Open Access Highly Accessed Research article

Executive function predicts risk of falls in older adults without balance impairment

Teresa J Buracchio12*, Nora C Mattek13, Hiroko H Dodge13, Tamara L Hayes34, Misha Pavel34, Diane B Howieson1 and Jeffrey A Kaye123

Author Affiliations

1 Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR-131, Portland, OR 97239 USA

2 Neurology Service, Portland Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239 USA

3 Oregon Center for Aging & Technology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA

4 Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239 USA

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BMC Geriatrics 2011, 11:74  doi:10.1186/1471-2318-11-74

Published: 9 November 2011



Executive dysfunction has previously been found to be a risk factor for falls. The aim of this study is to investigate the association between executive dysfunction and risk of falling and to determine if this association is independent of balance.


Participants were 188 community-dwelling individuals aged 65 and older. All participants underwent baseline and annual evaluations with review of health history, standardized neurologic examination, neuropsychological testing, and qualitative and quantitative assessment of motor function. Falls were recorded prospectively using weekly online health forms.


During 13 months of follow-up, there were 65 of 188 participants (34.6%) who reported at least one fall. Univariate analysis showed that fallers were more likely to have lower baseline scores in executive function than non-fallers (p = 0.03). Among participants without balance impairment we found that higher executive function z-scores were associated with lower fall counts (p = 0.03) after adjustment for age, sex, health status and prior history of falls using negative binomial regression models. This relationship was not present among participants with poor balance.


Lower scores on executive function tests are a risk factor for falls in participants with minimal balance impairment. However, this effect is attenuated in individuals with poor balance where physical or more direct motor systems factors may play a greater role in fall risk.