Stepping Out: A Pilot Program to Reduce Falls Risk in People with Mild Cognitive Impairment

Abstract

Cognitive impairment significantly increases the risk of accidental falls in older adults, and falls outcomes are more severe in this population. However, few interventions exist to reduce falls among individuals with cognitive impairment. To address this gap, we developed Stepping Out, by modifying the evidenced-based falls prevention program, Stepping On, tailoring it to meet the cognitive needs of individuals with mild cognitive impairment (MCI) who are at risk for falls. Our objectives were to determine whether incorporating specific teaching and learning strategies among people with MCI would be associated with program feasibility as well as with positive trends in reducing fall risk. 16 older veterans with MCI at risk for falls (mean age 77.5, SD 6.75) participated in Stepping Out. The intervention comprised a group program, each with four veterans and their partners, conducted in two-hour weekly sessions for seven weeks, with a follow-up phone call and subsequent booster session. Teaching and learning adaptations for cognitive impairment included cognitive and compensatory strategies, addition of a partner, increased incorporation of procedural memory, and use of principles of self-determination theory to enhance motivation. Pre-post measures included physical measures of balance and mobility and self-reported falls. The program was found to be feasible for participants, as measured by an attendance rate of 95%. While no change was exhibited on balance or mobility tasks, participants displayed a significant reduction in falls over a six-month period (median change 2.00 falls, range 0-12 falls, p=0.002). The findings of this feasibility and pilot study support the notion that individuals with MCI can benefit from specific teaching and learning techniques incorporated into a multifactorial, cognitively-based program to reduce falls risk. Stepping Out has potential for further investigation with a randomized control group to assess efficacy.