Falls and falls efficacy: the role of sustained attention in older adults

Aisling O’Halloran; Pénard, Nils; Galli, Alessandra; Fan, Chie Wei; Robertson, Ian H.; Kenny, Rose Anne · 2011 · OpenAlex-citations

DOI: 10.1186/1471-2318-11-85

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Summary

This study investigates the relationship between sustained attention performance and the risk of falls in older adults, addressing the gap in understanding how specific cognitive deficits contribute to fall risk beyond general executive function declines. The research was motivated by evidence that aging-related changes in attention increase fall risk, yet previous studies often focused on divided attention or populations with overt cognitive impairment. The authors aimed to determine if variability in sustained attention, specifically distinguishing between arousal and vigilance components, serves as a predictor for falls and falls efficacy (confidence in avoiding falls) in community-dwelling adults without dementia. The study utilized a cross-sectional design involving 458 community-dwelling adults aged 60 or older who underwent comprehensive geriatric assessments. Participants completed the Sustained Attention to Response Task (SART), a computerized test measuring reaction time (RT), commission errors, and omission errors. To analyze the temporal characteristics of attention, the researchers applied the Fast Fourier Transform (FFT) procedure to decompose RT variability into slow frequency variability (associated with arousal) and fast frequency variability (FFV, associated with top-down vigilant attention). Data on self-reported falls in the previous twelve months and falls efficacy scores from the Modified Falls Efficacy Scale were also collected. Statistical analyses included logistic regression models controlling for age and gender to identify independent predictors of falling. The results demonstrated that older adults with a history of falls exhibited significantly longer mean reaction times, greater overall RT variability, and higher omission errors on the SART compared to non-fallers. Crucially, logistic regression revealed that increasing FFV was a significant retrospective predictor of falling in the previous year (p < 0.01, OR = 1.14), independent of age and gender. This indicates that fluctuations in vigilant attention are strongly linked to fall history. Additionally, greater RT variability and omission errors were associated with reduced falls efficacy. The study found that recurrent fallers showed the most pronounced deficits in mean RT and omission errors compared to single fallers and non-fallers. While mean RT was also a significant predictor in regression models, FFV emerged as a distinct marker of the vigilance aspect of attention linked to falls. The findings suggest that greater variability in sustained attention, particularly in the vigilant component, is strongly correlated with retrospective falls and moderately with reduced falls efficacy. The authors conclude that sustained attention measures, specifically FFV, may serve as a novel and valuable biomarker for identifying fall risk in older adults. This insight implies that cognitive screening for attentional variability could facilitate early detection of at-risk individuals, potentially allowing for the implementation of targeted preventative interventions to break the cycle of falls and activity restriction.

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• vigilance