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. 2021 Mar 9:13:329-338.
doi: 10.2147/NSS.S299833. eCollection 2021.

Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study

Dani Kirshner  1 , Rachel Kizony  2   3 , Efrat Gil  1 , Kfir Asraf  4 , Tal Krasovsky  5   6 , Iris Haimov  7 , Tamar Shochat #  8 , Maayan Agmon #  8
Affiliations

Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study

Dani Kirshner et al. Nat Sci Sleep. .

Abstract

Study objectives: To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia.

Methods: Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann-Whitney U-tests.

Results: Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p<0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p<0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48-30.93 vs 7.81% IQR: 4.43-14.82, p<0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: -0.89-38.84 vs 15%, IQR: -0.89-38.84%, p=0.599).

Conclusion: Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.

Keywords: DT; actigraphy; dual-task; gait; sleep quality.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Comparisons between the insomnia and no-insomnia groups in single-task (ST) and dual-task (DT) gait speed performance. (B) Comparisons between the insomnia and no-insomnia groups in single-task (ST) and dual-task (DT) cognitive (number of correct responses) performance. (C) Dual-task cost (DTC), for gait speed and number of correct responses in the cognitive subtraction task. *p<0.05, **p<0.01, ***p<0.001. Error bars show standard error.
Figure 2
Figure 2
A theoretical model proposing underlying potential mechanisms explaining the link between sleep quality, executive function, and gait quality.
See this image and copyright information in PMC

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