title: The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis.
abstract: BACKGROUND
  cognitive impairment is an established fall risk factor; however, it is unclear whether a disease-specific diagnosis (i.e. dementia), measures of global cognition or impairments in specific cognitive domains (i.e. executive function) have the greatest association with fall risk. Our objective was to evaluate the epidemiological evidence linking cognitive impairment and fall risk.
  
  
  METHODS
  studies were identified through systematic searches of the electronic databases of MEDLINE, EMBASE, PyschINFO (1988-2009). Bibliographies of retrieved articles were also searched. A fixed-effects meta-analysis was performed using an inverse-variance method.
  
  
  RESULTS
  twenty-seven studies met the inclusion criteria. Impairment on global measures of cognition was associated with any fall, serious injuries (summary estimate of OR = 2.13 (1.56, 2.90)) and distal radius fractures in community-dwelling older adults. Executive function impairment, even subtle deficits in healthy community-dwelling older adults, was associated with an increased risk for any fall (summary estimate of OR = 1.44 (1.20, 1.73)) and falls with serious injury. A diagnosis of dementia, without specification of dementia subtype or disease severity, was associated with risk for any fall but not serious fall injury in institution-dwelling older adults.
  
  
  CONCLUSIONS
  the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk. There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values. Executive function was also associated with increased risk, which supports its inclusion in fall risk assessment especially when global measures are within normal limits.
authors.affiliation: Division of Geriatric Medicine, The University of Western Ontario, 801 Commissioners Road East, London, Ontario, Canada.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Muir
authors.forename: Karen
authors.initials: K
authors.lastname: Gopaul
authors.forename: Manuel M
authors.initials: MM
authors.lastname: Montero Odasso
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D056344:Executive Function; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors