Dual-task gait performance among community-dwelling senior women: the role of balance confidence and executive functions.

BACKGROUND: Exploring factors that contribute to dual-task gait performance among seniors is of particular interest in falls prevention because dual-task-related gait changes are associated with increased falls risk. It is unclear currently which specific executive processes are most relevant to dual-task gait performance and whether "balance confidence" is independently associated with dual-task gait performance.

METHODS: A cross-sectional analysis of 140 senior women aged 65-75 years old. Balance confidence was assessed by the Activities-Specific Balance Confidence scale. Three key executive processes were assessed by standard neuropsychological tests: (i) set shifting, (ii) working memory, and (iii) response inhibition. Dual-task gait performance was assessed by the simple and complex versions of the walking while talking (WWT) test. Two linear regression models were constructed to determine the independent association of executive functions and balance confidence with: (i) simple WWT completion time and (ii) complex WWT completion time.

RESULTS: Balance confidence was independently associated with both simple and complex WWT completion times after accounting for age, time to walk 40 ft without talking, and global cognition. Set shifting was independently associated with complex WWT completion time; no executive processes were independently associated with simple WWT completion time.

CONCLUSIONS: This study highlights that balance confidence is independently associated with dual-task gait performance. Furthermore, executive functions do not play a significant role in dual-task gait performance when the concurrent cognitive load is low. Clinicians may need to consider balance confidence and executive functions in the assessment and rehabilitation of dual-task gait performance among community-dwelling seniors.