One in three community dwelling people over age 65 and one in two over age 80 fall each year. The consequences of falls among older adults are often devastating, resulting in loss of independence, institutionalization and premature mortality. Falls also are responsible for greater than 20 billion dollars a year in healthcare costs in the United States. Although many fall prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest. Current falls research in aging is mostly focused on clinical predictors of falls and there is a knowledge gap regarding underlying biological and neural mechanisms of falls. Emerging evidence from our and other studies implicates biological derangements in inflammation, oxidative stress, and vascular pathways in the occurrence of disorders of gait, balance, and cognition, which are major risk factors for falls in older adults. We hypothesize that abnormal biological pathways initiate atherosclerosis leading to cerebral vascular damage that increases risk of falls in older adults. We draw together a multidisciplinary team to conduct high-quality research to establish biological and neural mechanisms of falls building on our extensive cognitive and mobility research. We will cross-enroll 530 participants, age 65 and older, from the ongoing Central Control of Mobility in Aging study offering a cost and time efficient strategy to study biological and neural mechanisms of falls. This proposal will employ rigorous clinical assessments, many developed and validated in our other aging studies, to assess fall risk. We propose the following three synergistic aims focusing on our common theme of biological and neural contributions to falls in aging. 1). Determine biological mechanisms (inflammation, oxidative stress, and vascular pathways) contributing to falls. 2). Establish contributions of central microvascular pathology to fall risk using state of the art neuroimaging techniques. 3). Establish the contribution of the prefrontal cortex to falls using an innovative functional near infrared spectroscopy (fNIRS), that enables imaging during walking. While biological risk factors for falls are potentially modifiable, the paucity of data is a critical barrier for translation to clinical interventions. While many fal prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest in research settings and even less so in the real world. A deeper understanding of underlying biological mechanisms and neural substrates for falls may lead to more efficient risk identification and improve the effectiveness of current interventions for fallsin older adults.

Public Health Relevance

One in three community dwelling people over age 65 and one in two over age 80 fall each year. The consequences of falls among older adults are often devastating and result in loss of independence, institutionalization and premature mortality. Falls also are responsible for greater than 20 billion dollars a year in healthcare costs in the United States. While many fall prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest. Current falls research is mostly focused on clinical predictors of falls and there is a knowledge gap regarding the underlying biological mechanisms of falls in older adults. Moreover, the biological and neural risk factors for falls are potentially modifiable, and the paucity of data is a critical barrier for translation to clinical interventions. We propose to examine biological and neural mechanisms of falls in aging building on our extensive cognitive and mobility research.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
1R01AG044007-01A1
Application #
8579322
Study Section
Aging Systems and Geriatrics Study Section (ASG)
Program Officer
Chen, Wen G
Project Start
2013-09-01
Project End
2018-05-31
Budget Start
2013-09-01
Budget End
2014-05-31
Support Year
1
Fiscal Year
2013
Total Cost
$674,913
Indirect Cost
$266,687
Name
Albert Einstein College of Medicine
Department
Neurology
Type
Schools of Medicine
DUNS #
110521739
City
Bronx
State
NY
Country
United States
Zip Code
10461
Mahoney, Jeannette R; Holtzer, Roee; Izzetoglu, Meltem et al. (2016) The role of prefrontal cortex during postural control in Parkinsonian syndromes a functional near-infrared spectroscopy study. Brain Res 1633:126-38
Verghese, Joe (2016) Person-Centered Fall Risk Awareness Perspectives: Clinical Correlates and Fall Risk. J Am Geriatr Soc 64:2528-2532
Pillemer, Sarah C; Holtzer, Roee (2016) The differential relationships of dimensions of perceived social support with cognitive function among older adults. Aging Ment Health 20:727-35
Holtzer, Roee; Verghese, Joe; Allali, Gilles et al. (2016) Neurological Gait Abnormalities Moderate the Functional Brain Signature of the Posture First Hypothesis. Brain Topogr 29:334-43
Allali, Gilles; Ayers, Emmeline I; Verghese, Joe (2016) Motoric Cognitive Risk Syndrome Subtypes and Cognitive Profiles. J Gerontol A Biol Sci Med Sci 71:378-84
Allali, G; Annweiler, C; Blumen, H M et al. (2016) Gait phenotype from mild cognitive impairment to moderate dementia: results from the GOOD initiative. Eur J Neurol 23:527-41
Mahoney, Jeannette R; Dumas, Kristina; Holtzer, Roee (2015) Visual-Somatosensory Integration is Linked to Physical Activity Level in Older Adults. Multisens Res 28:11-29
Allali, Gilles; Ayers, Emmeline I; Verghese, Joe (2015) Multiple modes of assessment of gait are better than one to predict incident falls. Arch Gerontol Geriatr 60:389-93
Blumen, Helena M; Holtzer, Roee; Brown, Lucy L et al. (2014) Behavioral and neural correlates of imagined walking and walking-while-talking in the elderly. Hum Brain Mapp 35:4090-104
Mahoney, Jeannette R; Verghese, Joe; Holtzer, Roee et al. (2014) The evolution of mild parkinsonian signs in aging. J Neurol 261:1922-8

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