Falling of older adults with cognitive impairment: a new home environment evaluation chart and a preliminary examination in the Wakuya Project

Sugawara, Tomohiro; Kumai, Keiichi; Shoji, Miwako; Meguro, Kenichi

doi:10.1590/1980-5764-DN-2022-0009

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2022-0009 copy

Falling of older adults with cognitive impairment: a new home environment evaluation chart and a preliminary examination in the Wakuya Project

Queda de idosos com comprometimento cognitivo: uma nova ficha de avaliação do ambiente domiciliar e um exame preliminar no Projeto Wakuya

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

It is important to evaluate the home environment because most fractures in older adults are caused by falls indoors. However, previous studies have not separated individual abilities from environments. Also, the interrelationship between falls, cognitive function, and home environments has not been clarified.

Objectives:

The purpose of this study was to develop an evaluation method specific to the home environment and examine the effects of environment and cognitive impairment on falls.

Methods:

This was a case-control study analyzing 95 older adults living in the community. A Visiting Checklist for the Home Environment (VICHe) was developed and examined for reliability and validity. Inter-rater reliability (IRR) was examined by determining Cohen's kappa and the intra-class correlation coefficient. Guttman's split-half method was used for internal consistency, and Cronbach's alpha coefficient was obtained. Criterion-related validity was confirmed by Spearman's rank correlation coefficient with the Fall Risk Index's (FRI) total score of the environmental factor items. As a preliminary study, trends in the number of falls by cognitive function and home environment were examined.

Results:

The VICHe obtained validity, but the IRR was inadequate. In contrast, the version that focused on the on-floor environment (VICHe-OFI) showed IRR for all items and validity through correlations with the FRI. The number of fallers increased in the cognitive impairment group when the home environment was bad.

Conclusions:

Reliability and validity of the VICHe-OFI were obtained. Preliminary examination using this scale indicates that falls in the home of the elderly may be more affected by the home environment as cognitive function declines.

Keywords:
Dementia; Cognitive Dysfunction; Home Environment

	n	Healthy group (CDR 0)	Cognitive impairment group (CDR ≥0.5)	Statistic, p-value
Number of participants (men/women)	95	23 (11/12)	72 (27/45)	χ²=0.774, p>0.05
Age, years	95	80.5 (3.8)	81.7 (4.2)	U=951.5, p>0.05
Years of education, years	93	11.7 (1.7)	10.4 (2.3)	U=524.0, p=0.008^* * Notes: p<0.05;
BI, scores	94	100 (0.0)	97.5 (6.7)	U=655.5, p=0.022^* * Notes: p<0.05;
MMSE, scores	94	25.4 (3.1)	22.5 (3.8)	U=452.0, p=0.001^† † p<0.0036 (Bonferroni correction).
TMT-A, s	92	61.7 (19.4)	65.6 (28.9)	U=806.5, p>0.05
DS 90, correct answers	94	32.7 (9.3)	27.2 (10.2)	t=2.291, p=0.024^* * Notes: p<0.05;
DS 120, correct answers	94	43.2 (11.7)	36.8 (13.9)	t=2.004, p=0.048^* * Notes: p<0.05;
Grip strength, kg	93	24.0 (7.3)	21.0 (7.4)	t=1.777, p>0.05
Right OLS, s	93	27.1 (24.3)	12.9 (19.5)	U=376.0, p<0.001^† † p<0.0036 (Bonferroni correction).
Left OLS, s	93	20.1 (21.5)	9.7 (14.9)	U=484.0, p=0.004^† † p<0.0036 (Bonferroni correction).
6 mw, m/s	93	1.4 (0.2)	1.2 (0.3)	U=499.0, p=0.006^* * Notes: p<0.05;
TUG, s	93	8.7 (1.4)	11.3 (4.9)	U=1089.5, p=0.011^* * Notes: p<0.05;
FRI, scores	94	4.8 (3.0)	8.2 (3.8)	t=-3.975, p<0.001^† † p<0.0036 (Bonferroni correction).
Estimated PA/day, METs	88	233.2 (243.8)	201.9 (256.8)	U=610.5, p>0.05
Daily activity at home, items	88	7.6 (3.1)	7.0 (2.8)	U=605.0, p>0.05
Number of rooms used, rooms	95	11.0 (0.8)	10.4 (1.3)	U=588.0, p=0.029^* * Notes: p<0.05;

Visiting Checklist on Home Environment (VICHe)		All items (98 items)	On-floor improvement (OFI) (7 items)
Reliability	Cohen's kappa	κ>0.61: 43 items	κ=0.62–1.00
	ICC (2, 2)	p=0.97 (95%CI 0.88–0.99)	p=0.87 (95%CI 0.54–0.99)
	Guttman's split-half method	G=0.98	G=0.34
	Cronbach's α	α=0.62	α=0.45
Validity	Correlation with FRI environmental scores	r_s=0.21^* * Note: p<0.05.	r_s=0.17
Validity	Correlation with FRI family environmental scores	r_s=0.18	r_s=0.20^* * Note: p<0.05.

	n	No fall	Fall	Statistic	p-value
Number of participants (men/women)	95	67 (29/38)	28 (9/19)	χ²=1.021	p=0.312
Age, years	95	80.6 (3.8)	83.5 (4.0)	U=1319.0	p=0.002^* * Notes: p<0.0036 (Bonferroni correction);
Years of education, years	93	10.7 (2.2)	10.7 (2.2)	U=833.0	p=0.729
BI, scores	94	99.0 (4.8)	96.1 (7.6)	U=653.0	p=0.000^* * Notes: p<0.0036 (Bonferroni correction);
MMSE, scores	94	23.6 (3.8)	22.5 (3.9)	U=770.5	p=0.203
TMT-A, s	92	61.5 (22.8)	72.2 (33.8)	U=1017.0	p=0.232
DS 90, correct answers	94	30.3 (10.1)	24.5 (9.1)	t=2.573	p=0.012^† † p<0.05.
DS 120, correct answers	94	40.5 (13.5)	33.4 (12.8)	t=2.362	p=0.020^† † p<0.05.
Grip strength, kg	93	22.9 (6.8)	18.9 (7.7)	t=2.541	p=0.013^† † p<0.05.
Right OLS, s	93	20.7 (24.0)	6.6 (8.5)	U=454.0	p=0.000^* * Notes: p<0.0036 (Bonferroni correction);
Left OLS, s	93	15.5 (19.6)	4.8 (5.1)	U=557.0	p=0.003^* * Notes: p<0.0036 (Bonferroni correction);
6 mw, m/s	93	1.3 (0.3)	1.0 (0.4)	U=431.0	p=0.000^* * Notes: p<0.0036 (Bonferroni correction);
TUG, s	93	9.5 (2.7)	13.4 (6.3)	U=1316.5	p=0.001^* * Notes: p<0.0036 (Bonferroni correction);
FRI, scores	94	6.5 (3.5)	9.5 (4.0)	t=-3.624	p=0.000^* * Notes: p<0.0036 (Bonferroni correction);
Estimated PA/day, METs	88	240.8 (262.9)	126.7 (205.2)	U=516.0	p=0.018^† † p<0.05.
Daily activity at home, items	88	7.3 (2.8)	6.8 (3.1)	U=672.5	p=0.368
Number of rooms used, rooms	95	10.7 (1.2)	10.1(1.3)	U=690.0	p=0.034^† † p<0.05.

	n	No fall	Fall	Statistic	p-value
Number of participants (men/women)	53	30 (12/18)	23 (7/16)	χ²=0.518	p>0.05
Age, years	53	81.3 (3.7)	83.4 (4.3)	U=443.5	p=0.038
Years of education, years	51	9.9 (2.4)	10.7 (2.4)	U=361.5	p>0.05
BI, scores	52	99.0 (4.7)	95.4 (8.2)	U=227.0	p=0.0030^* * Note: p<0.0036 (Bonferroni correction).
MMSE, scores	53	22.4 (4.2)	22.6 (3.8)	U=356.0	p>0.05
TMT-A, s	51	61.7 (17.6)	71.0 (27.7)	U=377.0	p>0.05
DS 90, correct answers	53	27.6 (11.1)	23.8 (8.9)	t=-1.333	p>0.05
DS 120, correct answers	53	37.0 (14.8)	32.9 (13.0)	t=-1.051	p>0.05
Grip strength, kg	52	21.6 (6.0)	18.3 (7.9)	t=-1.745	p=0.043
Right OLS, s	52	12.2 (17.7)	6.8 (9.1)	U=259.0	p>0.05
Left OLS, s	52	7.7 (10.4)	5.1 (5.5)	U=284.0	p>0.05
6 mw, m/s	52	1.2 (0.3)	1.0 (0.4)	U=186.5	p=0.0035^* * Note: p<0.0036 (Bonferroni correction).
TUG, s	52	10.7 (3.3)	13.8 (6.3)	U=440.0	p=0.025
FRI, scores	53	7.5 (3.7)	9.8 (4.1)	t=2.159	p=0.018
Estimated PA/day, METs	47	256.4 (296.9)	122.6 (215.8)	U=162.5	p=0.012
Daily activity at home, items	47	7.1 (2.6)	6.7 (3.0)	U=221.5	p>0.05
Number of rooms used, rooms	53	10.6 (1.4)	10.0 (1.3)	U=264.0	p=0.018

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: Kenichi Meguro; Email: kenichi.meguro.e6@tohoku.ac.jp.