Functional Cognition Part 2: Falls in the Elderly

1. Falls in the Elderly: Cognitive Impact on Safety

Falling is not a normal part of aging, but the elevated incidence and prevalence of falling highlights a significant problem in the older adult population. Understanding the demographics of the older adult population at risk, where falling most often occurs, how people fall, and the devastating consequences of falling are important considerations for the therapist treating the older adult.

2. Factors Related to Fall: Physical, Functional, Medical & Environmental

For the treating therapist, it is paramount to understand that the causes of falling are often multifactorial, with intrinsic and extrinsic risk factors playing critical roles in exposing the older adult to higher fall risk. Understanding these factors--as well as the age-related physiologic changes associated with falling, the impact of disease states on balance, the importance of nutrition for mitigating fall risk, the role of medications and polypharmacy in increased fall risk, and how the environment elevates fall potential--is important when comprehensively treating the older adult. Using screening tools that require patient self-assessment, as well as clinic balance and mobility testing, helps to better define the problem of fall risk and ultimately provides the therapist with the means to address this complex problem.

3. Cognitive Factors in Falls in the Elderly

Cognition is an often overlooked intrinsic factor that has significant relevance in mitigating fall risk. The older adult with impaired cognition is at higher risk for falling, although in the clinic as well as in the research, this is often overlooked when stratifying fall risk. Understanding the contribution of higher cognitive function such as awareness, executive function, and meta-cognitive skill, and how impairment in these areas have implications for safety and quality of life for the older adult, is very important.