2019 Volume 6 Issue 1 Pages 35-46
【Objective】We aimed to clarify the mechanism of falls associated with cognitive decline by investigating the cognitive processes through which patients perceived and judged their own mobility.
【Methods】We assessed 304 patients with an average age of 82 (range, 65-97) years who were hospitalized in a community-based integrated care ward after acute-phase treatment. Pre-hospitalized mobility was assessed according to information from the family. Actual mobility (Functional Independence Measure [FIM] transfer and gait), perceived mobility (physical functioning subscale on SF-8), and cognitive function (Mini-Mental State Examination [MMSE]) scores for each patient were evaluated upon admission and discharge. The presence or absence of falls was assessed three months after discharge. The participants were divided into three (high, medium, and low) or two (high and low) groups according to MMSE scores. We analyzed the cognitive processes involved in the patients’ perception and judgment of their mobility using structural equation modeling, and investigated whether a discrepancy between actual and perceived mobility affected the occurrence of falls after discharge using binomial logistic regression analysis.
【Results】Structural equation modeling indicated that self-evaluated mobility was affected by actual mobility at the time of admission in the group with high MMSE scores, and was affected by pre-hospitalized mobility in the groups with medium and low MMSE scores. Binomial logistic regression results showed that a discrepancy between actual (at discharge) mobility and perceived (pre-hospitalized) mobility affected the occurrence of falls at three months after discharge in the group with low MMSE scores.
【Conclusion】After acute-phase treatment, elderly patients with cognitive decline overestimated their mobility based on the mental representation of their pre-hospitalized mobility, and the inaccurate perception can lead to risky judgment and an increased risk of falls.
