Longitudinal Analysis of Physical Performance, Functional Status, Physical Activity, and Mood in Relation to Executive Function in Older Adults Who Fall

Best, John R.; Davis, Jennifer C.; Teresa Liu‐Ambrose · 2015 · OpenAlex-citations

DOI: 10.1111/jgs.13444

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Summary

This study investigates whether executive function (EF) serves as a marker of resiliency against functional decline in older adults who have experienced falls. While older fallers are at high risk for deterioration in physical performance, functional status, physical activity, and mood within 1–3 years, not all individuals decline. The authors hypothesized that EF, which governs goal-oriented and controlled behavior, might underlie this individual variation in resiliency. The research aimed to determine if baseline EF and its maintenance over time predict stability in these non-cognitive domains, and conversely, if baseline functioning in these domains predicts changes in EF. The researchers conducted a 12-month prospective cohort study involving 199 community-dwelling older adults (mean age 81.6; 63% female) referred to the Vancouver Falls Prevention Clinic after a non-syncopal fall. Participants were assessed at baseline and one-year follow-up. EF was measured using five tasks (Stroop Test, Trail Making Test, Backward Digit Span, Verbal Fluency, and Digit Symbol Substitution Test). Structural equation modeling (SEM) was employed to create a latent EF variable, ensuring that associations reflected the underlying cognitive construct rather than task-specific variations. Non-cognitive domains included physiological falls risk, gait speed, instrumental activities of daily living (IADLs), physical activity (IPAQ), and depressive symptoms (GDS). Analyses controlled for demographic characteristics and global cognitive function. Results indicated that higher baseline EF predicted reductions in depressive symptoms and maintenance of IADL performance over the one-year period. Furthermore, improvements in EF were significantly correlated with increases in gait speed and physical activity, as well as the maintenance of IADLs. These associations were independent of demographic factors and global cognition. Crucially, baseline performance in the non-cognitive domains did not predict changes in EF, suggesting a unidirectional relationship where EF influences, rather than is influenced by, these physical and functional outcomes. Group-level analysis showed significant decline only in IADLs, while other domains remained stable at the group level but varied significantly at the individual level. The study concludes that EF is a significant marker for resiliency in physical performance, functional status, physical activity, and mood among older fallers. The findings suggest that EF deficits may precede or co-occur with decline in these domains, particularly affecting independence in daily activities. Clinically, this implies that EF should be routinely assessed in older fallers to identify those at risk for deterioration. The authors recommend testing interventions that target EF, such as structured exercise programs or cognitive training, to potentially improve or maintain functional independence and mood in this vulnerable population.

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• cognitive impairment