Dual-task testing to predict falls in community-dwelling older adults: a systematic review

Abstract Background Cognitive impairment increases fall risk in older adults. Dual-task testing is an accepted way to assess the interaction between cognition and mobility; however, there is a lack of evidence-based recommendations for dual-task testing to evaluate fall risk in clinical practice. Objectives To evaluate the association between dual-task testing protocols and future fall risk, and to identify the specific dual-task test protocols associated with elevated risk. Data sources MEDLINE, Pubmed and EMBASE electronic databases were searched from January 1988 to September 2013. Study selection Two independent raters identified prospective cohort studies (duration of at least 1 year) of dual-task assessment in community-dwelling participants aged ≥60 years, with ‘falls’ as the primary outcome. Study appraisal and synthesis methods Methodological quality was scored independently by two raters using a published checklist of criteria for evaluating threats to the validity of observational studies. Results Deterioration in gait during dual-task testing compared with single-task performance was associated with increased fall risk. Shortcomings within the literature significantly limit knowledge translation of dual-task gait protocols into clinical practice. Limitations There is a paucity of prospective studies on the association of dual-task gait assessment with fall risk. Conclusion and implications of key findings Changes in gait under dual-task testing are associated with future fall risk, and this association is stronger than that for single-task conditions. Limitations in the available literature preclude development of detailed recommendations for dual-task gait testing procedures in clinical practice to identify and stratify fall risk in older adults.