Skip to main content

Advertisement

SpringerLink
Log in

Cognitive status is a determinant of health resource utilization among individuals with a history of falls: a 12-month prospective cohort study

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Falls are a costly public health problem worldwide. The literature is devoid of prospective data that identifies factors among fallers that significantly drive health care resource utilization. We found that cognitive function—specifically, executive functions—and cognitive status are significant determinants of health resource utilization among older fallers.

Introduction

Although falls are costly, there are no prospective data examining factors among fallers that drive health care resource utilization. We identified key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with a history of falls. Specifically, with the increasing recognition that cognitive impairment is associated with increased falls risk, we investigated cognition as a potential driver of health resource utilization.

Methods

This 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 319) included participants with a history of at least one fall in the previous 12 months. Based on their cognitive status, participants were divided into two groups: (1) no mild cognitive impairment (MCI) and (2) MCI. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, global cognition, executive functions, and cognitive status (MCI versus no MCI) were examined. Age, sex, comorbidities, depression status, and activities of daily living were included regardless of statistical significance.

Results

Global cognition, comorbidities, working memory, and cognitive status (MCI versus no MCI ascertained using the Montreal Cognitive Assessment (MoCA)) were significant determinants of total HRU at 6 months. The number of medical comorbidities and global cognition were significant determinants of total HRU at 12 months.

Conclusion

MCI status was a determinant of HRU at 6 months among older adults with a history of falls. As such, efforts to minimize health care resource use related to falls, it is important to tailor future interventions to be effective for people with MCI who fall.

Trial registration

ClinicalTrials.gov Identifier: NCT01022866.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22(3):465–475

    Article  PubMed  Google Scholar 

  2. Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284

    Article  CAS  PubMed  Google Scholar 

  3. Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12(4):271–278

    Article  CAS  PubMed  Google Scholar 

  4. Towne SD Jr, Ory MG, Smith ML (2014) Cost of fall-related hospitalizations among older adults: environmental comparisons from the 2011 Texas hospital inpatient discharge data. Popul Health Manag 17(6):351–356. doi:10.1089/pop.2014.0002

  5. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int 21(8):1295–1306. doi:10.1007/s00198-009-1162-0

  6. Heinrich S, Rapp K, Rissmann U, Becker C, Konig HH (2009) Cost of falls in old age: a systematic review. Osteoporos Int 21(6):891–902. doi:10.1007/s00198-009-1100-1

  7. Woolcott JC, Khan KM, Mitrovic S, Anis AH, Marra CA (2012) The cost of fall related presentations to the ED: a prospective, in-person, patient-tracking analysis of health resource utilization. Osteoporos Int 23(5):1513–1519

    Article  CAS  PubMed  Google Scholar 

  8. (1998) National Center for Injury Prevention and Control: statistics and activities. Int J Trauma Nurs 4(1):18–22

  9. Sattin RW, Lambert Huber DA, DeVito CA, Rodriguez JG, Ros A, Bacchelli S, Stevens JA, Waxweiler RJ (1990) The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol 131(6):1028–1037

    Article  CAS  PubMed  Google Scholar 

  10. Lord S, Clark R, Webster I (1991) Physiological factors associated with falls in an elderly population. J Am Geriatr Soc 39:1194–1200

    Article  CAS  PubMed  Google Scholar 

  11. Lord S, Ward J, Williams P, Anstey K (1994) Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 42:1110–1117

    Article  CAS  PubMed  Google Scholar 

  12. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707

    Article  CAS  PubMed  Google Scholar 

  13. van Dijk PT, Meulenberg OG, van de Sande HJ, Habbema JD (1993) Falls in dementia patients. Gerontologist 33(2):200–204

    Article  PubMed  Google Scholar 

  14. Delbaere K, Close JC, Heim J, Sachdev PS, Brodaty H, Slavin MJ, Kochan NA, Lord SR (2010) A multifactorial approach to understanding fall risk in older people. J Am Geriatr Soc 58(9):1679–1685

    Article  PubMed  Google Scholar 

  15. Lord S, Sherrington C, Menz H (2001) A physiological profile approach for falls prevention. In Falls in older people. Risk factors and strategies for prevention. Cambridge University Press, Cambridge, pp 221–238

    Google Scholar 

  16. Whitney JC, Lord SR, Close JC (2005) Streamlining assessment and intervention in a falls clinic using the Timed Up and Go Test and Physiological Profile Assessments. Age Ageing 34(6):567–571

    Article  PubMed  Google Scholar 

  17. Groll DL, To T, Bombardier C, Wright JG (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58(6):595–602

    Article  PubMed  Google Scholar 

  18. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186

    Article  CAS  PubMed  Google Scholar 

  19. Yesavage JA (1988) Geriatric depression scale. Psychopharmacol Bull 24(4):709–711

    CAS  PubMed  Google Scholar 

  20. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17(1):37–49

    Article  PubMed  Google Scholar 

  21. van Marwijk HW, Wallace P, de Bock GH, Hermans J, Kaptein AA, Mulder JD (1995) Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Pract 45(393):195–199

    PubMed  PubMed Central  Google Scholar 

  22. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332(9):556–561

    Article  CAS  PubMed  Google Scholar 

  23. Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 80(9):896–903

    CAS  PubMed  Google Scholar 

  24. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332(9):556–562. doi:10.1056/NEJM199503023320902

    Article  CAS  PubMed  Google Scholar 

  25. Delbaere K, Close JCT, Brodaty H, Sachdev P, Lord SR (2010) Determinants of disparities between perceived and physiological risk o falling among elderly people: cohort study. Br Med J 341:c4165. doi:10.1136/bmj

  26. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  CAS  PubMed  Google Scholar 

  27. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699

    Article  PubMed  Google Scholar 

  28. Miyake A, Emerson MJ, Friedman NP (2000) Assessment of executive functions in clinical settings: problems and recommendations. Semin Speech Lang 21(2):169–183

    Article  CAS  PubMed  Google Scholar 

  29. Graf P, Uttl B, Tuokko H (1995) Color- and picture-word Stroop tests: performance changes in old age. J Clin Exp Neuropsychol 17(3):390–415

    Article  CAS  PubMed  Google Scholar 

  30. Spreen O, Strauss E (1998) A compendium of neurological tests, 2nd edn. Oxford University Press, Inc., New York

    Google Scholar 

  31. Wechsler D (1981) Wechsler Adult Intelligence Scale - Revised.: The Psychological Corporation, Harcourt Brace Jovanovich

    Google Scholar 

  32. Spreen O, S. E. (1998) A Compendium of Neurological Tests. 2nd Edition, New York, Oxford University Press, Inc.

  33. Wechsler D (1981) Wechsler Adult Intelligence Scale - Revised. In: The Psychological Corporation, Harcourt Brace Jovanovich

    Google Scholar 

  34. Baddeley A (1992) Working memory. Science 255(5044):556–559

    Article  CAS  PubMed  Google Scholar 

  35. Maetzel A, Li LC, Pencharz J, Tomlinson G, Bombardier C (2004) The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Ann Rheum Dis 63(4):395–401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Liu-Ambrose T, Nagamatsu LS, Hsu CL, Bolandzadeh N (2013) Emerging concept: ‘central benefit model’ of exercise in falls prevention. Br J Sports Med 47(2):115–117

    Article  PubMed  Google Scholar 

  37. Delbaere K, Kochan NA, Close JC, Menant JC, Sturnieks DL, Brodaty H, Sachdev PS, Lord SR (2012) Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry 20(10):845–853

    Article  PubMed  Google Scholar 

  38. Murray CWS, Lopez A (1996) Global and regional descriptive epidemiology of disability: incidence, prevalence, health expectancies, and year lived with disability. The Havard School of Public Health, Boston

    Google Scholar 

  39. Lo AX, Brown CJ, Sawyer P, Kennedy RE, Allman RM (2014) Life-space mobility declines associated with incident falls and fractures. J Am Geriatr Soc 62(5):919–923

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank the Vancouver Falls Prevention Cohort study participants. The Canadian Institute for Health Research Emerging Team Grant (CIHR, MOB-93373 to KMK, TLA, CAM) provided funding for this study. TLA is a Canada Research Chair in Physical Activity, Mobility, and Cognitive Neuroscience, a Michael Smith Foundation for Health Research (MSFHR) Scholar, a Canadian Institutes of Health Research (CIHR) New Investigator, and a Heart and Stroke Foundation of Canada’s Henry JM Barnett’s Scholarship recipient. JCD was funded by a CIHR and MSFHR Postdoctoral Fellowship. CLS is an Alzheimer’s Society Research Program Trainee. These funding agencies did not play a role in study design.

Author information

Authors and Affiliations

  1. Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada

    J. C. Davis, K. M. Khan, C. L. Hsu, P. Jacova, B. K. Chiu & T. Liu-Ambrose

  2. Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada

    J. C. Davis, C. L. Hsu, P. Jacova, B. K. Chiu & T. Liu-Ambrose

  3. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    L. Dian

  4. Centre for Clinical Epidemiology and Evaluation, University of British Columbia & VCHRI, 828 West 10th Avenue, Vancouver, BC, V6T 2B5, Canada

    S. Bryan

  5. School of Pharmacy, Memorial University, St. John’s, NF, Canada

    C. A. Marra

  6. Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada

    J. C. Davis, C. L. Hsu, P. Jacova, B. K. Chiu & T. Liu-Ambrose

Authors
  1. J. C. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Dian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. M. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Bryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. A. Marra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. L. Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Jacova
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. K. Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. T. Liu-Ambrose
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Liu-Ambrose.

Ethics declarations

Conflicts of interest

None.

Funding

The Canadian Institute for Health Research Emerging Team Grant (CIHR, MOB-93373 to KMK, TLA, CAM) provided funding for this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Davis, J.C., Dian, L., Khan, K.M. 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 Int 27, 943–951 (2016). https://doi.org/10.1007/s00198-015-3350-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-015-3350-4

Keywords

Search

Navigation