The Association Between Social Engagement, Mild Cognitive Impairment, and Falls Among Older Primary Care Patients

Abstract

Objectives: To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations.

Design: Cross sectional analysis using baseline data from an observational cohort study.

Setting: Primary care.

Participants: Community-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y).

Main outcome measures: The number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100.

Results: MCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01).

Conclusions: While MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.

Keywords: Falls; Mild cognitive impairment; Rehabilitation.