Abstract
BackgroundPrevious evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls. The aim of this study was to investigate whether performance and variability in sustained attention is associated with falls and falls efficacy in older adults.Methods458 community-dwelling adults aged ≥ 60 years underwent a comprehensive geriatric assessment. Mean and variability of reaction time (RT), commission errors and omission errors were recorded during a fixed version of the Sustained Attention to Response Task (SART). RT variability was decomposed using the Fast Fourier Transform (FFT) procedure, to help characterise variability associated with the arousal and vigilance aspects of sustained attention.The number of self-reported falls in the previous twelve months, and falls efficacy (Modified Falls Efficacy Scale) were also recorded.ResultsSignificant increases in the mean and variability of reaction time on the SART were significantly associated with both falls (p < 0.01) and reduced falls efficacy (p < 0.05) in older adults. An increase in omission errors was also associated with falls (p < 0.01) and reduced falls efficacy (p < 0.05). Upon controlling for age and gender affects, logistic regression modelling revealed that increasing variability associated with the vigilance (top-down) aspect of sustained attention was a retrospective predictor of falling (p < 0.01, OR = 1.14, 95% CI: 1.03 - 1.26) in the previous year and was weakly correlated with reduced falls efficacy in non-fallers (p = 0.07).ConclusionsGreater variability in sustained attention is strongly correlated with retrospective falls and to a lesser degree with reduced falls efficacy. This cognitive measure may provide a novel and valuable biomarker for falls in older adults, potentially allowing for early detection and the implementation of preventative intervention strategies.
Highlights
Previous evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls
There was a significant difference in mean reaction time (RT) (t(456) = 4.40, p < 0.001), SDRT (t(456) = 2.74, p = 0.006), fast frequency variability (FFV) (t (382) = 3.10, p = 0.002) and omission errors (t(456) = 2.55, p = 0.011) between fallers and non-fallers
Even when the group which were excluded from the Fast Fourier Transform (FFT) analysis (n = 74) were removed for the analysis of the traditional Sustained Attention to Response Task (SART) measures significant differences remained between fallers (n = 157) and non-fallers (n = 227) for mean reaction time (mean RT) (396 versus 370 ms, p = 0.007), SDRT (161 versus 138, p = 0.009) and omission errors (10.5 versus 8.5, p < 0.014) but not commission errors
Summary
Previous evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls. Older people often voluntarily restrict their activity fearing a reoccurrence This reduction in exercise leads to further weakness that in turn increases the risk of another fall – a vicious cycle [3]. Low falls-related self efficacy (loss of one’s confidence to perform activities of daily living without falling) and fear of falling are significant psychological consequences of having fallen [7]. While low falls efficacy and fear of falling were traditionally considered interchangeable concepts, more recent evidence indicates that they are correlated but distinct dimensions [3,8,9]. Fear of falling has been reported in older people who have not fallen suggesting that factors other than falls history may influence the manifestation of fear of falling among older people [12,16]
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