Background: Individuals with Parkinson's disease (PD) are at increased risk for falls, which lead to substantial morbidity and mortality. Understanding the motor and non-motor impairments associated with falls in PD is critical to informing prevention strategies. In addition to motor symptoms, individuals with PD exhibit non-motor deficits, including impaired set shifting, an aspect of executive function related to cognitive flexibility that can be measured quickly with the Trailmaking Test.
Research question: To determine whether impaired set shifting is associated with fall history in people with and without PD. Methods: We examined associations between set shifting, PD status, and fall history (≥1 falls in the previous 6 months) in data from PD patients (n = 65) with and without freezing of gait (FOG) and community-dwelling neurologically-normal older adults (NON-PD) (n = 73) who had participated in our rehabilitation studies.
Results: Impaired set shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD status, FOG, and PD disease duration (OR = 1.29 [1.03–1.60]; P = 0.02). Consistent with literature, PD and FOG were also independently associated with increased fall prevalence (PD OR = 4.15 [95% CI 1.65–10.44], P < 0.01; FOG OR = 3.63 [1.22–10.80], P = 0.02). Although the strongest associations between set shifting and falling were observed among PD without FOG (OR = 2.11) compared to HOA (OR = 1.14) and PD with FOG (OR = 1.46), no statistically-significant differences were observed across groups.
SIGNIFICANCE. Impaired set shifting is associated with previous falls in older adults with and without PD. Set shifting may be useful to include in fall risk assessments, particularly when global cognitive measures are within reference limits.
The DREAMS Team research advocacy training program helps clinical faculty and health students introduce basic clinical research concepts to diverse older adults to galvanize their active involvement in the research process. Older adults are frequently underrepresented in clinical research, due to barriers to participation including distrust, historical mistreatment, and their lack of health literacy. The DREAMS Team program aims to involve diverse older adults throughout all phases of research and increase research participation, thereby contributing to the growth of quality patient-centered, evidence-based health care. This course was developed for clinical faculty to deliver to diverse adults aged 55+ in eight 50-minute lectures, followed by half-hour small group discussions moderated by health students. A pilot cohort of 24 individuals was assessed for satisfaction post-program, and self-efficacy before and after the program. Older adult participants improved on a survey measure of self-efficacy, and indicated satisfaction on a post-program questionnaire. All agreed or strongly agreed that they enjoyed participating, and that classes enhanced knowledge/skills about the topics, were high quality, and provided useful information. Twenty-two out of 24 individuals who completed the program indicated they planned to get involved as research advocates. The DREAMS Team program can be offered either on its own, or as a follow-up program to a general health education course led by health students and/or professional researchers or clinicians. Educating older adults about the research process and advocacy through interactive seminars led by congenial and respectful researchers and health students may remove some barriers to research participation and involvement among diverse older adults.