Abstract
BackgroundUnderstanding falls risk in advanced age is critical with people over 80 a rapidly growing demographic. Slow gait and cognitive complaint are established risk factors and together comprise the Motoric Cognitive Risk Syndrome (MCR). This study examined trajectories of gait and cognition and their association with falls over 5 years, and documented MCR in Māori and non-Māori of advanced age living in New Zealand.MethodFalls frequency was ascertained retrospectively at annual assessments. 3 m gait speed was measured and cognition was assessed using the Modified Mini-Mental Status Examination (3MS). Frequency of MCR was reported. Gait and cognition trajectories were modelled and clusters identified from Latent Class Analysis. Generalised linear models examined association between changes in gait, cognition, MCR and falls.ResultsAt baseline, 138 of 408 Māori (34%) and 205 of 512 non-Māori (40%) had fallen. Mean (SD) gait speed (m/s) for Māori was 0.66 (0.29) and 0.82 (0.26) for non-Māori. Respective 3MS scores were 86.2 (15.6) and 91.6 (10.4). Ten (4.3%) Maori participants met MCR criteria, compared with 7 (1.9%) non-Māori participants. Māori men were more likely to fall (OR 1.56; 95% CI 1.0–2.43 (P = 0.04) whilst for non-Māori slow gait increased falls risk (OR 0.40; 95% CI 0.24–0.68(P < 0.001). Non-Māori with MCR were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06–5.68 (P = 0.03).ConclusionsMāori and non-Māori of advanced age show a mostly stable pattern of gait and cognition over time. Risk factors for falls differ for Māori, and do not include gait and cognition.
Highlights
Falls in older people are burdensome and their impact is far-reaching
Māori men were more likely to fall (OR 1.56; 95% CI 1.0–2.43 (P = 0.04) whilst for non-Māori slow gait increased falls risk (OR 0.40; 95% CI 0.24– 0.68(P < 0.001)
Non-Māori with Motoric Cognitive Risk Syndrome (MCR) were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06–5.68 (P = 0.03)
Summary
Falls in older people are burdensome and their impact is far-reaching. The effect of even a sporadic fall can be significant, especially for adults of advanced age. Falls are the third most common cause of accidental injuryrelated death globally, and the dominant cause of injuryrelated disability-adjusted life years (DALY) in older people [1]. Compounding this issue is the rapid demographic change with the number of adults aged 80 years and over projected to triple by 2050, rising globally from 137 million in 2017 to 425 million [2]. This age group is most vulnerable to the effect of falls. This study examined trajectories of gait and cognition and their association with falls over 5 years, and documented MCR in Māori and non-Māori of advanced age living in New Zealand
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