Executive control deficits as a prodrome to falls in healthy older adults: A prospective study linking thinking, walking, and falling

Talia Herman, Anat Mirelman, Nir Giladi, Avraham Schweiger, Jeffrey M. Hausdorff

Research output: Contribution to journalArticlepeer-review

334 Scopus citations


Background.Executive function (EF) deficits may increase fall risk, even among older adults with no overt cognitive impairment. Indeed, the effects of dual tasking (DT) on gait, a challenge to executive control, are more exaggerated in persons with a history of falls. Prospective evidence is, however, lacking.Methods.We prospectively evaluated whether EF predicts falls over a 2-year period among 262 community-living, healthy, and well-functioning older adults, focusing on the 201 who reported no falls during the previous year. At baseline, participants completed a computerized cognitive battery that generated an index of EF and other cognitive domains. Gait was assessed using performance-based tests and by quantifying walking during single- and dual-task conditions.Results.The 262 participants (mean age: 76.3 ± 4.3 years, 60.3% women) had intact cognitive function on testing, a low comorbidity index, and good mobility. The EF index predicted future falls. Among those who reported no previous falls, participants in the worst EF quartile were three times more likely to fall during the 2 years of follow-up, and they were more likely to transition from nonfaller to faller sooner. DT gait variability also predicted future falls and multiple falls, whereas other measures of cognitive function, gait, and mobility did not.Conclusions.Among healthy older adults, individuals with poorer EF are more prone to falls. Higher-level cognitive functions such as those regulated by the frontal lobes are apparently needed for safe everyday navigation that demands multitasking. Optimal screening, early detection, and treatment of falls should, apparently, also target this cognitive domain.

Original languageEnglish
Pages (from-to)1086-1092
Number of pages7
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume65 A
Issue number10
StatePublished - 1 Oct 2010
Externally publishedYes


  • Aging
  • Cognitive impairment
  • Executive function
  • Falls
  • Gait
  • Gait variability

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology


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