Restricted accessResearch articleFirst published online 2023-2
Prevalence,risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis
To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment.
Data sources
Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library.
Review methods
All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures.
Results
Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnestic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found.
Conclusions
Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.
BrowningCKendigHO’LoughlinK. Ageing in Australia: challenges and opportunities. New York, NY: Springer New York, 2016.
2.
Montero-OdassoMCamicioliR (eds). Falls and cognition in older persons: fundamentals, assessment and therapeutic options. 1st ed. Cham: Springer International Publishing, 2020.
GanguliMSnitzBSaxtonJ, et al.Outcomes of mild cognitive impairment depend on definition: a population study. Arch Neurol2011; 68: 761–767.
5.
PetersenR. Mild cognitive impairment. N Engl J Med2011; 364: 2227–2234.
6.
SchepkerCLeveilleSPedersenM, et al.Effect of pain and mild cognitive impairment on mobility. J Am Geriatr Soc2016; 64: 138–143.
7.
HarveyLTosonBBrodatyH, et al.Injury-related hospitalisation in community-dwelling older people across the cognitive spectrum: a population based study. Arch Gerontol Geriatr2019; 83: 155–160.
8.
SpeechleyM. Unintentional falls in older adults: a methodological historical review. Can J Aging2011; 30: 21–32.
9.
SheridanPHausdorffJ. The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer’s disease. Dement Geriatr Cogn Disord2007; 24: 125–137.
10.
KearneyFHarwoodRGladmanJ,et al.The relationship between executive function and falls and gait abnormalities in older adults: a systematic review. Dement Geriatr Cogn Disord2013; 36: 20–35.
11.
SherringtonCFairhallNWallbankG, et al.Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med2020; 54: 885–891.
12.
BoothVHoodVKearneyF. Interventions incorporating physical and cognitive elements to reduce falls risk in cognitively impaired older adults: a systematic review. JBI Database Syst Rev Implement Rep2016; 14: 110–135.
13.
BurtonECavalheriVAdamsR, et al.Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clin Interv Aging2015; 10: 421–434.
14.
BahureksaLNajafiBSalehA, et al.The impact of mild cognitive impairment on gait and balance: a systematic review and meta-analysis of studies using instrumented assessment. Gerontology2017; 63: 67–83.
15.
FarhangMMiranda-CastilloCRubioM,et al.Impact of mind-body interventions in older adults with mild cognitive impairment: a systematic review. Int Psychogeriatr2019; 31: 643–666.
16.
RaceyMMarkle-ReidMFitzpatrick-LewisD, et al.Fall prevention in community-dwelling adults with mild to moderate cognitive impairment: a systematic review and meta-analysis. BMC Geriatr2021; 21: 689.
17.
Mai BaHKimJ. The effects of combined physical and cognitive interventions on direct and indirect fall outcomes for the elderly with mild cognitive impairment: a systematic review. Healthcare (Basel)2022; 10: 862.
18.
NakahataNNakamuraTKawarabayashiT, et al.Age-Related cognitive decline and prevalence of mild cognitive impairment in the Iwaki health promotion project. J Alzheimers Dis2021; 84: 1233–1245.
19.
PageMMcKenzieJBossuytP, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J2021; 372: n71.
20.
HigginsJAltmanDGøtzscheP, et al.The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J2011; 343: d5928.
21.
KmetLLeeRCookL. Standard quality assessment criteria for evaluating primary research papers from a variety of fields: Alberta Heritage Foundation for Medical Research; 2004.
22.
DerSimonianRLairdN. Meta-analysis in clinical trials. Control Clin Trials1986; 7: 177–188.
AnsaiJAndradeLMasseF, et al.Risk factors for falls in older adults with mild cognitive impairment and mild Alzheimer disease. J Geriatr Phys Ther2019; 42: E116–E121.
25.
AnsaiJAndradeLNakagawaT,et al.Performances on the timed up and go test and subtasks between fallers and non-fallers in older adults with cognitive impairment. Arq Neuropsiquiatr2018; 76: 381–386.
26.
AnsaiJVassimon-BarrosoVSilva-FarcheA,et al.Accuracy of mobility tests for screening the risk of falls in patients with mild cognitive impairment and Alzheimer’s disease. Fisioterapia e Pesquisa2019; 26: 258–264.
27.
GonçalvesJAnsaiJMasseF,et al.Dual-task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer’s disease: a prospective cohort study. Braz J Phys Ther2018; 22: 417–423.
28.
AnsaiJAndradeLRossiP,et al.Gait, dual-task and history of falls in elderly with preserved cognition, mild cognitive impairment, and mild Alzheimer’s disease. Braz J Phys Ther2017; 21: 144–151.
29.
Del DinSGalnaBLordS, et al.Falls risk in relation to activity exposure in high-risk older adults. J Gerontol A Biol Sci Med Sci2020; 75: 1198–1205.
30.
MirelmanARochesterLMaidanI, et al.Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet2016; 388: 1170–1182.
31.
BunceDHaynesBLordS, et al.Intraindividual stepping reaction time variability predicts falls in older adults with mild cognitive impairment. J Gerontol A Biol Sci Med Sci2017; 72: 832–837.
32.
ChantanachaiTTaylorMELordSR, et al.Risk factors for falls in community-dwelling older people with mild cognitive impairment: a prospective one-year study. PeerJ (San Francisco, CA)2022; 10: e13484.
33.
Montero-OdassoMSpeechleyMChertkowH, et al.Donepezil for gait and falls in mild cognitive impairment: a randomized controlled trial. Eur J Neurol2019; 26: 651–659.
34.
HsuBBleicherKWaiteL, et al.Community-dwelling older men with dementia are at high risk of hip fracture, but not any other fracture: the concord health and aging in men project. Geriatr Gerontol Int2018; 18: 1479–1484.
35.
LipardoDTsangW. Effects of combined physical and cognitive training on fall prevention and risk reduction in older persons with mild cognitive impairment: a randomized controlled study. Clin Rehabil2020; 34: 773–782.
36.
MakizakoHShimadaHDoiT, et al.Poor balance and lower gray matter volume predict falls in older adults with mild cognitive impairment. BMC Neurol2013; 13: 1–8.
37.
NaharciMKatipogluBVeiziB,et al.Gait speed is independently associated with depression symptoms in mild cognitive impairment. Aging Neuropsychol Cogn2021; 29: 637–650.
38.
OnenFHenry-FeugeasMRoyC,et al.Mobility decline of unknown origin in mild cognitive impairment: an MRI-based clinical study of the pathogenesis. Brain Res2008; 1222: 79–86.
39.
Pieruccini-FariaFSarquis-AdamsonYAnton-RodrigoI, , et al.Mapping associations between gait decline and fall risk in mild cognitive impairment. J Am Geriatr Soc2020; 68: 576–584.
40.
SchwenkMSabbaghMLinI, et al.Sensor-based balance training with motion feedback in people with mild cognitive impairment. J Rehabil Res Dev2016; 53: 945–958.
41.
SnirJBarthaRMontero-OdassoM. White matter integrity is associated with gait impairment and falls in mild cognitive impairment. Results from the gait and brain study. NeuroImage Clin2019; 24: 101975.
42.
SungkaratSBoripuntakulSChattipakornN,et al.Effects of Tai Chi on cognition and fall risk in older adults with mild cognitive impairment: a randomized controlled trial. J Am Geriatr Soc2017; 65: 721–727.
43.
UemuraKHasegawaTTougouH,et al.Analysis of choice stepping with visual interference can detect prolonged postural preparation in older adults with mild cognitive impairment at high risk of falling. Dement Geriatr Cogn Disord2015; 40: 13–21.
44.
LiFHarmerPVoitJ,et al.Implementing an online virtual falls prevention intervention during a public health pandemic for older adults with mild cognitive impairment: a feasibility trial. Clin Interv Aging2021; 16: 973–983.
45.
HagovskáMOlekszyováZ. Impact of the combination of cognitive and balance training on gait, fear and risk of falling and quality of life in seniors with mild cognitive impairment. Geriatr Gerontol Int2016; 16: 1043–1050.
46.
LinY-FLiuMFHoM-H, et al.A pilot study of interactive-video games in people with mild cognitive impairment. Int J Environ Res Public Health2022; 19: 3536.
47.
Liu-AmbroseTAsheMGrafP,et al.Increased risk of falling in older community-dwelling women with mild cognitive impairment. Phys Ther2008; 88: 1482–1491.
48.
AllaliGLaunayCBlumenH, et al.Falls, cognitive impairment, and gait performance: results from the GOOD initiative. J Am Med Dir Assoc2017; 18: 335–340.
49.
BeauchetOLaunayCAnnweilerC,et al.Hippocampal volume, early cognitive decline and gait variability: which association?Exp Gerontol2015; 61: 98–104.
50.
BlackwoodJShubertTForgartyK,et al.Relationships between performance on assessments of executive function and fall risk screening measures in community-dwelling older adults. J Geriatr Phys Ther2016; 39: 89–96.
51.
BorgesSRadanovicMForlenzaO. Fear of falling and falls in older adults with mild cognitive impairment and Alzheimer’s disease. Aging Neuropsychol Cogn2015; 22: 312–321.
52.
DoiTShimadaHParkH, et al.Cognitive function and falling among older adults with mild cognitive impairment and slow gait. Geriatr Gerontol Int2015; 15: 1073–1078.
53.
HiraseTMakizakoHOkuboY, et al.Falls in community-dwelling older adults with lower back or knee pain are associated with cognitive and emotional factors. Int J Environ Res Public Health2020; 17: 4960.
54.
KumaiKKumaiMTakadaJ,et al.Decreased time on the nondominant one-leg standing test associated with repeated falls in older residents with healthy aging, mild cognitive impairment, and dementia: the Wakuya project. Dement Geriatr Cogn Dis Extra2021; 11: 122–128.
55.
Le FlochMAliPAsfarM,et al.Volumetric Brain Changes in Older Fallers: A Voxel-Based Morphometric Study. Front Bioeng Biotechnol2021; 9. DOI: 10.3389/fbioe.2021.610426.
56.
MacAulayRBoeveAD’ErricoL,et al.Slower gait speed increases risk of falling in older adults with depression and cognitive complaints. Psychol Health Med2021; 27: 1576–1581.
57.
MignardotJBeauchetOAnnweilerC,et al.Postural sway, falls, and cognitive status: a cross-sectional study among older adults. J Alzheimers Dis2014; 41: 431–439.
58.
O’ConnellMDal Bello-HaasVCrossleyM,et al.Clinical correlates of awareness for balance, function, and memory: evidence for the modality specificity of awareness. J Aging Res2014; 2014: 1–12.
59.
UemuraKShimadaHMakizakoH, et al.Effects of mild and global cognitive impairment on the prevalence of fear of falling in community-dwelling older adults. Maturitas2014; 78: 62–66.
60.
WeiEOhEHarunA,et al.Saccular impairment in Alzheimer’s disease is associated with driving difficulty. Dement Geriatr Cogn Disord2017; 44: 294–302.
61.
da SilvaAAnsaiJCezarN,et al.Outcomes and interventions in the elderly with and without cognitive impairment: a longitudinal study. Dementia Neuropsychol2020; 14: 394–402.
62.
DavisJBestJHsuC,et al.Examining the effect of the relationship between falls and mild cognitive impairment on mobility and executive functions in community-dwelling older adults. J Am Geriatr Soc2015; 63: 590–593.
63.
DavisJDianLKhanK, et al.Cognitive status is a determinant of health resource utilization among individuals with a history of falls: a 12-month prospective cohort study. Osteoporos Int2016; 27: 943–951.
64.
DelbaereKKochanNCloseJ, et al.Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry2012; 20: 845–853.
65.
DelgadoNHernandezDRadlerK,et al.Mild cognitive impairment, dementia and risk of mortality in essential tremor: a longitudinal prospective study of elders. J Neurol Sci2021; 428: 117563.
66.
HarperKRileyVPettaA,et al.Occupational therapist use of the ‘Timed Up and Go’ test in a memory clinic to compare performance between cognitive diagnoses and screen for falls risk. Aust Occup Ther J2020; 67: 13–21.
67.
KangMLeeIHongH,et al.Predictors of changes in cognitive function in older Korean adults: the 2006-2018 Korean longitudinal study of aging. Int J Environ Res Public Health2021; 18: 6345.
68.
UemuraKShimadaHMakizakoH, et al.Effects of mild cognitive impairment on the development of fear of falling in older adults: a prospective cohort study. J Am Med Dir Assoc2015; 16: 1104.e9–1104.e13.
69.
ChulakadabbaKMuangpaisanWSiritipakornP, et al.Characteristics and real-life outcomes of dementia and cognitive impairment at a geriatric clinic. Dement Geriatr Cogn Disord2020; 49: 312–320.
70.
ShubertTChokshiAMendesV, et al.Stand Tall—a virtual translation of the Otago Exercise Program. J Geriatr Phys Ther2020; 43: 120–127.
71.
TrompAPluijmSSmitJ,et al.Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol2001; 54: 837–844.
72.
AllanLBallardCRowanE,et al.Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One2009; 4: e5521.
73.
GriffinJLallRBruceJ, et al.Comparison of alternative falls data collection methods in the prevention of falls injury trial (PreFIT). J Clin Epidemiol2019; 106: 32–40.
74.
LambSEJørstad-SteinECHauerK,et al.Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc2005; 53: 1618–1622.
75.
BennettIGolobEParkerE,et al.Memory evaluation in mild cognitive impairment using recall and recognition tests. J Clin Exp Neuropsychol2006; 28: 1408–1422.
76.
ChenYLiangNLiX,et al.Diagnosis and treatment for mild cognitive impairment: a systematic review of clinical practice guidelines and consensus statements. Front Neurol2021; 12. DOI: 10.3389/fneur.2021.719849.
77.
LautenschlagerNCoxKHillKD, et al. Physical activity guidelines for older Australians with mild cognitive impairment or subjective cognitive decline. Melbourne: Dementia Collaborative Research Centres; [cited 10 August]. https://medicine.unimelb.edu.au/__data/assets/pdf_file/0008/2672846/PAG.pdf (2018).
78.
PiercyKTroianoRBallardR, et al.The physical activity guidelines for Americans. J Am Med Assoc2018; 320: 2020–2028.
79.
BurtonEHillKEllisKA, et al.Balance on the brain: a randomised controlled trial evaluating the effect of a multimodal exercise programme on physical performance, falls, quality of life and cognition for people with mild cognitive impairment—study protocol. BMJ Open2022; 12: e054725.
80.
von HippelP. The heterogeneity statistic I2 can be biased in small meta-analyses. BioMed Central Med Res Methodol2015; 15: 35.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
