The role of cognitive impairment in fall risk among older adults: A systematic review and meta-analysis

Division of Geriatric Medicine, The University of Western Ontario, 801 Commissioners Road East, London, Ontario, Canada.
Age and Ageing (Impact Factor: 3.64). 02/2012; 41(3):299-308. DOI: 10.1093/ageing/afs012
Source: PubMed


cognitive impairment is an established fall risk factor; however, it is unclear whether a disease-specific diagnosis (i.e. dementia), measures of global cognition or impairments in specific cognitive domains (i.e. executive function) have the greatest association with fall risk. Our objective was to evaluate the epidemiological evidence linking cognitive impairment and fall risk.
studies were identified through systematic searches of the electronic databases of MEDLINE, EMBASE, PyschINFO (1988-2009). Bibliographies of retrieved articles were also searched. A fixed-effects meta-analysis was performed using an inverse-variance method.
twenty-seven studies met the inclusion criteria. Impairment on global measures of cognition was associated with any fall, serious injuries (summary estimate of OR = 2.13 (1.56, 2.90)) and distal radius fractures in community-dwelling older adults. Executive function impairment, even subtle deficits in healthy community-dwelling older adults, was associated with an increased risk for any fall (summary estimate of OR = 1.44 (1.20, 1.73)) and falls with serious injury. A diagnosis of dementia, without specification of dementia subtype or disease severity, was associated with risk for any fall but not serious fall injury in institution-dwelling older adults.
the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk. There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values. Executive function was also associated with increased risk, which supports its inclusion in fall risk assessment especially when global measures are within normal limits.

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    • "In particular, Nagamatsu et al. (2011) revealed that baseline activation of left orbital frontocortex and anterior cingulate gyrus were both associated with falls risk in community-dwelling seniors. Since the earlier reports on the connection between cognitive performance and balance there now exists a vast collection of reports that clearly expose the link between reduced cognitive capacity and heightened falls risk (Ambrose et al., 2013; Chen et al., 2012; Herman et al., 2010; Holtzer et al., 2007; Liu-Ambrose et al., 2008; Mirelman et al., 2012; Morris et al., 1987; Muir et al., 2012) even when the cognitive decline is slight (Gleason et al., 2009). "
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    • "With aging, individuals are more likely to present muscle weakness (Leveille et al., 2009), change in postural control (Sorond et al., 2010), chronic pain (Stubbs et al., 2014), peripheral neuropathy and proprioceptive sensory loss (Richardson and Hurvitz, 1995), vision impairment (Yip et al., 2014), vestibular dysfunctions, hypoacusia (Viljanen et al., 2009), cognitive decline (Muir et al., 2012), and orthostatic hypotension. All these aspects have been related to an increased tendency to fall in the elderly; moreover, multiple medical illness, drugs, and polypharmacy (Berry et al., 2010), which are very common among the elderly, have been related to an increased risk of falling. "
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