ROLE OF DUAL-TASK COST IN PREDICTING FALL RISK AMONG OLDER ADULTS RECEIVING INSTITUTIONAL CARE

ROLE OF DUAL-TASK COST IN PREDICTING FALL RISK IN OLDER ADULTS RECEIVING INSTITUTIONAL CARE: A CROSS-SECTIONAL CLASSIFICATION MODEL

There is a need for studies that examine the role of dual-task cost in predicting fall risk among older adults receiving institutional care and that develop classification models that can be used in clinical practice. The planned study aims to determine the discriminative ability of dual-task cost in identifying fall risk and to establish clinically meaningful cutoff values. In this respect, the study will both contribute to a more sensitive assessment of fall risk and provide a scientific basis for a low-cost, practical, and applicable screening approach.

Study Overview

• Status: Not yet recruiting
• Conditions: Older Adults (65 Years and Older); Dual Task Cost; INSTITUTIONAL CARE; Falls in Old Age

Detailed Description

Changes in motor and cognitive functions that occur with the aging process negatively affect individuals' mobility and balance performance, there by increasing the risk of falls. Today, it is widely accepted that gait and postural control are not merely motor processes, but also require the active participation of attention and executive cognitive processes. In this context, the dual-task approach-wherein an individual simultaneously performs a second cognitive or motor task during gait-has become a widely utilized method for evaluating cognitive-motor interaction in older adults (Muir-Hunter & Wittwer, 2016). Performance degradation under dual-task conditions is explained by the individual having to allocate limited cognitive resources between two tasks, a phenomenon that becomes particularly more pronounced in older adults. Studies in the literature examining the relationship between dual-task performance and falls demonstrate that performance changes occurring under dual-task conditions are more strongly associated with falls compared to single-task conditions (Muir-Hunter & Wittwer, 2016). However, there is still no full consensus on which protocol, which secondary task, and which performance outcome are clinically most meaningful in dual-task assessments. The dual-task Timed Up and Go (TUG) test stands out as a practical and clinically applicable method for evaluating functional mobility. Tang et al. (2014) showed that motor dual-task TUG performance was superior to single-task TUG in discriminating the state of prefrailty in middle-aged and older adults. In the same study, it was reported that the ROC analysis of dual-task TUG performance showed significant discriminative power, and slow performance significantly increased the likelihood of prefrailty. These findings reveal that dual-task-based measurements are not only explanatory but also possess the potential to serve as classification tools and contribute to clinical decision-making processes. The relationship between cognitive functions and dual-task performance is another notable topic in the literature. It has been shown that both gait performance and cognitive performance deteriorate more markedly under dual-task conditions in individuals with mild cognitive impairment (Muir-Hunter & Wittwer, 2016). Furthermore, it is indicated that the type and difficulty level of the secondary task used have significant effects on dual-task performance. This situation highlights the critical importance of standardizing dual-task assessments. Fear of falling is also a major factor affecting functional performance in older adults. In a study conducted by Sapmaz et al. (2021) on institutionalized older adults, it was shown that individuals with a fear of falling had worse single-task and dual-task TUG performances; additionally, their balance and mobility levels were also lower. These findings demonstrate that the fear of falling is not merely a psychological condition but is closely related to functional capacity. However, a large part of current studies remains at the group-comparison level, and analyses modeling the role of dual-task performance in predicting clinical fall risk remain limited. Recent studies show that dual-task assessments are highly sensitive in uncovering hidden functional impairments in older adults (Falbo et al., 2016). Especially in frail populations such as institutionalized older adults, dual-task performance is thought to be closely associated with falls. However, most of these studies either feature intervention-based designs or are limited strictly to correlation analyses. A prominent gap in the literature is the scarcity of studies evaluating fall risk via dual-task cost (which represents the relative change compared to single-task performance) rather than absolute measurements of dual-task performance. Because dual-task cost reflects the relative deterioration in an individual's performance under cognitive load, it may serve as a clinically more meaningful indicator. Nevertheless, studies examining the role of dual-task cost in discriminating fall risk and establishing a cross-sectional classification model based on this variable remain highly limited.

• Study Type: Observational
• Enrollment (Estimated): 52

Contacts and Locations

• Study Contact: Name: Mine PEKESEN KURTÇA, ASISTANT PROFESSOR, PhD; Phone Number: +903623121919; Email: mine.pekesenkurtca@omu.edu.tr

Study Locations

• Turkey (Türkiye)
  • Samsun, Turkey (Türkiye), 55270
    • ONDOKUZ MAYIS UNIVERSITY, Samsun, Atakum 55270
    • Contact: MİNE PEKESEN P KURTÇA, PhD; Phone Number: +903623121919; Email: mine.pekesenkurtca@omu.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The target population for this cross-sectional study consists of older adults residing in long-term care facilities and nursing homes. Participants will be selected based on the predefined inclusion criteria. These eligibility criteria are designed to ensure safety, cognitive comprehension, and physical compliance during the functional and dual-task assessments.

Description

Inclusion Criteria:

• Being 65 years of age or older
• Residing in a nursing home or care institution for at least 1 month
• Ability to walk a distance of at least 10 meters
• Ability to ambulate independently with an assistive device (e.g., cane, walker), if needed
• Having a Montreal Cognitive Assessment (MoCA) score of 18 or above
• Ability to understand and execute single- and two-step verbal commands
• Voluntary agreement to participate in the study and providing informed consent

Exclusion Criteria:

• History of stroke or major orthopedic surgery within the past 6 monthsPresence of Parkinson's disease Stage ≥3 (Hoehn & Yahr) or any other neurological condition significantly affecting gait
• Having a MoCA score below 18
• History of fracture within the past 3 months
• Presence of severe pain affecting gait during test administration (Visual Analog Scale [VAS] ≥ 7)
• Uncontrolled hypertension (≥ 180/100 mmHg) or unstable cardiovascular status
• Active vestibular disease or a history of syncope within the past 3 months
• Visual or hearing impairment severe enough to impede test execution
• Inability to walk/ambulate without the physical assistance of another person

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Information Form	The following participant information will be recorded using a clinical information form developed by the researcher: Age (years) Sex (male/female) Educational status(illitirate/primare education/secondary education/high school or higher) Length of institutional stay( months and years) Height(cm) Weight(kg) Body mass index BMI (kg/m²) Number of chronic diseases and comorbidities Number of daily medications Use of assistive devices	Single assessment (baseline)
Fall Assesment	Fall history (Tripping, Slipping, Loss of Balance, Transposition) Fall History Questionnaire A fall will be defined as an event which results in an individual coming to rest inadvertently on the ground, floor, or a lower level. In this context, the following information will be recorded: Presence of a fall within the last 12 months (yes/no) Total number of falls within the last 12 months Presence of a fall within the last month (yes/no) Primary cause of the last fall Location of the last fall Injury status resulting from the last fall	Single assessment (baseline)
Montreal Cognitive Assessment (MoCA)	This assessment will be utilized to determine whether participants possess the cognitive competence to understand and execute the study protocol. Individuals with a MoCA score below 18 will be excluded from the study.	Single assessment (baseline)
Timed Up and Go Test (TUG)	This test will be utilized to assess the functional mobility of the participants. The participant will be instructed to rise from a standard-height chair, walk a distance of 3 meters, turn around, return to the chair, and sit back down. The duration of the test will be recorded in seconds.	Single assessment (baseline)
Dual-task Timed Up and Go Test (TUG-DT)	This test will be administered to evaluate the dual-task performance of the participants. Participants will be instructed to simultaneously perform a cognitive task during the TUG test. Cognitive Task Animal naming will be utilized as the cognitive task under the dual-task condition. The participant will be asked to name as many animals as possible while walking. All participants will be assigned the same task, and standard verbal instructions will be utilized.	Single assessment (baseline)
Dual-Task Cost (DTC)	The dual-task cost will be calculated using the single-task TUG and dual-task TUG durations according to the following formula: DTC (%)"=(TUG_DT-TUG)/TUG×100 An increase in the DTC percentage will indicate greater performance degradation under the dual-task condition.	Single assessment (baseline)
Tinetti Performance-Oriented Mobility Assessment (POMA)	This assessment will be utilized to evaluate the balance and gait performance of the participants. The total Tinetti score will be used to determine the risk of falls. Operational Definition of Fall Risk Fall risk will be operationalized in two ways in the study: As a continuous variable: Total Tinetti score As a binary classification variable: Risk group based on the Tinetti score Classification based on the Tinetti score will be structured as follows: Low fall risk: 25-28 points Increased fall risk: 24 points and below This binary classification will be utilized for the classification model and ROC analysis.	Single assessment (baseline)
Falls Efficacy Scale-International (FES-I)	This scale will be utilized to assess the participants' level of fear of falling as a descriptive and secondary variable. The FES-I score will not serve as a primary variable in the main model; however, it will be reported in descriptive analyses and secondary analyses as required.	Single assessment (baseline)

Collaborators and Investigators

• Sponsor: Ondokuz Mayıs University

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): November 1, 2026

Study Registration Dates

• First Submitted: May 16, 2026
• First Submitted That Met QC Criteria: June 3, 2026
• First Posted (Actual): June 8, 2026

Study Record Updates

• Last Update Posted (Actual): June 8, 2026
• Last Update Submitted That Met QC Criteria: June 3, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Functional mobility; Fall risk; Dual Task; Institutionalized older adults; Dual-task cost
• Other Study ID Numbers: 2026/276

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No