Modified STEADI Fall Risk Categories Predict Incident Cognitive Impairment

Abstract

Background/objectives: It is unknown whether older adults at high risk of falls but without cognitive impairment have higher rates of subsequent cognitive impairment.

Design: This was an analysis of cross-sectional and longitudinal data from National Health and Aging Trends Study (NHATS).

Setting: NHATS, secondary analysis of data from 2011 to 2019.

Participants: Community dwelling adults aged 65 and older without cognitive impairment.

Measurements: Participants were classified at baseline in three categories of fall risk (low, moderate, severe) using a modified algorithm from the Center for Disease Control's STEADI (Stop Elderly Accidents, Deaths, and Injuries) and fall risk from data from the longitudinal NHATS. Impaired global cognition was defined as NHATS-derived impairment in either the Alzheimer's Disease-8 score, immediate/delayed recall, orientation, clock-drawing test, or date/person recall. The primary outcome was the first incident of cognitive impairment in an 8 year follow-up period. Cox-proportional hazard models ascertained time to onset of cognitive impairment (referent = low modified STEADI incidence).

Results: Of the 7,146 participants (57.8% female), the median age category was 75 to 80 years. Prevalence of baseline fall modified STEADI risk categories in participants was low (51.6%), medium (38.5%), and high (9.9%). In our fully adjusted model, the risk of developing cognitive impairment was hazard ratio (HR) 1.18 [95% CI = 1.08, 1.29] in the moderate risk category, and HR 1.74 [95% CI = 1.53, 1.98] in the high-risk category.

Conclusion: Older, cognitively intact adults at high fall risk at baseline had nearly twice the risk of cognitive decline at 8 year follow-up.

Keywords: cognitive decline; dementia; fall; frequent falls.

Figure 1.. 1- KM Curve for Cognitive Impairment by Modified STEADI Categories Risk Based on Model 3 Data

Results are adjusted for age category, gender, smoking, education plus comorbidities including heart disease, hypertension, diabetes, lung disease, stroke, cancer, ever walk for exercise. Figure counts represent those at risk in each modified STEADI category. The number of at-risk individuals is displayed at each time point. Combined Dementia is a combination of Alzheimer’s Disease-8 score or Washington University Dementia Screening Test (AD8) + 3 domains (memory, orientation, executive). Each individual domain binarized based on NHATS cutoffs (0 = not impaired, 1 = impaired). If AD8 score not present, individual domain scores summed – dementia defined as impairment in any domain (summed score 1,2, or 3). Clock draw test; Memory domain (immediate word recall, delayed word recall). Orientation consists of date recall and president/vice president naming. Fall risk defined by the modified version of the Center for Disease Control (CDC) Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative, Preventing Falls in Older Patients-A Provider Tool Kit.