EXECUTIVE FUNCTIONING AND PREDICTORS OF FALLS IN THE REHABILITATION SETTING

Objective: To examine the incremental utility of executive function te sts in the prediction of inpatient falls. Design: Evaluation of neurop sychologic and medical risk factors for fall was completed at admissio n. Inpatient falls were tabulated following discharge. Setting: A free standing, urban rehabilitation hospital. Patients: Ninety consecutive admissions to traumatic brain injury, orthopedic, and spinal cord inju ry wards. Age of the participants ranged from 17 to 73 years old. Main Outcome Measure: Incident reports of inpatient falls. Results: Standa rd multiple regression analyses indicated that measures of executive f unctioning sensitive to self-monitoring accounted for unique variance in falls beyond that explained by age and functional motor ability as assessed by the Functional Independence Measure. Visuospatial function ing, although not directly related to falls, was a significant predict or in combination with measures of executive functioning. Together, th ese variables accounted for 30.3% of the variance in inpatient falls ( multiple r = .55; p < .001). Conclusion: The findings suggest that the influence of motor and sensory impairments on falls are moderated, in part, by executive functioning. Patients with intact executive functi oning are less likely to act in ways that could result in a fall; thus , aggressive fall prevention measures may be unnecessary. In contrast, executive dysfunction may signal the need for intervention, even amon g patients whose profiles are unremarkable with regard to traditional risk factors for fall. (C) 1998 by the American Congress of Rehabilita tion Medicine and the American Academy of Physical Medicine and Rehabi litation.