May/June 2024

May/June 2024 Issue

Fall Risk: Can Cognitive Training Help Prevent Falls?
By Keith Loria
Today’s Geriatric Medicine
Vol. 17 No. 3 P. 6

A 10-Year Study Assessed the Effect

Nearly 36 million falls are reported among older adults each year, an alarming number representing 25% of all people 65 and older. Tragically, these falls result in more than 32,000 deaths annually, according to the CDC.

What’s more, approximately 800,000 older adults are hospitalized each year for a head injury or hip fracture following a fall.

Awareness of these statistics also creates fear among older adults, and because of that, many limit their activities and social engagements, which can lead to other issues, such as depression, social isolation, and overall physical decline.

There are many causes and reasons for falls, though falling is not an inevitable result of aging. Common contributors are vitamin D deficiency, vision problems, improper footwear, and use of certain medicines such as tranquilizers, sedatives, and antidepressants.

It’s also theorized that falls are caused by memory problems. A new study by the Regenstrief Institute examined whether cognitive training could prevent falls and decrease risk in support of this assertion.

The study, “Does Cognitive Training Reduce Falls Across Ten Years?,” first published in the International Journal of Environmental Research and Public Health, looked at whether speed of processing, memory, and reasoning training lowered the risk of falling; however, it found that the training had no effect on the likelihood of falling for those at low risk of falling.

Briana Sprague, PhD, an assistant professor of medicine at Indiana University School of Medicine and research scientist with the Regenstrief Institute, was lead author of the study.

“My training is in adult development and aging, so I’m really an expert in the aging process,” she says. “I’m interested in how do we develop interventions to support optimal aging, as well as the kind of statistical tools we can use to answer those questions.”

With that background, she’s always been interested in how you build skill and contribute to older adult health.

“This project is stemming from that interest,” Sprague says. “So the purpose of this study was to look at the effect of different brain training programs on fall risk over time. The reason that we took this approach was because most of the work people do tends to look at physical rehab for preventing falls. There are a lot of people who have fallen and might need some extra help.”

Therefore, the researchers thought cognitive training could supplement physical training for those people who need it.

The Regenstrief Institute study examined data collected from 2,802 older adults who were mentally high functioning at the onset of the 10-year period during which they were followed. The cohort included those aged 65 to 94 when data collection began, all classified as “high functioning cognitively” with no dementia at baseline.

The cohort was recruited from six states and was reflective of community-dwelling older adults, according to the researchers.

“We looked at three different training programs and the effect to see if they reduced the risk of falls over 10 years,” Sprague says. “These were fairly healthy older adults. When we looked at them on the whole, regardless of training, there was no benefit over 10 years.”

What the study found, however, Sprague notes, is that older adults who had previously suffered a fall and received speed of processing training were 31% less likely to experience a subsequent fall during the next 10 years compared with individuals at high risk for falls who did not receive this mental training.

Once they broke up the sample and looked at the high-risk group of individuals who had fallen previously, they found that speed processing training was especially beneficial in those individuals, Sprague says. “This is complementary to other findings about the speed of processing training, so it seems to be more effective for high-risk across different categories, like if people have more depression symptoms.”

This speed of processing training consists of correctly identifying increasingly complex visual information to help older adults respond quicker to stimuli and disregard those that are unimportant.

“The findings support the belief that for some individuals, physical-based interventions to reduce falls may be further enhanced by cognitive training,” Sprague says. “Not everyone benefits the same way from brain coaching, and the study revealed that for individuals at high risk for falls who received this one specific type of brain coaching—speed of processing training—it did help limit falls.”

Furthermore, the researchers did not find any association between fall occurrence and demographic factors or cognitive status.

The research team isn’t suggesting that older adults get speed of processing training instead of physical activity interventions, but they believe there’s a place for cognitive training within the rehab program for those who have fallen before.

“There are commercially available programs that are sort of a gamified version of these programs that allow one to practice these skills,” Sprague says, pointing to BrainHQ as one source of such training activities.

The biggest challenge of the study was the fall outcome, as there weren’t many fall measures in the data.

“Trying to find a measure that was important to individuals but also meaningful to clinicians, too, was one aspect that was tricky,” Sprague says. “One of the hardest things about the study was there weren’t a lot of measures about what else they were doing during the intervention. There’s this idea that when you have someone in an intervention, they might start engaging in other health behaviors, too.” For example, maybe the individuals who benefitted from the speed of processing training may have been doing physical activity as well, as an unintended positive. That exercise, and not the speed of processing, could have actually been responsible for bridging the fall risk.

“In the future, we would want to do a good job of what other things people are doing in the intervention and looking at if they are changing their behaviors or starting to engage in spontaneous health behaviors,” Sprague says. “It if turns out that speed of processing training spontaneously gets people to start exercising, that would be awesome. But I don’t think that’s the case.”

Since the results of the study, some of Sprague’s coauthors with The Regenstrief Institute research team have teamed with BrainHQ to look further into this. “It’s an area that we are very much still exploring,” she said, noting that she doesn’t have any commercial ties of her own. “One of my coauthors developed the [cognitive] program and sold it, so she maintained those relationships.”

The group is now is looking at whether these games, which were played on computer screens, can be used in different settings. For instance, they are experimenting to see if the older adults can perform them on their smart phones and if they would get the same benefit and the same therapeutic dose.

“We’re really excited and moving this toward how can we get people interventions more in in real time,” Sprague says. “In our study, our measure of falls was pretty crude. It was a retrospective of ‘have you fallen in the last couple of months?’ That’s not the most sensitive measure. So, in addition to getting more intervention ‘in the wild’ measures, we’re also interested in what other measures can we get.”

With mobile technology, people will be able to ascertain whether people can move more places and be mobile in the way that they want to be. The technology allows researchers to look beyond falls to see whether individuals can be more mobile in their everyday lives.

With the study behind them, Sprague and the research team expect to delve further into the issue by investigating how multicomponent lifestyle interventions such as nutrition and exercise are related to physical and brain health.

— Keith Loria is a D.C.-based award-winning journalist who has been writing for major publications for nearly 20 years on topics as diverse as real estate, travel, Broadway, and health care.