Validity of divided attention tasks in predicting falls in older individuals: a preliminary study.
OBJECTIVE
Although cognitive impairment is known to be a major risk factor for falls in older individuals, the role of cognitive tests in predicting falls has not been established. Limited attentional resources may increase the risk for falls in older individuals. We examined the reliability and validity of divided attention tasks, walking while talking (WWT), in predicting falls.


METHODS
A prospective cohort study of 12-months' duration.


METHODS
Community-based longitudinal aging study, the Einstein Aging Study.


METHODS
Sixty nondemented community-living subjects, aged 65 to 98 (mean age +/- standard deviation = 79.6 +/- 6.3).


METHODS
Simple and complex versions of the WWT task in addition to standard balance and cognitive assessments. The primary outcome was cumulative incidence of falls at 12 months.


RESULTS
Thirteen subjects fell over the 12 months, four of whom had major injuries. The WWT task had good interrater reliability (r = 0.602, P <.001). Poor performance on simple (odds ratio (OR) = 7.02, 95% confidence interval (CI) = 1.7-29.4) and complex WWT tasks (OR = 13.7, 95% CI = 2.3-83.6) was highly predictive of falls. The simple task had a sensitivity of 46% and specificity of 89%. For the complex task, sensitivity was 39%, and specificity was 96%.


CONCLUSIONS
The WWT is a reliable and valid test to identify older individuals at high risk for falls. Future studies with larger sample sizes and in different settings are needed to confirm the findings of this study.
Verghese
Joe
J
Departments of Neurology and Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA. jverghes@aecom.yu.edu
Buschke
Herman
H
Viola
Lisa
L
Katz
Mindy
M
Hall
Charles
C
Kuslansky
Gail
G
Lipton
Richard
R
D000058:Accidental Falls; D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D001288:Attention; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020922:Sleep-Wake Transition Disorders; D016138:Walking