Executive function and prospective falls: a 6-year longitudinal study in community-dwelling older adults
Cindi Smith, Laurence Seematter‐Bagnoud, Brigitte Santos‐Eggimann, Hélène Krief, Christophe Büla
Abstract
Abstract Background Older people with impaired executive function (EF) might have an increased fall risk, but prospective studies with prolonged follow-up are scarce. This study aimed to investigate the association between a) EF at baseline; b) 6-year decline in EF performance; and fall status 6 years later. Methods Participants were 906 community-dwelling adults aged 65–69 years, enrolled in the Lausanne 65 + cohort. EF was measured at baseline and at 6 years using clock drawing test (CDT), verbal fluency (VF), Trail Making Test (TMT) A and B, and TMT ratio (TMT-B – TMT-A/TMT-A). EF decline was defined as clinically meaningful poorer performance at 6 years. Falls data were collected at 6 years using monthly calendars over 12 months. Results Over 12-month follow-up, 13.0% of participants reported a single benign fall, and 20.2% serious (i.e., multiple and/or injurious) falls. In multivariable analysis, participants with worse TMT-B performance (adjusted Relative Risk Ratio, adjRRR TMT-B worst quintile = 0.38, 95%CI:0.19–0.75, p = .006) and worse TMT ratio (adjRRR TMT ratio worst quintile = 0.31, 95%CI:0.15–0.64, p = .001) were less likely to report a benign fall, whereas no significant association was observed with serious falls. In a subgroup analysis among fallers, participants with worse TMT-B (OR:1.86, 95%CI = 0.98–3.53, p = .059) and worse TMT ratio (OR:1.84,95%CI = 0.98–3.43, p = .057) tended to have higher odds of serious falls. EF decline was not associated to higher odds of falls. Conclusions Participants with worse EF were less likely to report a single benign fall at follow-up, while fallers with worse EF tended to report multiple and/or injurious falls more frequently. Future studies should investigate the role of slight EF impairment in provoking serious falls in active young-old adults.