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Mild Neurocognitive Disorder, Social Engagement, and Falls Among Older Primary Care Patients

Published:December 10, 2022DOI:https://doi.org/10.1016/j.apmr.2022.10.008

      Abstract

      Objectives

      (1) To estimate the association between social engagement (SE) and falls; (2) To examine the relation between mild neurocognitive disorder (MNCD) and falls by different levels of SE.

      Design

      We performed a secondary data analysis using prospective cohort study design.

      Setting

      Primary care.

      Participants

      A total of 425 older adult primary care patients at risk for mobility decline (N=425). As previously reported, at baseline, 42% of participants exhibit MNCD.

      Main Outcome Measures

      The outcome variable was the number of falls during 2 years of follow-up. Exposure variables at baseline included (1) MNCD identified using a cut-off of 1.5 SD below the age-adjusted mean on at least 2 measures within a cognitive performance battery and (2) SE, which was assessed using the social component of the Late-Life Function and Disability Instrument. High SE was defined as having a score ≥ median value (≥49 out of 100). All models were adjusted for age, sex, education, marital status, comorbidities, and pain status.

      Results

      Over 2 years of follow-up, 48% of participants fell at least once. MNCD was associated with a higher rate of falls, adjusting for the covariates (Incidence Rate Ratio=1.6, 95% confidence interval: 1.1-2.3). There was no significant association between MNCD and the rate of falls among people with high SE. In participants with low SE (having a score less than 49.5 out 100), MNCD was associated with a higher rate of falls as compared with participants with no neurocognitive disorder (No-NCD).

      Conclusions

      Among participants with low SE, MNCD was associated with a higher rate of falls, but not among participants with high SE. The findings suggest that high SE may be protective against falls among older primary care patients with MNCD.

      Keywords

      List of abbreviations:

      Boston RISE (Boston Rehabilitative Impairment Study of the Elderly), CI (confidence interval), HVLT-R (Hopkins Verbal Learning Test, Revised), MNCD (mild neurocognitive disorder), SE (social engagement), TMT (Trail Making Test)
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