Date of Award

Summer 8-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Rehabilitation Sciences

Program/Concentration

Kinesiology and Rehabilitation

Committee Director

Brittany Samulski

Committee Member

Anastasia M. Raymer

Committee Member

Julie Cavallario

Abstract

Falls are multifactorial events influenced by physiological, cognitive, behavioral, and perceptual factors. Although falls prevention research has traditionally focused on older adults and objectively measured physical impairments, less is known about how cognitive performance, physical activity, and perceptions of ability collectively contribute to falls risk vulnerability across middle and older adulthood. This dissertation examined these relationships through three complementary studies.

Study 1 examined associations between cognitive screening performance and physiological falls risk in 315 community-dwelling older adults. Lower global cognitive performance was associated with greater physiological falls risk. Performance on items reflecting attention and visuospatial/executive function demonstrated the strongest domain-level associations, and global cognitive performance explained additional variance in physiological falls risk beyond age and sex.

Studies 2 and 3 included 45 community-dwelling adults divided equally among early middle-aged, late middle-aged, and older-adult groups. Study 2 examined age-related differences in physiological falls risk, SRT, and executive function and their associations with physical activity. Early middle-aged adults demonstrated lower physiological falls risk than late middle-aged and older adults, whereas late middle-aged and older adults did not differ significantly. Greater physical activity was associated with lower physiological falls risk beyond chronological age but was not significantly associated with SRT or executive function performance.

Study 3 examined alignment between perceived and objectively measured physiological falls risk, physiological function, and cognitive function. The magnitude of perceived-objective discrepancy did not differ significantly across age groups after accounting for physical activity. Physical activity also did not explain discrepancy magnitude beyond chronological age.

Collectively, these findings demonstrate that falls risk vulnerability reflects related but distinct physiological, cognitive, behavioral, and perceptual dimensions. The results support a multidimensional, person-centered approach to falls risk assessment and suggest that meaningful physiological differences may emerge during middle adulthood, before the age at which falls prevention efforts are commonly initiated.

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DOI

10.25777/ey68-5227

ORCID

0000-0002-4853-3602

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