The Association Between Cognitive Decline and Fall in Elderly Adults

Abstract

Background: Falls are a leading cause of morbidity among older adults and constitute a growing public health concern, particularly in low- and middle-income countries. Evidence linking mild cognitive impairment and falls remains inconsistent, and studies examining domain-specific cognitive function in Middle Eastern populations are scarce.

Objectives: This study aimed to estimate the frequency of falls among community-dwelling older adults in Lebanon and to examine the association between individual cognitive domains and global cognition with the occurrence of falls among older adults.

Methods: Data were obtained from a population-based Lebanon Study on Ageing and Health (LSAHA) for Lebanese adults residing in Beirut and Zahle, aged ≥ 60 years, where falls were self-reported during the recall period (two years). Confirmatory factor analysis was used to generate standardized latent scores for language, executive function, memory, orientation, and global cognition, followed by weighted logistic regression models adjusting for sociodemographic, functional, and health-related covariates.

Results: Out of the 2,899 participants in this study, 43% (weighted percent) reported at least one fall in the past two years, 40.6% of which experienced a bone or joint fracture. Falls occurred more frequently among females and individuals with functional limitations. Although higher cognitive domain scores were associated with lower odds of falling in unadjusted models, no cognitive domain or global cognition model remained statistically significant (p-value < 0.05) after adjustment. However, increased age (OR= 1.02, p-value= 0.01), female sex (OR= 1.35, p-value= 0.01), and difficulty walking for 30 minutes (OR= 1.39, p-value= 0.01) were consistently associated with fall risk.

Conclusion: Falls were highly prevalent among Lebanese older adults, highlighting an urgent need for targeted prevention and mitigation strategies. Although mild cognitive impairment was not independently associated with falls after adjustment, this may be due to the way falls were measured and the type of cognitive tests that were included, underscoring the need for better measurement structures in future studies. Furthermore, physical function and sociodemographic factors appear to play a more proximal role, suggesting that interventions focusing on mobility and functional capacity may be most effective. Additional work is needed to assess the role of mild cognitive impairment in modifying fall risk at each level of physical function.