Longitudinal Analysis of Physical Performance, Functional Status, Physical Activity, and Mood in Relation to Executive Function in Older Adults Who Fall

ObjectivesTo examine whether good executive function (EF; the cognitive processes important for goal-oriented and controlled behavior) at baseline and maintenance of EF over time predict maintenance of physical performance, functional status, physical activity, and mood over a 1-year period, and conversely, to examine whether baseline functioning in these noncognitive domains predicts maintenance of EF over the same period of time. Design12-month prospective cohort study. SettingVancouver Falls Prevention Clinic. ParticipantsCommunity-dwelling older adults (N=199; mean age 81.66.5; 63% female) referred to the clinic after a fall. MeasurmentsAt each time point, structural equation modeling created a latent EF variable from performance on five EF tasks. Physical performance (physiological falls risk and gait speed), instrumental activities of daily living (IADLs), physical activity, and depressive symptoms were also assessed at each time point. ResultsHigher baseline EF predicted decreases in depressive symptoms (P=.005) and maintenance of IADLs (P=.006) from baseline to follow-up. Improvements in EF correlated with increases in gait speed (P=.005) and physical activity (P=.03) and with the maintenance of IADLs (P=.002) over follow-up. All effects were independent of demographic characteristics and global cognitive function. Baseline performance in the noncognitive domains did not predict changes in EF. ConclusionIn older fallers, EF is a marker of resiliency in several noncognitive domains and should therefore be assessed. Furthermore, interventions to improve EF should be tested in older fallers with EF deficits.