title: Cognitive status is a determinant of health resource utilization among individuals with a history of falls: a 12-month prospective cohort study.
abstract: CONCLUSIONS
  Falls are a costly public health problem worldwide. The literature is devoid of prospective data that identifies factors among fallers that significantly drive health care resource utilization. We found that cognitive function--specifically, executive functions--and cognitive status are significant determinants of health resource utilization among older fallers.
  
  
  BACKGROUND
  Although falls are costly, there are no prospective data examining factors among fallers that drive health care resource utilization. We identified key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with a history of falls. Specifically, with the increasing recognition that cognitive impairment is associated with increased falls risk, we investigated cognition as a potential driver of health resource utilization.
  
  
  METHODS
  This 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 319) included participants with a history of at least one fall in the previous 12 months. Based on their cognitive status, participants were divided into two groups: (1) no mild cognitive impairment (MCI) and (2) MCI. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, global cognition, executive functions, and cognitive status (MCI versus no MCI) were examined. Age, sex, comorbidities, depression status, and activities of daily living were included regardless of statistical significance.
  
  
  RESULTS
  Global cognition, comorbidities, working memory, and cognitive status (MCI versus no MCI ascertained using the Montreal Cognitive Assessment (MoCA)) were significant determinants of total HRU at 6 months. The number of medical comorbidities and global cognition were significant determinants of total HRU at 12 months.
  
  
  CONCLUSIONS
  MCI status was a determinant of HRU at 6 months among older adults with a history of falls. As such, efforts to minimize health care resource use related to falls, it is important to tailor future interventions to be effective for people with MCI who fall.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01022866.
authors.affiliation: Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.|Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.|Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
authors.forename: J C
authors.initials: JC
authors.lastname: Davis
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Dian
authors.affiliation: Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: K M
authors.initials: KM
authors.lastname: Khan
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, University of British Columbia & VCHRI, 828 West 10th Avenue, Vancouver, BC, V6T 2B5, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Bryan
authors.affiliation: School of Pharmacy, Memorial University, St. John's, NF, Canada.
authors.forename: C A
authors.initials: CA
authors.lastname: Marra
authors.affiliation: Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.|Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.|Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
authors.forename: C L
authors.initials: CL
authors.lastname: Hsu
authors.affiliation: Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.|Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.|Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Jacova
authors.affiliation: Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.|Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.|Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
authors.forename: B K
authors.initials: BK
authors.lastname: Chiu
authors.affiliation: Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada. tlambrose@exchange.ubc.ca.|Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. tlambrose@exchange.ubc.ca.|Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. tlambrose@exchange.ubc.ca.
authors.forename: T
authors.initials: T
authors.lastname: Liu-Ambrose
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D003071:Cognition; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D056344:Executive Function; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D051346:Mobility Limitation; D009483:Neuropsychological Tests; D004856:Postural Balance; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cost; Falls; Health resource utilization; Older adults