Abstract
Falls by older adults often result in reduced quality of life and debilitating fear of further falls. Stopping walking when talking (SWWT) is a significant predictor of future falls by older adults and is thought to reflect age-related increases in attentional demands of walking. We examine whether SWWT is associated with use of explicit movement cues during locomotion, and evaluate if conscious control (i.e. movement specific reinvestment) is causally linked to fall-related anxiety during a complex walking task. We observed whether twenty-four older adults stopped walking when talking when asked a question during an adaptive gait task. After certain trials, participants completed a visuospatial recall task regarding walkway features, or answered questions about their movements during the walk. In a subsequent experimental condition, participants completed the walking task under conditions of raised postural threat. Compared to a control group, participants who SWWT reported higher scores for aspects of reinvestment relating to conscious motor processing but not movement self-consciousness. The higher scores for conscious motor processing were preserved when scores representing cognitive function were included as a covariate. There were no group differences in measures of general cognitive function, visuospatial working memory or balance confidence. However, the SWWT group reported higher scores on a test of external awareness when walking, indicating allocation of attention away from task-relevant environmental features. Under conditions of increased threat, participants self-reported significantly greater state anxiety and reinvestment and displayed more accurate responses about their movements during the task. SWWT is not associated solely with age-related cognitive decline or generic increases in age-related attentional demands of walking. SWWT may be caused by competition for phonological resources of working memory associated with consciously processing motor actions and appears to be causally linked with fall-related anxiety and increased vigilance.
Highlights
Falls are a leading cause of injury in older adults, reducing quality of life and increasing the risk of further falls (Rubenstein 2006)
Researchers have previously rationalised stops walking when talking (SWWT) according to so-called age-related shifts in the allocation of generic attentional resources (Ayers et al 2014; Boisgontier et al 2013; Verghese et al 2007, 2008), but our findings suggest that the phenomenon is specific to aspects of working memory engaged in responding to a question when walking
We highlighted an association between SWWT and the self-reported propensity of older adults to consciously control their walking, an association that appears to be independent from levels of general cognitive function
Summary
Falls are a leading cause of injury in older adults, reducing quality of life and increasing the risk of further falls (Rubenstein 2006). The process of observing whether an older adult stops walking when talking (SWWT; LundinOlsson et al 1997) is an efficient, cost-free clinical tool that can predict falls (Beauchet et al 2009). As a result of practice, declarative information is consolidated into procedural knowledge and movement execution becomes more automatic, placing fewer demands on cognitive resources. This progression corresponds with gradual freeing of the degrees of freedom, such that expert performers can exploit the flexibility of the human motor system (Bernstein 1967; Masters and Maxwell 2008). Reinvestment is a term used to describe situations in which individuals who are able to execute a motor task with relative autonomy reinvest cognitive effort in consciously controlling specific aspects of performance that are otherwise carried out subconsciously (often when experiencing high levels of performance anxiety) (Masters and Maxwell 2008)
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