Orientation and verbal fluency in the English Longitudinal Study of Ageing: modifiable risk factors for falls?

Smith, Toby O.; Neal, Samuel R.; Peryer, Guy; Sheehan, Katie Jane; Tan, Maw Pin; Myint, Phyo Kyaw · 2018 · OpenAlex-citations

DOI: 10.1017/s1041610218002065

archive: archived pipeline: cataloged verified

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Summary

This study investigates whether specific cognitive domains—memory, executive function, and numeracy skills—are associated with fall risk in older adults, aiming to identify modifiable risk factors for targeted prevention. While global cognitive impairment is known to increase fall risk, the specific cognitive phenotypes driving this association remain unclear. The authors sought to determine if deficits in particular cognitive areas predict falls or recurrent falls in community-dwelling older adults, potentially enabling more precise clinical interventions. The research utilized data from Wave 4 (2008–2009) of the English Longitudinal Study of Ageing (ELSA), a prospective population-based cohort. The final analysis included 5,197 participants with complete data on falls and cognitive assessments. Cognitive function was measured using standardized tasks: orientation in time, word recall (immediate, delayed, and prospective), verbal fluency (naming animals), letter cancellation, and numeracy skills. The primary outcome was self-reported falls in the preceding 12 months, with recurrent falls (two or more) as a secondary outcome. Binomial logistic regression was employed to evaluate associations, using three models: unadjusted (Model A), adjusted for demographics and BMI (Model B), and fully adjusted for demographics, BMI, self-reported hearing, eyesight, and physical performance via the Short Physical Performance Battery (Model C). In the fully adjusted model, no cognitive domain was significantly associated with the occurrence of any fall in the preceding 12 months. However, for recurrent falls, two specific cognitive measures remained significant predictors. Better orientation in time was associated with a 20% lower likelihood of recurrent falls (adjusted odds ratio [OR]: 0.80; 95% CI: 0.65–0.98; p=0.03). Similarly, better verbal fluency was associated with a 2% lower likelihood of recurrent falls (adjusted OR: 0.98; 95% CI: 0.96–1.00; p=0.05). Other cognitive domains, including memory tasks and numeracy, lost statistical significance after adjusting for sensory and physical impairments. The findings suggest that specific cognitive phenotypes, rather than general cognitive impairment, may predict recurrent falls in older adults. Orientation and verbal fluency, which involve temporal awareness and executive processing, appear to be critical for negotiating environmental hazards. The authors conclude that assessing these specific domains could improve falls risk screening in community settings, allowing for earlier identification of high-risk individuals. This approach supports a precision-medicine strategy to reduce the physical and economic burden of recurrent falls, though the authors note limitations regarding self-reported data and the cross-sectional nature of the analysis.

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• cognitive impairment