Abstract
BackgroundCognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2–3 times more than cognitively healthy older adults and 60–80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community.MethodsWe conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings.ResultsFive hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [− 1.10, − 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [− 0.94, − 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls.ConclusionThe effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.
Highlights
Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control
Cognitive impairment is often due to neurodegenerative diseases that are associated with advancing age, but it can occur due to head trauma, stroke, or other diseases and affect those at any age [7]
While we had strict definitions and criteria for inclusion of studies based on population, we found a broad range of participants in terms of how they were classified and diagnosed and the tools and cut-off scores that were used to characterize mild and moderate cognitive impairment
Summary
Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Falls affect more than 30% of the adult population aged 65 years and older [1] and can result in negative health outcomes and severe injuries such as traumatic brain injuries and even death [2]. Mild cognitive impairment (MCI) is an intermediate clinical state between normal cognitive aging and dementia, and it precedes and leads to dementia in many cases [6, 7]. It is defined by subjective cognitive complaints and measurable cognitive decline in the absence of interference with daily function that is not due to age [8]. Cognitive impairment is often due to neurodegenerative diseases that are associated with advancing age, but it can occur due to head trauma, stroke, or other diseases and affect those at any age [7]
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