Dual-task testing to predict falls in community-dwelling older adults: a systematic review

Abstract

Background: Cognitive impairment increases fall risk in older adults. Dual-task testing is an accepted way to assess the interaction between cognition and mobility; however, there is a lack of evidence-based recommendations for dual-task testing to evaluate fall risk in clinical practice.

Objectives: To evaluate the association between dual-task testing protocols and future fall risk, and to identify the specific dual-task test protocols associated with elevated risk.

Data sources: MEDLINE, Pubmed and EMBASE electronic databases were searched from January 1988 to September 2013.

Study selection: Two independent raters identified prospective cohort studies (duration of at least 1 year) of dual-task assessment in community-dwelling participants aged ≥60 years, with 'falls' as the primary outcome.

Study appraisal and synthesis methods: Methodological quality was scored independently by two raters using a published checklist of criteria for evaluating threats to the validity of observational studies.

Results: Deterioration in gait during dual-task testing compared with single-task performance was associated with increased fall risk. Shortcomings within the literature significantly limit knowledge translation of dual-task gait protocols into clinical practice.

Limitations: There is a paucity of prospective studies on the association of dual-task gait assessment with fall risk.

Conclusion and implications of key findings: Changes in gait under dual-task testing are associated with future fall risk, and this association is stronger than that for single-task conditions. Limitations in the available literature preclude development of detailed recommendations for dual-task gait testing procedures in clinical practice to identify and stratify fall risk in older adults.

Keywords: Accidental falls; Aged; Cognitive function; Gait.