Original Research Ar cle Predic ng falls in the elderly: do dual-task tests offer any added value? A systema c review Mina Sarofim Fi h Year Medicine (Undergraduate) University of New South Wales
AM S J
Mina spent a year working alongside some great researchers at Neuroscience Research Australia. Most of his work focused on falls in the elderly, which is very relevant today thanks to our ageing popula on.
The issue of falls is a significant health concern in geriatric medicine and a major contributor to morbidity and mortality in those over 65 years of age. Gait and balance problems are responsible for up to a quarter of falls in the elderly. It is unclear whether dualtask assessments, which have become increasingly popular in recent years, have any added benefit over single-task assessments in predic ng falls. A previous systema c review that included manuscripts published prior to 2006 could not reach a conclusion due to a lack of available data. Therefore, a systema c review was performed on all dual-task material published from 2006 to 2011 with a focus on fall predic on. The review included all studies published between 2006-2011 and available through PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials databases that sa sfied inclusion and exclusion criteria u lised by the previous systema c review. A total of sixteen ar cles met the inclusion criteria and were analysed for qualita ve and quan ta ve results. A majority of the studies demonstrated that poor performance during dual-task assessments was associated with a higher risk of falls in the elderly. Only three of the 16 ar cles provided sta s cal data for comparison of single- and dual-task assessments. These studies provided insufficient data to demonstrate whether dual-task tests were superior to singletask tests in predic ng falls in the elderly. Further head-to-head studies are required to determine whether dual-task assessments are superior to single-task assessments in their ability to predict future falls in the elderly.
Introduc on Many simple tasks of daily living such as standing, walking or rising from a chair can poten ally lead to a fall. Each year one in three people over the age of 65 living at home will experience a fall, with five percent requiring hospitalisa on. [1, 2] Gait and balance problems are responsible for 10-25% of falls in the elderly, only surpassed by ‘slips and trips,’ which account for 30-50%. [2] Appropriate clinical evalua on of iden fiable gait and balance disturbances, such as lower limb weakness or gait disorders, has been proposed as an efficient and cost-effec ve prac ce which can prevent many of these falls. As such, fall preven on programs have placed a strong emphasis on determining a pa ent’s fall risk by assessing a variety of physiological characteris cs. [2, 3] Dual-task assessments have become increasingly popular in recent years, because they examine the rela onship between cogni ve func on and a en onal limita ons, that is, a subject’s ability to divide their a en on. [4] The accepted model for conduc ng such tests involves a primary gait or balance task (such as walking at normal pace) performed concurrently with a secondary cogni ve or manual task (such as coun ng backwards). [4, 5] Divided a en on whilst walking may manifest as subtle changes in posture, balance or gait. [5, 6] It is these changes that provide poten ally clinically significant correla ons, for example, detec ng changes in balance and gait a er an exercise interven on. [5, 6] However, it is unclear whether a pa ent’s performance during a dual-task assessment has any added benefit over a single-task assessment in predic ng falls. In 2008, Zijlstra et al. [7] produced a systema c review of the literature which a empted to evaluate whether dual-task balance assessments
are more sensi ve than single balance tasks in predic ng falls. It included all published studies prior to 2006 (inclusive), yet there was a lack of available data for a conclusion to be made. This was followed by a review ar cle by Beauchet et al. [8] in 2009 that included addi onal studies published up to 2008. These authors concluded that changes in performance while dual-tasking were significantly associated with an increased risk of falling in older adults. The purpose of this present study was to determine, using recently published data, whether dual-task tests of balance and/or gait have any added benefit over single-task tests in predic ng falls. A related outcome of the study was to gather data to either support or challenge the use of dual-task assessments in fall preven on programs. A systema c review of all published material from 2006 to 2011 was performed, focusing on dual-task assessments in the elderly. Inclusion criteria were used to ensure only relevant ar cles repor ng on fall predic ons were selected. The method and results of included manuscripts were qualita vely and quan ta vely analysed and compared.
Methods Literature Search A systema c literature search was performed to iden fy ar cles which inves gated the rela onship between falls in older people and balance/gait under single-task and dual-task condi ons. The electronic databases searched were PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials. The search strategy u lised by Ziljstra et al. [7] was carried out. Individual search strategies were tailored to each database, being adapted from the following which was used in PubMed: 1. (gait OR walking OR locomo on OR musculoskeletal equilibrium OR posture) 2. (aged OR aged, 80 and over OR aging) 3. #1 AND #2 4. (cogni on OR a en on OR cogni ve task(s) OR a en on tasks(s) OR dual task(s) OR double task paradigm OR second task(s) OR secondary task(s)) 5. #3 AND #4 6. #5 AND (humans) Bold terms are MeSH (Medical Subjects Headings) key terms. The search was performed without language restric ons and results
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