Dr Morag Taylor

PUBLICATIONS

White matter hyperintensities are associated with falls in older people with dementia.

Taylor ME, Lord SR, Delbaere K, Wen W, Jiang J, Brodaty H, Kurrle SE, Stefanie Mikolaizak A, Close JCT

White Matter Hyperintensities (WMHs) are associated with impaired gait, balance and cognition and increased fall risk in cognitively healthy older people. However, few studies have examined such relationships in older people with dementia. Understanding the role of WMHs in falls may assist in developing effective fall prevention strategies. We investigated the relationship between baseline WMHs, cognitive and sensorimotor function and prospective falls in older people with dementia. Twenty-eight community-dwelling older people with mild-moderate dementia (MMSE 11-23; ACE-R < 83) underwent magnetic resonance imaging and assessment of sensorimotor and cognitive (global and processing speed) function at baseline. WMHs, were quantified using a fully automated segmentation toolbox, UBO Detector ( https://cheba.unsw.edu.au/group/neuroimaging-pipeline ). Falls were ascertained prospectively for 12-months using monthly calendars with the assistance of carers. The median age of the participants was 83 years (IQR 77-86); 36% were female; 21 (75%) fell during follow-up. Using Generalized Linear Models, larger volumes of total WMHs were found to be significantly associated with poorer global cognitive and sensorimotor function. Using modified Poisson regression, total, periventricular and deep WMHs were each associated with future falls while controlling for age, sex, intracranial volume and vascular risk. Each standard deviation increase in total and periventricular WMH volume resulted in a 33% (RR 1.33 95%CI 1.07-1.66) and 30% (RR 1.30 95%CI 1.06-1.60) increased risk of falling, respectively. When the deep WMH volume z-scores were dichotomized at the median, individuals with greater deep WMH volumes had an 81% (RR 1.81 95% CI 1.02-3.21) increased risk of falling. WMHs were associated with poorer sensorimotor and cognitive function in people with dementia and total, periventricular and deep WMHs were associated with falls. Further research is needed to confirm these preliminary findings and explore the impact of vascular risk reduction strategies on WMHs, functional performance and falls.

The role of cognitive function and physical activity in physical decline in older adults across the cognitive spectrum.

Taylor ME, Boripuntakul S, Toson B, Close JCT, Lord SR, Kochan NA, Sachdev PS, Brodaty H, Delbaere K

The aim of this study was to investigate physical decline over 1-year in a cohort of older people across the cognitive spectrum.

Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study.

Taylor ME, Lasschuit DA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Kvelde T, Close JCT

This study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia. Older people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition.

Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study.

Taylor ME, Lasschuit DA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Kvelde T, Close JCT

This study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia. Older people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition.

A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia.

Taylor ME, Lord SR, Brodaty H, Kurrle SE, Hamilton S, Ramsay E, Webster L, Payne NL, Close JC

This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.

Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment.

Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JC

To explore the relationship between cognitive performance and falls in older people with mild to moderate cognitive impairment (CI) by investigating the mediational effects of medical, medication, neuropsychological, and physiological factors. Within this sample of older people with mild to moderate CI, poorer EF increased the risk of multiple falls. This relationship was mediated by reaction time and postural sway,suggesting cognitively impaired older people with poorer EF may benefit from fall prevention programs targeting these mediating factors.

Self-reported chronic pain is associated with physical performance in older people leaving aged care rehabilitation.

Pereira LS, Sherrington C, Ferreira ML, Tiedemann A, Ferreira PH, Blyth FM, Close JC, Taylor M, Lord SR

The impact of pain on the physical performance of patients in aged care rehabilitation is not known. The study sought to assess 1) the prevalence of pain in older people being discharged from inpatient rehabilitation; 2) the association between self-reported pain and physical performance in people being discharged from inpatient rehabilitation; and 3) the association between self-reported pain and physical performance in this population, after adjusting for potential confounding factors. One-third of participants reported chronic pain, and close to one-fifth reported that this pain interfered with daily activities. Chronic pain was associated with impaired physical performance, and this relationship persisted after adjusting for likely confounding factors.

Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults.

Taylor ME, Delbaere K, Lord SR, Mikolaizak AS, Brodaty H, Close JC

This study identified several risk factors of falls in older people with cognitive impairment, a number of which are potentially modifiable. Future research involving targeted interventions addressing medication use, balance, mood, and functional performance may prove useful for fall prevention in this population.

A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia.

Wesson J, Clemson L, Brodaty H, Lord S, Taylor M, Gitlin L, Close J

The pilot study was feasible and acceptable to people with mild dementia and their carers. The lessons learnt included: recruitment for a larger trial will require multiple approaches; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change; strategies to ensure an adequate dosage of exercise should be further explored. We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication. A refined intervention should be tested in a randomised trial with an adequately powered sample size.

Validation of the Iconographical Falls Efficacy Scale in cognitively impaired older people.

Delbaere K, Close JC, Taylor M, Wesson J, Lord SR

Icon-FES is the first measure of fear of falling that compensates for reduced abstract abilities by using pictures to match the verbal descriptions. This study supports its feasibility, reliability, and validity to assess fear of falling in people with moderate cognitive impairment or dementia living in the community. Compared with Falls Efficacy Scale-International, Icon-FES was better at identifying participants with higher fall risk and did not show a floor effect likely due to a greater range of physically challenging activities.

Gait parameter risk factors for falls under simple and dual task conditions in cognitively impaired older people.

Taylor ME, Delbaere K, Mikolaizak AS, Lord SR, Close JC

Impaired gait may contribute to the increased rate of falls in cognitively impaired older people. We investigated whether gait under simple and dual task conditions could predict falls in this group. The study sample consisted of 64 community dwelling older people with mild to moderate cognitive impairment. Participants walked at their preferred speed under three conditions: (a) simple walking, (b) walking while carrying a glass of water and (c) walking while counting backwards from 30. Spatiotemporal gait parameters were measured using the GAITRite(®) mat. Falls were recorded prospectively for 12months with the assistance of carers. Twenty-two (35%) people fell two or more times in the 12month follow-up period. There was a significant main effect of gait condition and a significant main effect of faller status for mean value measures (velocity, stride length, double support time and stride width) and for variability measures (swing time variability and stride length variability). Examination of individual gait parameters indicated that the multiple fallers walked more slowly, had shorter stride length, spent longer time in double support, had a wider support width and showed more variability in stride length and swing time (p<0.05). There was no significant interaction between gait condition and faller status for any of the gait variables. In conclusion, dual task activities adversely affect gait in cognitively impaired older people. Multiple fallers performed worse in each gait condition but the addition of a functional or cognitive secondary task provided no added benefit in discriminating fallers from non-fallers with cognitive impairment.

Gait impairment and falls in cognitively impaired older adults: an explanatory model of sensorimotor and neuropsychological mediators.

Taylor ME, Ketels MM, Delbaere K, Lord SR, Mikolaizak AS, Close JC

to explore the associations between spatiotemporal gait parameters and falls in cognitively impaired older people and to investigate whether sensorimotor and neuropsychological factors mediate the association between gait performance and falls. the findings indicate that slow and variable gait patterns increase the risk of falls in cognitively impaired older adults. Further, the association between gait and falls seems to be mediated in large by reduced sensorimotor functioning. Further research is needed to investigate whether interventions aimed at improving gait and/or sensorimotor fall risk factors, such as strength and balance, can prevent falls in cognitively impaired older adults.

Physiological fall risk factors in cognitively impaired older people: a one-year prospective study.

Taylor ME, Lord SR, Delbaere K, Mikolaizak AS, Close JC

These findings indicate poor performance on physiological fall risk factors, particularly balance, increases the risk of falls in older cognitively impaired people.

Physical impairments in cognitively impaired older people: implications for risk of falls.

Taylor ME, Delbaere K, Lord SR, Mikolaizak AS, Close JC

Fall risk in the CIG was significantly increased due to multiple physical impairments. Physical profiles provide a means of quantifying the extent of impairment in older people with cognitive impairment and potential direction for targeting interventions for reducing fall risk.

Older people presenting to the emergency department after a fall: a population with substantial recurrent healthcare use.

Close JC, Lord SR, Antonova EJ, Martin M, Lensberg B, Taylor M, Hallen J, Kelly A

To document patient characteristics, care pathways, healthcare use and costs of fall-related emergency department (ED) presentations by older adults. Older fallers presenting to the ED consume significant healthcare resources and are an easily identifiable high-risk population. They may benefit from systematic fall-risk assessment and tailored fall-prevention interventions.

A simple tool predicted probability of falling after aged care inpatient rehabilitation.

Sherrington C, Lord SR, Close JC, Barraclough E, Taylor M, O'Rourke S, Kurrle S, Tiedemann A, Cumming RG, Herbert RD

To develop and internally validate a falls prediction tool for people being discharged from inpatient aged care rehabilitation. After external validation, this simple tool could be used to quantify the probability with which an individual will fall in the 3 months after an aged care rehabilitation stay. It may assist in the discharge process by identifying high-risk individuals who may benefit from ongoing assistance or intervention.

Development of a tool for prediction of falls in rehabilitation settings (Predict_FIRST): a prospective cohort study.

Sherrington C, Lord SR, Close JC, Barraclough E, Taylor M, Oâ Rourke S, Kurrle S, Tiedemann A, Cumming RG, Herbert RD

To develop and internally validate a simple falls prediction tool for rehabilitation settings. This tool provides a simple way to quantify the probability with which an individual patient will fall during a rehabilitation stay.

Mobility-related disability three months after aged care rehabilitation can be predicted with a simple tool: an observational study.

Sherrington C, Lord SR, Close JC, Barraclough E, Taylor M, Cumming RG, Herbert RD

Mobility-related disability 3 months after discharge from inpatient rehabilitation is common and can be predicted easily with a clinical tool.