Gait cognition and falls - from theory to practice

Abstract

BACKGROUND: Population ageing has contributed to the epidemic of dementia and gait disorders which both in turn increase risk of falls. However, fall prevention programs are not effective in older adults with cognitive impairment and gait disorders. METHODS: The thesis has included a narrative review to explore mechanisms of fall risks in cognitively impaired older adults with higher-level gait disorders (HLGD); a cross-sectional study to examine the characteristics of HLGD using Inertial Measurement Units (IMUs) and the association between gait and cognition; a systematic review to explore the evidence for interventions that improve gait in cognitively impaired older adults; an intervention pilot study-Safe Mobilisation Program was developed and tested for feasibility and acceptability in people with cognitive impairment and HLGD. The development process of the program was described and the intervention design and delivery were reflected. RESULTS: Gait, cognition and falls are closely related. The combined impact of gait disorder and cognitive impairment may be the underlying mechanism contributing to the increased fall risks. IMUs were successfully used to measure characteristics of HLGD and correlations were found between gait parameters and cognitive performance. Physical and cognitive training should be combined in a functional context to assist generalisation of skills. The Safe Mobilisation Program was feasible and acceptable in people with HLGD and cognitive impairment, and there was a trend towards improvement in functional mobility. The complexity of the program development was identified, design and delivery of the program should be client-centred, goal-directed, problem-based and family-integrated. CONCLUSION: Gait and cognition are closely related. This thesis has explored the co-existence of cognitive impairment and gait disorders, establishing a theoretical framework that has implications for clinical practice, future research and policy.