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Examining the relationship between specific cognitive processes and falls risk in older adults: a systematic review

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Abstract

This systematic review aims to establish which cognitive domains are associated with falls or falls risk. Recent evidence suggests that impaired cognition increases seniors’ risk of falling. The purpose of this review was to identify the cognitive domains that are significantly associated with falls or falls risk in older adults. We conducted a systematic review of peer-reviewed journal articles published from 1948 to present, focusing on studies investigating different domains of cognitive function and their association with falls or falls risk in adults aged 60 years or older. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we completed a comprehensive search of MEDLINE, PubMed, and EMBASE databases to identify studies examining the association between cognitive function and falls or falls risk. With an expert in the field, we developed a quality assessment questionnaire to rate the quality of the studies included in this systematic review. Twenty-five studies were included in the review. We categorized studies based on two related but distinct cognitive domains: (1) executive functions or (2) dual-task ability. Twelve studies reported a significant association between executive functions and falls risk. Thirteen studies reported that dual-task performance is a predictor of falls or falls risk in older adults. Three studies did not report an association between cognition and falls risk. Consistent evidence demonstrated that executive functions and dual-task performance were highly associated with falls or falls risk. The results from this review will aid healthcare professionals and researchers in developing innovative screening and treatment strategies for mitigating falls risk by targeting specific cognitive domains.

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Conflicts of interest

Dr. Liu-Ambrose is a Michael Smith Foundation for Health Research Scholar and a Canadian Institute for Health Research New Investigator. Dr. Davis is funded by a Canadian Institute for Health Research and a Michael Smith Foundation for Health Research Postdoctoral Fellowship. Ms. Nagamatsu is a Michael Smith Foundation for Health Research Scholar and a Natural Science and Engineering Council of Canada trainee.

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Authors and Affiliations

  1. Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Brain Research Centre, Centre for Hip Health and Mobility, VCH Research Institute, The University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    C. L. Hsu & L. S. Nagamatsu

  2. Centre for Clinical Epidemiology and Evaluation, Aging, Mobility, and Cognitive Neuroscience Laboratory, VCH Research Institute, The University of British Columbia, Research Pavilion, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1 M9, Canada

    J. C. Davis

  3. Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    T. Liu-Ambrose

  4. Department of Psychology, UBC is 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada

    L. S. Nagamatsu

Authors
  1. C. L. Hsu
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  2. L. S. Nagamatsu
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  3. J. C. Davis
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  4. T. Liu-Ambrose
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Corresponding author

Correspondence to T. Liu-Ambrose.

Additional information

Lindsay Nagamatsu and C. Liang Hsu are CO-FIRST AUTHORS.

This work was supported by the Canadian Institutes of Health Research (MOB-93373) to TLA.

Appendices

Appendix 1: Search strategy: MEDLINE (OvidSP)

  • 01. *Cognition/or cognition.mp.

  • 02. *Executive function/or executive function.mp.

  • 03. *Accidental falls/or falls.mp.

  • 04. *Attention/or dual task.mp.

  • 05. Limit 1 to (English language and full text and humans and “all aged (65 and over)” and English and humans)

  • 06. Limit 2 to (English language and full text and humans and “all aged (65 and over)” and English and humans)

  • 07. Limit 3 to (English language and full text and humans and “all aged (65 and over)” and English and humans)

  • 08. Limit 4 to (English language and full text and humans and “all aged (65 and over)” and English and humans)

  • 09. 5 and 710. 6 and 7

  • 11. 7 and 8

Appendix 2

Table 3 Details of measures
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Hsu, C.L., Nagamatsu, L.S., Davis, J.C. et al. Examining the relationship between specific cognitive processes and falls risk in older adults: a systematic review. Osteoporos Int 23, 2409–2424 (2012). https://doi.org/10.1007/s00198-012-1992-z

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