Nature and Science of Sleep (Mar 2021)

Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case–Control Study

  • Kirshner D,
  • Kizony R,
  • Gil E,
  • Asraf K,
  • Krasovsky T,
  • Haimov I,
  • Shochat T,
  • Agmon M

Journal volume & issue
Vol. Volume 13
pp. 329 – 338

Abstract

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Dani Kirshner,1 Rachel Kizony,2,3 Efrat Gil,1 Kfir Asraf,4 Tal Krasovsky,5,6 Iris Haimov,7 Tamar Shochat,8,* Maayan Agmon8,* 1Clalit Health Services; Faculty of Medicine, Technion, Haifa, Israel; 2Occupational Therapy Department, University of Haifa, Haifa, Israel; 3Occupational Therapy Department, Sheba Medical Center, Tel- Hashomer, Tel-Aviv, Israel; 4Department of Psychology, University of Haifa, Haifa, Israel; 5Physical Therapy Department, University of Haifa, Haifa, Israel; 6Pediatric Rehabilitation Department, Sheba Medical Center, Tel- Hashomer, Tel-Aviv, Israel; 7The Center for Psychobiological Research, Department of Psychology, The Max Stern Yezreel Valley College, Yezreel Valley, Israel; 8School of Nursing, Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel*These authors contributed equally to this workCorrespondence: Maayan Agmon Email [email protected] Objectives: To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia.Methods: Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann–Whitney U-tests.Results: Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p< 0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p< 0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48– 30.93 vs 7.81% IQR: 4.43– 14.82, p< 0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: − 0.89– 38.84 vs 15%, IQR: − 0.89– 38.84%, p=0.599).Conclusion: Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.Keywords: actigraphy, sleep quality, gait, dual-task, DT

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