The Impact of Misaligned Perceived and Objective Fall Risk in Cognitively Impaired Older People

Article type: Research Article

Authors: Taylor, Morag E.^{a; b; c; d; 1; *} | Kerckhaert, Luuk^{a; e; 1} | Close, Jacqueline C.T.^{a; f} | van Schooten, Kimberley S.^{a; b; c; 2} | Lord, Stephen R.^{a; b; 2}

Affiliations: [a] Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia | [b] School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia | [c] Ageing Futures Institute, UNSW Sydney, Sydney, Australia | [d] School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia | [e] Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands | [f] School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia

Correspondence: [*] Correspondence to: Dr. Morag Taylor, Neuroscience Research Australia, PO Box 1165, Randwick, NSW, Australia, 2031. Tel.: +61293991885; E-mail: [email protected].

Note: [1] These authors contributed equally to this work.

Note: [2] Shared senior authors.

Abstract: Background:Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. Objective:We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Methods:Participants (n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). Results:The anxious (IRR = 1.70, 95% CI = 1.02–2.84), unaware (IRR = 2.00, 95% CI = 1.22–3.26), and aware (IRR = 2.53, 95% CI = 1.67–3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Conclusions:Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.

Keywords: Accidental falls, aged, Alzheimer’s disease, cognitive dysfunction, dementia, fear of falling, perception, risk factors

DOI: 10.3233/JAD-240489

Journal: Journal of Alzheimer's Disease, vol. 100, no. 4, pp. 1389-1398, 2024