From the Emergency Department to Daily Life: A 12-Month Comparison of Fall Risk and Physical Function in Older Adults With and Without Mild Cognitive Impairment

Introduction Older adults with mild cognitive impairment (MCI) are at elevated risk for falls and related complications. However, longitudinal data on fall incidence and functional recovery in high-risk individuals following a severe fall remain limited. This study aimed to compare 12-month fall incidence, cognitive and physical function, and physical activity in older adults with and without probable MCI who presented to the emergency department (ED) after a severe fall but were not hospitalized. Methods Data was collected from the SeFallED study, a prospective observational study of community-dwelling older adults (≥60 years) presenting to the ED due to a fall and discharged within 72 hours of a fall. Participants were classified into older adults with and without probable MCI based on Montreal Cognitive Assessment scores (cut-off ≤24). Primary outcome were recurrent falls and those demanding medical attention, assessed monthly via telephone interviews over 12 months. Secondary outcomes included cognitive performance, physical function (Short Physical Performance Battery, gait speed, postural sway), life-space mobility, and physical activity (accelerometry, self-report). Results Older adults with probable MCI (n=116) were significantly more likely to experience a recurrent fall (52.6% vs. 36.5%; p=0.012) and a fall requiring medical attention (33.6% vs. 11.9%; p<0.001) than older adults without MCI (n=126), as shown by Chi-square tests. RM-ANCOVA indicated that cognitive performance improved in older adults with probable MCI over time, but no significant group differences emerged in physical function or physical activity. Life-space mobility remained consistently lower in older adults with probable MCI. Conclusion Despite comparable physical function, older adults with probable MCI are at substantially higher risk of experiencing recurrent falls, including falls requiring medical attention. Further research should investigate whether incorporating a cognitive screening in the ED and initiating secondary falls prevention strategies at the earliest opportunity can reduce fall incidence, particularly among older adults with MCI.