What Tools Can We Use to Screen for Fall Risk in Older Patients with Mild Cognitive Impairment? Findings from the MEMENTO Cohort
Journal of the American Medical Directors Association
J Am Med Dir Assoc. 2023 Jul;24(7):1028-1034.e18. doi: 10.1016/j.jamda.2022.12.020. Epub 2023 Jan 19.
ABSTRACT
OBJECTIVES: Identifying risk factors for falls can improve outcomes in older patients without cognitive decline. Yet this has not been demonstrated in older people with mild cognitive impairment (MCI). We therefore sought to better identify risk factors for falls in this particular group.
DESIGN: The analysis was conducted on the MEMENTO cohort, which is a large, French, prospective cohort.
SETTING AND PARTICIPANTS: We included older people (>65 years old) with MCI (defined from neuropsychological scores) and a Short Physical Performance Battery (SPPB) score at baseline.
METHODS: Fallers were defined as participants having fallen at least once during the study's 2-year follow-up period. We compared clinical, neuropsychological, and biological data at baseline in fallers vs nonfallers. Additional analyses were performed on the following subgroups: women, men, people aged ≥75 years.
RESULTS: Of the 1416 people included in our study, 194 (13.5%) fell at least once. A bivariate analysis showed that fallers were older, predominantly women, less independent in activities of daily living, and more apathetic. Fallers performed less well in executive function, balance, and gait tests. In a multivariable analysis, only age, gender, the number of limitations in instrumental activities of daily living, and living alone were significantly associated with falls. In a multivariable analysis of the subgroup of oldest patients and of the subgroup of men, executive function was significantly worse in fallers than in nonfallers.
CONCLUSION AND IMPLICATIONS: Our results demonstrate that easily attainable risk factors can be used to identify individuals with MCI with a higher risk of falls and for whom prevention could be beneficial. Future studies are needed to further evaluate the role of mild executive dysfunction in certain subgroups, such as men and oldest patients.
