Motor Imagery Deficits in High-Functioning Older Adults and Its Impact on Fear of Falling and Falls

Background: Older adults at risk of falling or who have fear of falling (FoF) present a discrepancy between "imagined" and "performed" actions. Using the gait-related motor imagery paradigm, we investigated whether prediction accuracy in motor execution is associated with the onset of FoF and with prospective falls among older adults with FoF. Methods: A cohort of 184 community-dwelling older adults was tested for imaginary and executed Timed Up and Go (TUG) tests at a fast pace at baseline. They were first asked to imagine performing TUG and estimate the time taken to complete it (iTUG) and then to perform the actual trial (aTUG); the difference between the 2 times was calculated. Prospective falls were monitored between baseline and 2-year follow-up of FoF assessment. Results: At follow-up, 27 of 85 participants without FoF at baseline (31.8%) had developed FoF. Twenty-seven of 99 participants (27.2%) with FoF at baseline experienced falls. A significantly shorter iTUG duration, when compared with aTUG, was observed in those who developed FoF or experienced multiple prospective falls, indicating overestimation of their TUG performance. The adjusted logistic regression model showed that a greater Delta TUG (ie, tendency to overestimate) at baseline was associated with an increased risk of new-onset FoF among those without FoF at baseline and multiple prospective falls among those with FoF at baseline. Conclusions: Deficits in motor imagery (ie, overestimation of physical capabilities), reflecting impairment in motor planning, could provide an additional explanation of the high risk of FoF and recurrent falls among people with FoF.