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The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults

BACKGROUND: Cognitive impairment has been reported to be associated with falls in older adults. However, the complex relationship among falls, cognitive impairment and its associated factors, which could be targeted with specific interventions, remains to be elucidated. This study aimed to examine t...

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Autores principales: Zhang, Tianyi, Yang, Cunmei, Shu, Gangming, Gao, Chang, Ma, Hongying, Zou, Lin, Zuo, Jing, Liu, Shaoni, Yan, Jin, Hu, Yixin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285398/
https://www.ncbi.nlm.nih.gov/pubmed/37359023
http://dx.doi.org/10.3389/fmed.2023.1190831
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author Zhang, Tianyi
Yang, Cunmei
Shu, Gangming
Gao, Chang
Ma, Hongying
Zou, Lin
Zuo, Jing
Liu, Shaoni
Yan, Jin
Hu, Yixin
author_facet Zhang, Tianyi
Yang, Cunmei
Shu, Gangming
Gao, Chang
Ma, Hongying
Zou, Lin
Zuo, Jing
Liu, Shaoni
Yan, Jin
Hu, Yixin
author_sort Zhang, Tianyi
collection PubMed
description BACKGROUND: Cognitive impairment has been reported to be associated with falls in older adults. However, the complex relationship among falls, cognitive impairment and its associated factors, which could be targeted with specific interventions, remains to be elucidated. This study aimed to examine the direct effects of cognitive impairment on falls, to identify the factors associated with cognitive impairment and to explore the mediation role of cognitive impairment in the association of fall with cognition related factors. METHODS: This 1-year follow-up cohort study enrolled old adults aged 60  years or over. Information about demographic and anthropometric characteristics, fall outcomes, function and nutritional status were collected through face-to-face interview. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Multivariable regression analyses were used to test the association between cognitive impairment and falls and to identify the factors related to cognitive impairment. Additionally, we conduct causal mediation analyses to estimate the mediation effects of cognitive impairment in the pathways of fall occurrence. RESULTS: Of the 569 participants included in this study, 366 (64.32%) had cognitive impairment, 96 (16.87%) had fall history in the past 1  year, 81 (14.24%) experienced fall and 47 (8.26%) received treatment because of falling during the 1-year follow-up. The association between cognitive impairment and 1-year fall risk was confirmed after adjusting for multiple covariates [odds ratio (OR):2.03, 95% confidence interval (CI): 1.13–3.80]. IADL disability, depression and low grip strength were associated with a higher prevalence of cognitive impairment. While overweight, higher education and higher income level were found to be related to a lower risk of cognitive impairment. Among these associated factors, cognitive impairment mediated the positive association of falling with IADL ability and depression, and a negative relationship with education and income level. CONCLUSION: Our study not only confirmed the direct influence of cognitive impairment on fall risk in older adults, but also suggested a mediating role that cognitive impairment played in the pathways of fall occurrence. Our finding could help develop more specific interventions for fall prevention.
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spelling pubmed-102853982023-06-23 The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults Zhang, Tianyi Yang, Cunmei Shu, Gangming Gao, Chang Ma, Hongying Zou, Lin Zuo, Jing Liu, Shaoni Yan, Jin Hu, Yixin Front Med (Lausanne) Medicine BACKGROUND: Cognitive impairment has been reported to be associated with falls in older adults. However, the complex relationship among falls, cognitive impairment and its associated factors, which could be targeted with specific interventions, remains to be elucidated. This study aimed to examine the direct effects of cognitive impairment on falls, to identify the factors associated with cognitive impairment and to explore the mediation role of cognitive impairment in the association of fall with cognition related factors. METHODS: This 1-year follow-up cohort study enrolled old adults aged 60  years or over. Information about demographic and anthropometric characteristics, fall outcomes, function and nutritional status were collected through face-to-face interview. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Multivariable regression analyses were used to test the association between cognitive impairment and falls and to identify the factors related to cognitive impairment. Additionally, we conduct causal mediation analyses to estimate the mediation effects of cognitive impairment in the pathways of fall occurrence. RESULTS: Of the 569 participants included in this study, 366 (64.32%) had cognitive impairment, 96 (16.87%) had fall history in the past 1  year, 81 (14.24%) experienced fall and 47 (8.26%) received treatment because of falling during the 1-year follow-up. The association between cognitive impairment and 1-year fall risk was confirmed after adjusting for multiple covariates [odds ratio (OR):2.03, 95% confidence interval (CI): 1.13–3.80]. IADL disability, depression and low grip strength were associated with a higher prevalence of cognitive impairment. While overweight, higher education and higher income level were found to be related to a lower risk of cognitive impairment. Among these associated factors, cognitive impairment mediated the positive association of falling with IADL ability and depression, and a negative relationship with education and income level. CONCLUSION: Our study not only confirmed the direct influence of cognitive impairment on fall risk in older adults, but also suggested a mediating role that cognitive impairment played in the pathways of fall occurrence. Our finding could help develop more specific interventions for fall prevention. Frontiers Media S.A. 2023-06-08 /pmc/articles/PMC10285398/ /pubmed/37359023 http://dx.doi.org/10.3389/fmed.2023.1190831 Text en Copyright © 2023 Zhang, Yang, Shu, Gao, Ma, Zou, Zuo, Liu, Yan and Hu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Zhang, Tianyi
Yang, Cunmei
Shu, Gangming
Gao, Chang
Ma, Hongying
Zou, Lin
Zuo, Jing
Liu, Shaoni
Yan, Jin
Hu, Yixin
The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults
title The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults
title_full The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults
title_fullStr The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults
title_full_unstemmed The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults
title_short The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults
title_sort direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285398/
https://www.ncbi.nlm.nih.gov/pubmed/37359023
http://dx.doi.org/10.3389/fmed.2023.1190831
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