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Fall risk assessment and early intervention can prevent falls, yet factors associated with fall risk are understudied in this high-risk group. We aimed to evaluate whether slow gait, impaired cognition, or a combination of the two are associated with elevated fall risk in the oldest old. Participants were from The 90\u2009+\u2009Study, a longitudinal study with evaluations every six months. We tested the association of \u2018slow gait\u2019 (Four-Meter Walk Test, below sex-specific median), \u2018impaired cognition\u2019 (cognitive impairment no dementia or dementia), and \u2018both\u2019 (slow gait and impaired cognition) with fall rate over time. We used generalized linear mixed regression models to estimate incidence rate ratios (IRRs) using \u2018none\u2019 (neither slow gait nor impaired cognition) as the reference. We analyzed 1099 participants (749 women, 350 men, mean age 93.2\u00a0years). Prevalence of slow gait, impaired cognition, and falls was similar in men and women. In women, \u2018slow gait\u2019 (IRR\u2009=\u2009\n                    <jats:bold>1.33,<\/jats:bold>\n                    95% CI\u2009=\u20091.03\u20131.72) and \u2018both\u2019 (IRR\u2009=\u2009\n                    <jats:bold>1.35<\/jats:bold>\n                    , 95% CI\u2009=\u20091.06\u20131.73) were significantly associated with an elevated risk of future falls, whereas \u2018impaired cognition\u2019 was not (IRR\u2009=\u20091.06, 95% CI\u2009=\u20090.83\u20131.36). In contrast, in men, \u2018slow gait\u2019 (IRR\u2009=\u2009\n                    <jats:bold>1.70<\/jats:bold>\n                    , 95% CI\u2009=\u20091.15\u20132.50), \u2018impaired cognition\u2019 (IRR\u2009=\u2009\n                    <jats:bold>1.75,<\/jats:bold>\n                    95% CI\u2009=\u20091.21\u20132.53), and \u2018both\u2019 (IRR\u2009=\u2009\n                    <jats:bold>2.34<\/jats:bold>\n                    , 95% CI\u2009=\u20091.66\u20133.30) were all significantly associated with an elevated risk of future falls. Gait and cognition both play an important role in fall risk assessment in the oldest and fastest-growing segment of the U.S. population.\n                  <\/jats:p>","DOI":"10.1007\/s11357-026-02516-0","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:16:01Z","timestamp":1789366561000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enhancing fall risk assessment in the oldest old: The interplay of cognition and gait speed"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3889-3356","authenticated-orcid":false,"given":"Katherine A.","family":"Colcord","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley B.","family":"Kristinsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luohua","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zarui A.","family":"Melikyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinah","family":"Al-darsani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R.","family":"Falvey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia H.","family":"Kawas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda M.","family":"Corrada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"issue":"18","key":"2516_CR1","doi-asserted-by":"publisher","first-page":"509","DOI":"10.15585\/mmwr.mm6718a1","volume":"67","author":"E Burns","year":"2018","unstructured":"Burns E, Kakara R. 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