Declines in executive function and dual-task performance have been related to falls in older adults, and recent research suggests that older adults at risk for falls also show impairments on real-world tasks, such as crossing a street. The present study examined whether falls risk was associated with driving performance in a high-fidelity simulator. Participants were classified as high or low falls risk using the Physiological Profile Assessment and completed a number of challenging simulated driving assessments in which they responded quickly to unexpected events. High falls risk drivers had slower response times (~2.1 seconds) to unexpected events compared to low falls risk drivers (~1.7 seconds). Furthermore, when asked to perform a concurrent cognitive task while driving, high falls risk drivers showed greater costs to secondary task performance than did low falls risk drivers, and low falls risk older adults also outperformed high falls risk older adults on a computer-based measure of dual-task performance. Our results suggest that attentional differences between high and low falls risk older adults extend to simulated driving performance. 1. Introduction Per mile driven, adults over age 65 are more likely to be involved in motor vehicle collisions than are younger experienced drivers [1], and declines in attention are related to older driver impairment [2, 3]. Attention is also critical to balance and gait, especially for older adults. Walkers must monitor for changes in environment and plan their next step. When a walking or balance task is combined with a cognitively challenging secondary task (e.g., memorizing a list of words), performance decrements are found for both tasks relative to performing each task separately [4]. These dual-task costs suggest that walking competes for shared attentional resources, as predicted by resource models of attention [5–9]. Older adults often have increased difficulty when multitasking, including paradigms that involve balancing or walking [10–12]. For example, older adults show larger dual-task costs on walking while memorizing task than do younger adults [13–16]. Such declines in multitasking ability are theorized to result in an increased risk for falls among older adults. Approximately 30% of community-dwelling older adults experience one or more falls annually [17, 18]. Age-related declines in the ability to multitask are related to an increase in falls risk. For example, performance on a counting while walking task predicts falls in older adults ([19]; see also [20–22]). Similarly, older adults at high
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