Understanding fall risk in cognitively impaired older people

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Copyright: Taylor, Morag Elizabeth
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Abstract
Rates of both falls and dementia are expected to increase exponentially with population ageing. Falls in older people with dementia are common, with 60% falling annually. There is a lack of evidence that falls can be prevented in older people with dementia and this is partly a reflection of our limited understanding of fall risk factors in this population. This thesis explores fall risk factors in community-living cognitively impaired older people (CIOP) with the goal of developing a better understanding of risk, and therefore, of directing future intervention. Consenting CIOP (n=177) and age- and gender-matched controls were enrolled in the study (n=276). Baseline data included sociodemographic characteristics, medical conditions, medication use, and neuropsychological, sensorimotor, balance, functional and gait performance. Participants were followed-up for 12-months using monthly falls diaries and telephone calls (with assistance of carers in CIOP). Significant findings include: 1. CIOP perform significantly worse than age- and gender-matched cognitively intact older people in a number of sensorimotor and functional measures, and are at increased risk of falls and multiple falls. 2. The Physiological Profile Assessment, with the addition of a leaning balance test (coordinated stability) predicted multiple falls with similar accuracy to previously published data in cognitively intact older people. 3. Depressive symptoms, static and leaning balance are independently and significantly associated with falls in CIOP. 4. Simple spatiotemporal gait parameters predict falls in CIOP, a relationship primarily mediated through impaired sensorimotor performance. 5. Dual-task spatiotemporal gait parameters predict falls in CIOP; however, without additional benefit to simple gait assessment in relation to fall prediction. The findings of this thesis demonstrate that CIOP perform significantly worse in a number of measures of sensorimotor and functional performance when compared to a cognitively intact population. Both static and leaning balance measured using the extended Physiological Profile Assessment, in addition to depressive symptomatology, are important independent and potentially modifiable contributors to fall risk in this high risk population. Further research is needed to determine if these risk factors can be modified in CIOP and whether this in turn leads to a meaningful reduction in falls and fall-related injury in this expanding population.
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Author(s)
Taylor, Morag Elizabeth
Supervisor(s)
Close, Jacqueline
Lord, Stephen
Delbaere, Kim
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Publication Year
2013
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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