Chaired by Dr. Manuel Montero-Odasso, Scientist at Lawson Health Research Institute, a group of 96 experts from 39 countries and 36 societies and agencies in Geriatric Medicine and Aging have come together to develop the “World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative.”

Published in Age and Ageing, the official journal of the British Geriatric Society, the guidelines provide recommendations to clinicians working with older adults to identify and assess fall risks.

“The global population is aging. Thanks to social and medical advances, some chronic conditions are diminishing proportionally. This is not the case for falls,” says Dr. Montero-Odasso, who is also a Geriatrician at St. Joseph’s Health Care London’s Parkwood Institute and a Professor at Western University’s Schulich School of Medicine & Dentistry. “Unfortunately, falls and related injuries among older adults are increasing and there is no sign of future decline.”

With new evidence and studies released since previous guidelines were published more than a decade ago, experts felt it was the right time for an update and an opportunity to incorporate a worldwide perspective

“Besides the rigorous methodology that 11 international working groups followed to provide new meta-analyses, including several new Cochrane collaborations, this World Falls Guidelines are, to the best of our knowledge, the first clinical practice guidelines in fall prevention to include a panel of older adults with lived experience in falls and mobility problems,” says Dr. Montero-Odasso. “They provided feedback, comments and opinions on our recommendations, making them considerably better and with wider applicability.”

Some key themes in the recommendations include: 

• Falls can be prevented, but it requires multidisciplinary management.
• Preventing falls has wider benefits for quality of life.
• Fall risk can be assessed by trained clinicians with simple resources. 
• A combination of interventions, including specific exercises to improve balance and strength, when delivered correctly, can effectively reduce fall risk in older adults.

Dr. Montero-Odasso says there was enough evidence to suggest that a global approach is needed to prevent falls in older adults and that “low risk does not mean no risk.” Even active older adults who are low risk should work on preventing loss of mobility and falls.

The next steps are for the guidelines to continue obtaining formalized endorsement of all the groups involved in the initiative and then for the guidelines to be fully implemented.

You can read the full guidelines here. 

In a new study, researchers at Lawson Health Research Institute and Western University are demonstrating that gait, or motion testing, while simultaneously performing a cognitively demanding task can be an effective predictor of progression to dementia and eventually help with earlier diagnosis. To date, there is no definitive way for health care professionals to forecast the onset of dementia in a patient with memory complaints.

Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph’s Health Care London, and associate professor in the Division of Geriatric Medicine at Western University’s Schulich School of Medicine & Dentistry, is leading the “Gait and Brain Study.” His team is assessing up to 150 seniors with mild cognitive impairment (MCI), a slight decline of memory and other mental functions which is considered a pre-dementia syndrome, in order to detect an early predictor of cognitive and mobility decline and progression to dementia.

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Dr. Montero-Odasso with study participant, Roy Bratty

“Finding methods to detect dementia early is vital to our ability to slow or halt the progression of the disease,” says Dr. Montero-Odasso. The study, funded by the Canadian Institutes of Health Research, followed participants for six years and included bi-annual visits. Researchers asked participants to walk while simultaneously performing a cognitively demanding task, such as counting backwards or naming animals. Those individuals with MCI that slow down more than 20 per cent while performing a cognitively demanding task are at a higher risk of progressing to dementia.

“While walking has long been considered an automatic motor task, emerging evidence suggests cognitive function plays a key role in the control of walking, avoidance of obstacles and maintenance of navigation,” says Dr. Montero-Odasso. “We believe that gait, as a complex brain-motor task, provides a golden window of opportunity to see brain function.”

The “gait cost,” or speed at which participants completed a single task (walking) versus a dual-task, was higher in those MCI individuals with worse episodic memory and who struggle with executive functions such as attention keeping and time management.

“Our results reveal a ‘motor signature’ of cognitive impairment that can be used to predict dementia,” adds Dr. Montero-Odasso. “It is conceivable that we will be able to diagnose Alzheimer’s disease and other dementias before people even have significant memory loss. Our hope is to combine these methods with promising new medications to slow or halt the progression of MCI to dementia.”

The study, “Association of Dual-Task Gait with Incident Dementia in Mild Cognitive Impairment”, was published in the journal, JAMA NEUROLOGY.

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Members of the study’s research team, from left to right: Korbin Blue, Research Assistant (Co-op Student); Yanina Sarquis-Adamson, Lab Research Assistant; Frederico Faria, Post-Doctoral Fellow; Dr. Montero Odasso, Director, Gait and Brain Lab; research participant; Alanna Black, Lab Research Coordinator; Stephanie Cullen, Research Assistant (Undergraduate Student); and, Navena Lingum, Research Assistant (Master Student).