrating persistently slow gait speed at 12 months (OACI: 1.0±0.3; OACH: 1.1±0.3 m/s; p = 0.51). Since physical function remained unchanged, the high fall rate may be more closely linked to deficits in attention or executive function. Nevertheless, a longer follow-up is needed to identify the clinical relevance of these findings. Future studies should explore cognitive training and dual-task exercise interventions to mitigate fall risk in this vulnerable population.