Article

Declining cognition is a risk factor for falls among older adults.
The extent to which impaired judgment in performance of daily activities
increases fall risk is unclear.
The aim of this study was to determine
whether engagement in mobility activities in a risky manner explains the
association between declining cognition and rate of falls.
This study was
a secondary analysis of baseline and prospective data from older adults enrolled
in the intervention arm of a randomized clinical trial.
METHODS: Two hundred
forty-five community-dwelling older adults (79% female; mean age=79 years,
SD=8.0) who were at risk for falls received physical, cognitive, and functional
evaluations. Cognition was assessed with the Short Portable Mental Status
Questionnaire (SPMSQ). Using interview and in-home assessment data, physical
therapists determined whether participants were at risk for falls when performing
mobility-related activities of daily living (ADL) and instrumental ADL (IADL).
Falls were measured prospectively for 1 year using monthly falls diaries.
RESULTS: Declining cognition was associated with increased number of mobility
activities designated as risky (1.5% of mobility activities performed in a risky
manner per SPMSQ point) and with increased rate of falls (rate ratio=1.16 for
each unit change in SPMSQ score). Risky performance of mobility activities
mediated the relationship between cognition and rate of falls. LIMITATIONS: Risk
assessment was based on the clinical judgment of experienced physical therapists.
Cognition was measured with a relatively insensitive instrument, and only
selected mobility activities were evaluated. CONCLUSIONS: Engagement in mobility
ADL and IADL tasks in a risky manner emerged as a link between declining
cognition and increased number of falls, suggesting a mechanism through which the
rate of falls may increase. Specifically, declining cognition is associated with
performance of mobility activities in an unsafe manner, thereby increasing the
risk for falls.

Langue : ANGLAIS