Reducing Fall Risk with Combined Motor and Cognitive Training in Elderly Fallers

Abstract

Background: Falling is a major clinical problem in elderly people, demanding effective solutions. At present, the only effective intervention is motor training of balance and strength. Executive function-based training (EFt) might be effective at preventing falls according to evidence showing a relationship between executive functions and gait abnormalities. The aim was to assess the effectiveness of a motor and a cognitive treatment developed within the EU co-funded project I-DONT-FALL.

Methods: In a sample of 481 elderly people at risk of falls recruited in this multicenter randomised controlled trial, the effectiveness of a motor treatment (pure motor or mixed with EFt) of 24 one-hour sessions delivered through an i-Walker with a non-motor treatment (pure EFt or control condition) was evaluated. Similarly, a 24 one-hour session cognitive treatment (pure EFt or mixed with motor training), delivered through a touch-screen computer was compared with a non-cognitive treatment (pure motor or control condition).

Results: Motor treatment, particularly when mixed with EFt, reduced significantly fear of falling (F(1,478) = 6.786, p = 0.009) although to a limited extent (ES -0.25) restricted to the period after intervention.

Conclusions: This study suggests the effectiveness of motor treatment empowered by EFt in reducing fear of falling.

Keywords: cognitive training; elderly; executive functions; fall risk; fear of falling; motor training.

Figure 1

Flow chart of participants in the study showing the allocated and analyzed participants and drop-outs in the four arms of the study and the three multidimensional assessments before: the onset of the treatment, at the end of the treatment after 3 months (M3) and after other 3 months of follow-up (M6). Abbreviations: MT: motor treatment; MixT: mixed treatment; CT: cognitive treatment; AC: active control.

Figure 2

The figure represents the average performance at the Falls Efficacy Scale—International (FES-I) and at the delayed recall of the Rey Auditory Verbal Learning test (RAVLT) at baseline (M0), after the 3 months at the end of the treatment (M3), and after the next 3 months of follow-up (M6). The different lines indicate the four different kinds of treatment: mixed (MixT), motor (MT), cognitive (CT) and the active control (AC). Stars indicate the p-level of significant results at the analysis of variance.