Date of Award


Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

First Advisor

Meridee Danks


Accidental Falls -- prevention & control; Aged, 80 and over; Cognitive Dysfunction -- complications; Postural Balance; Risk Assessment; Risk Factors


Introduction: Falls are a common and devastating injury for the older adult. Fall programs, such as the Stepping On program, are used to educate, strengthen, and sequentially reduce the number of falls its participant's endure. The Stepping On program is a multifactorial fall prevention program that addresses: balance and strength exercises, visual impairments, home modifications, pharmacologic effects, and even assistive devices. One aspect that has been found to be influential on fall risk is cognition, in particular executive functioning during ambulation.

Purpose: The purpose of this study was to screen participants of the Stepping On program for unknown cognitive issues and balance deficits that are adding to their fall risk. This will be determined by having the participants perform the TUG and the COGTUG and assessing their results. Looking at the efficacy of performing the COG-TUG, 71% predictor of falls, this could be added to fall prevention programs to get a better understanding of the participants fall risk factors.

Methods: Of the 14 participants of the Stepping On Program, mean age 87.3,13 were assessed during Week 1, 9 assessed during Week 7, and 8 of the 14 were present during both Week 1 and Week 7 of the program. The participants performance of both the TUG and the COG-TUG was assessed in order to determine if an increase in time spent to complete the TUG-COG by ≥ 10% was present. An increase of ten percent identifies those who are at a higher risk of falls with the addition of a task, it has also been shown to an indicator of cognitive deficits. Individuals that required greater than 15 seconds to perform the COG-TUG are associated with an increased fall risk. Once this is determined it will be correlated with each individual's stated number of falls and their overall number of fall risk factors provided on their initial/post surveys.

Results: During Week 1 of the program 46% of the participants, 6 of the 13, had an increased COG-TUG time by 10% or more. During the Week 7 assessment the percentage jumped up to 56%, 5 of the 9. These results compared to their balance confidence, ABC scores, and surveys (UND Fall Risk Survey, CDC Fall Risk Survey) indicate no significant correlation. There was a significant correlation, p=.031, between their reported number of falls and cognition deficits shown during the Week 1 performance of the COG-TUG and TUG. Only one individual that partook in both Week 1 and Week 7 assessments reduced the percent change between the COG-TUG and the TUG, this same individual was still above the 15 second COG-TUG fall risk threshold.

Conclusions: The performance of the COG-TUG to assess for fall risk has been found effective in numerous studies. The data collected during this Stepping On program did not find the COG-TUG to be an effective measure of fall risk. However, with further modifications to performing and scoring the COG-TUG better results may be had, providing increased clarity to the effect of cognition on a participant's fall risk. This Stepping On program participation pool had many limitations which influenced the effectiveness of determining the correlation between fall risk and cognitive deficits. It is clear that cognition plays a role in an individual's ability to ambulate and multitask.