Mild Neurocognitive Disorder, Social Engagement and Falls Among Older Primary Care Patients

Lien T Quach, Mette M Pedersen, Elisa Ogawa, Rachel E Ward, David R Gagnon, Avron Spiro, Jeffrey A Burr, Jane A Driver, Michael Gaziano, Amar Dhand, Jonathan F Bean

Abstract

OBJECTIVES: (1) To estimate the association between social engagement (SE) and falls; (2) To examine the relation between mild neurocognitive disorder (MNCD) and falls by different levels of SE.

DESIGN: We performed a secondary data analysis using prospective cohort study design.

SETTING: Primary care.

PARTICIPANTS: A total of 425 older adult primary care patients at risk for mobility decline (N=425). As previously reported, at baseline, 42% of participants exhibit MNCD.

MAIN OUTCOME MEASURES: The outcome variable was the number of falls during 2 years of follow-up. Exposure variables at baseline included (1) MNCD identified using a cut-off of 1.5 SD below the age-adjusted mean on at least 2 measures within a cognitive performance battery and (2) SE, which was assessed using the social component of the Late-Life Function and Disability Instrument. High SE was defined as having a score ≥ median value (≥49 out of 100). All models were adjusted for age, sex, education, marital status, comorbidities, and pain status.

RESULTS: Over 2 years of follow-up, 48% of participants fell at least once. MNCD was associated with a higher rate of falls, adjusting for the covariates (Incidence Rate Ratio=1.6, 95% confidence interval: 1.1-2.3). There was no significant association between MNCD and the rate of falls among people with high SE. In participants with low SE (having a score less than 49.5 out 100), MNCD was associated with a higher rate of falls as compared with participants with no neurocognitive disorder (No-NCD).

CONCLUSIONS: Among participants with low SE, MNCD was associated with a higher rate of falls, but not among participants with high SE. The findings suggest that high SE may be protective against falls among older primary care patients with MNCD.

Original languageEnglish
JournalArchives of Physical Medicine and Rehabilitation
Volume104
Issue number4
Pages (from-to)541-546
Number of pages6
ISSN0003-9993
DOIs
Publication statusPublished - Apr 2023

Keywords

  • Accidental Falls
  • Aged
  • Humans
  • Neurocognitive Disorders
  • Primary Health Care
  • Prospective Studies
  • Social Participation
  • Falls
  • Neurocognitive disorder
  • Rehabilitation
  • Social participation
  • Social engagement

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