The impact of divided attention on automatic postural responses: A systematic review and meta-analysis

The perceived control model of falling: developing a unified framework to understand and assess maladaptive fear of falling

BACKGROUND

fear of falling is common in older adults and can have a profound influence on a variety of behaviours that increase fall risk. However, fear of falling can also have potentially positive outcomes for certain individuals. Without progressing our understanding of mechanisms underlying these contrasting outcomes, it is difficult to clinically manage fear of falling.

METHODS

this paper first summarises recent findings on the topic of fear of falling, balance and fall risk-including work highlighting the protective effects of fear. Specific focus is placed on describing how fear of falling influences perceptual, cognitive and motor process in ways that might either increase or reduce fall risk. Finally, it reports the development and validation of a new clinical tool that can be used to assess the maladaptive components of fear of falling.

RESULTS

we present a new conceptual framework-the Perceived Control Model of Falling-that describes specific mechanisms through which fear of falling can influence fall risk. The key conceptual advance is the identification of perceived control over situations that threaten one's balance as the crucial factor mediating the relationship between fear and increased fall risk. The new 4-item scale that we develop-the Updated Perceived Control over Falling Scale (UP-COF)-is a valid and reliable tool to clinically assess perceived control.

CONCLUSION

this new conceptualisation and tool (UP-COF) allows clinicians to identify individuals for whom fear of falling is likely to increase fall risk, and target specific underlying maladaptive processes such as low perceived control.

Effects of gender on dual-tasking and prioritization in older adults

BACKGROUND

The ability to produce effective posture and balance while distracted (dual-tasking; DT), is critical for mobility. In particular, individuals implicit prioritization across posture and secondary, distracting stimuli may impact fall risk. However, the impact of gender on DT and prioritization during gait is poorly understood.

RESEARCH QUESTION

Does gender impact DT effects or prioritization while DT walking?

METHODS

One hundred older adults participated. The timed up and go (TUG) was completed with and without a secondary cognitive task (counting backwards by 3's). Gait (time to complete the TUG), and cognitive (rate of correct numbers listed) performance was recorded during both single tasks and while dual-tasking. DT effects were calculated for cognitive and gait performance. Prioritization was calculated as the difference between cognitive and gait DT effects. The effect of gender on DT and prioritization was assessed, controlling for age and cognitive ability.

RESULTS

Gender by condition (single vs. dual-task) interaction effects were observed (Gait: F_1,96 =8.7; p = 0.004; Cognition: F_1,96 =5.2; p = 0.024) such that, compared to male participants, females exhibited smaller cognitive DT effects, and larger gait DT effects. Further, females exhibited significantly larger prioritization scores (F_1,95 =10.0, p = 0.002), indicating a cognitive prioritization compared to males.

SIGNIFICANCE

Given the link between posture-second strategies and falls, the current findings may provide some insight into previous results suggesting an increased fall-risk in older-adult women. However, this study did not investigate falls. Therefore, additional work is necessary to confirm current findings and further investigate the relationship between gender, prioritization, and falls; and its possible clinical relevance.