Impaired Standing Balance in Older Adults with Cognitive Impairment after a Severe Fall

Abstract

<b><i>Introduction:</i></b> Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge. <b><i>Methods:</i></b> The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in <i>n</i> = 69 OACH (72.0 ± 8.2 years) and <i>n</i> = 76 OACI (78.7 ± 8.1 years). Data were collected at participants’ homes as part of a comprehensive geriatric assessment in the “SeFallED” study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age. <b><i>Results:</i></b> The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (<inline-formula><mml:math id="m1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.190, <i>p</i> &lt; 0.001) and eyes closed on a balance cushion (<inline-formula><mml:math id="m2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.059, <i>p</i> = 0.029), as well as during tandem stance (<inline-formula><mml:math id="m3" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.034, <i>p</i> = 0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s²) during parallel stance with eyes open (<inline-formula><mml:math id="m4" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.144, <i>p</i> &lt; 0.001) and eyes closed (<inline-formula><mml:math id="m5" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.044, <i>p</i> &lt; 0.027) and for range (m/s²) during tandem (<inline-formula><mml:math id="m6" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.036, <i>p</i> = 0.036) and parallel stance with eyes closed (<inline-formula><mml:math id="m7" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.045, <i>p</i> = 0.032). <b><i>Conclusion:</i></b> Even though both groups have experienced a severe fall with presentation to the ED in the preceding 4 weeks, balance control among OACI indicated a higher fall risk than among OACH. Therefore, effective secondary fall prevention efforts have to be established, particularly for OACI.