The Association Between Social Engagement,Mild Cognitive Impairment,and Falls Among Older Primary Care Patients |
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Authors: | Lien T Quach Rachel E Ward Mette M Pedersen Suzanne G Leveille Laura Grande David R Gagnon Jonathan F Bean |
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Institution: | 1. New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA;2. Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA;3. Department of Gerontology, University of Massachusetts Boston, Boston, MA;4. Spaulding Rehabilitation Hospital, Boston, MA;5. Clinical Research Centre, Copenhagen University Hospital Hvidovre, Denmark;6. College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA;7. Beth Israel Deaconess Medical Center, Boston, MA;8. VA Boston Healthcare System, Boston, MA;9. Department of Biostatistics, Boston University, Boston, MA;10. Harvard Medical School, Cambridge, MA |
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Abstract: | ObjectivesTo examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations.DesignCross sectional analysis using baseline data from an observational cohort study.SettingPrimary care.ParticipantsCommunity-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y).Main Outcome MeasuresThe number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100.ResultsMCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01).ConclusionsWhile MCI is associated with a greater risk for falls, higher levels of SE may play a protective role. |
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Keywords: | Corresponding author Lien T Quach PhD MPH MD MAVERIC/GRECC VA Boston Healthcare System 150 S Huntington Ave Boston MA 02131 Falls Mild cognitive impairment Rehabilitation CI confidence interval ICF International Classification of Functioning Disability and Health LLFDI Late Life Function and Disability Instrument MCI mild cognitive impairment RR rate ratio SE social engagement SPPB Short Physical Performance Battery |
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