Division of Geriatrics

Biological and Neural Mechanisms of Falls

Dr. Joe Verghese research on biological reasons for falls

"Mr. K.", a moderately active, healthy 75-year-old man, enjoyed participating in social activities until one day, distracted by talking to his wife while walking, he suffered a fall. Though he did not sustain any major injuries, Mr. K. grew fearful of falling again and gradually became homebound.

Each year, one in three community-dwelling adults over age 65 and one in two adults over age 80 fall, with devastating results including loss of independence, institutionalization, and premature mortality. Falls cost the United States over 20 billion dollars a year in healthcare expenses. Research by Dr. Joe Verghese seeks to gain a deeper understanding of the biological mechanisms and nervous system components responsible for falls to improve the effectiveness of risk identification and fall prevention strategies.

"Identifying mechanisms and preventive strategies for falls has been recognized as a national research priority," said Dr. Verghese, Professor of Medicine (Geriatrics) and Neurology, Murray D. Gross Memorial Faculty Scholar in Gerontology, Director of the Resnick Gerontology Center at Einstein and Chief of the integrated Divisions of Cognitive and Motor Aging (Neurology) and Geriatrics (Medicine)

 
Dr. Joe Verghese chief of geriatrics and cognitive and motor aging neurology albert einstein college of medicine bronx ny
Joe Verghese, M.B., B.S.

Mobility, executive control, and fatigue are closely linked through the frontal cortex of the brain. In older adults, factors such as inflammation and oxidative stress in the body may initiate atherosclerosis (arterial blockage), leading to vascular damage in this part of the brain that in turn may increase risk of falls, according to Dr. Verghese. Current research has primarily focused on the clinical predictors of falls (gait changes or foot placement, for example), and fall prevention strategies based on this research have had limited success. "We are trying to shift the focus from clinical predictors of falls to underlying biological mechanisms, as this type of mechanistic approach has been limited in falls research," he said. 

Building on an extensive collection of prior and current cognition and mobility research, Dr. Verghese's five-year study will be conducted on over 500 participants age 65 and older, many of whom are enrolled in our ongoing Central Control of Mobility in Aging study examining the effects of executive control and fatigue on older adults' ability to successfully maintain mobility. The research will use rigorous evaluation methods (many of which were developed and validated in his other aging studies) to assess the fall risk of these adults. With state-of-the-art neuroimaging techniques, researchers will examine small blood vessels in the brain to establish how abnormalities in this complex network may contribute to fall risk. Additionally, they will implement innovative functional near-infrared spectroscopy (fNIRS), a non-invasive imaging method that uses light to monitor brain blood flow and measure blood oxygenation levels in the brain, to assess brain activity during walking and establish the contribution of the prefrontal cortex to falls. 

Results of Dr. Verghese's study will be applied to cultivate more efficient risk identification methods, and improve the efficacy of current fall interventions. "We want to help patients like Mr. K. stay mobile, maintain confidence and independence, and lead long and productive lives," he said.

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