Recent Publications in falls prevention

Yoga-based exercise improves balance and mobility in people aged 60 and over: a systematic review and meta-analysis
Age and Ageing 2016; 0: 1–9

Objective: one-third of community-dwelling older adults fall annually. Exercise that challenges balance is proven to prevent falls. We conducted a systematic review with meta-analysis to determine the impact of yoga-based exercise on balance and physical mobility in people aged 60+ years.
Methods: searches for relevant trials were conducted on the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database and the Physiotherapy Evidence Database (PEDro) from inception to February 2015. Trials were included if they evaluated the effect of physical yoga (excluding meditation and breathing exercises alone) on balance in people aged 60+ years. We extracted data on balance and the secondary outcome of physical mobility. Standardised mean differences and 95% confidence intervals (CI) were calculated using random-effects models. Methodological quality of trials was assessed using the 10-point Physiotherapy Evidence Database (PEDro) Scale. Results: six trials of relatively high methodological quality, totalling 307 participants, were identified and had data that could be included in a meta-analysis. Overall, yoga interventions had a small effect on balance performance (Hedges’ g = 0.40, 95% CI 0.15–0.65, 6 trials) and a medium effect on physical mobility (Hedges’ g = 0.50, 95% CI 0.06–0.95, 3 trials).
Conclusion: yoga interventions resulted in small improvements in balance and medium improvements in physical mobility in people aged 60+ years. Further research is required to determine whether yoga-related improvements in balance and mobility translate to prevention of falls in older people.

Hearing Loss and Falls: A Systematic Review and Meta-analysis
Nicole Tin-Lok Jiam, BA; Carol Li, MD; Yuri Agrawal, MD, MPH
Laryngoscope 00: Month 2015

Background: Falls are a devastating condition in older individuals. Identifying potentially modifiable risk factors such as hearing loss would provide a substantial public health benefit.
Objective: To evaluate the current evidence for an association between hearing loss and falls risk.
Data Sources: A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Web of Science, and Cochrane databases was performed in July 2014.
Study Eligibility: Studies were eligible for inclusion if they were published in the peer-reviewed literature. All studies used a predetermined definition of hearing loss. Main outcomes and measurements were fall hospitalization records or selfreports of falls by structured interview or validated questionnaires.
Study Appraisal and Synthesis: Two investigators independently reviewed the literature related to hearing loss, falls, and older adults. We pooled effect sizes from across the studies and performed a meta-analysis to compute an overall effect size.
Results and Limitations: Twelve eligible studies were identified. The odds of falling were 2.39 times greater among older adults with hearing loss than older adults with normal hearing (pooled odds ratio 2.39, 95% confidence interval [CI]: 2.11-2.68). In sensitivity analyses, we restricted the meta-analysis to studies where hearing loss was audiometrically defined (N 5 6) and observed hearing loss to be associated with a 69% increase in the odds of falling (pooled odds ratio 1.69, 95% CI: 1.18-2.19). When we further limited to studies that also performed multivariate regression analyses (N 5 4), the overall effect size did not appreciably change (pooled odds ratio 1.72, 95% CI: 1.07-2.37). We observed a potential positive publication bias in the literature. Limitations of the systematic review and meta-analysis are the cross-sectional designs of most studies and the heterogeneity across studies (Q 5 631, P < .05, I2 5 98.1%).
Conclusions and Relevance: In the published literature, hearing loss is associated with a significantly increased odds of falling in older adults. These findings need to be interpreted in light of the potential for positive publication bias in the literature on this topic.

Updating the Evidence for Physical Activity: Summative Reviews of the Epidemiological Evidence, Prevalence, and Interventions to Promote “Active Aging”
Adrian Bauman, MD, MPH, PhD, Dafna Merom, PhD, Fiona C. Bull, PhD, David M. Buchner, MD, MPH, and Maria A. Fiatarone Singh, MD
Gerontologist, 2016, Vol. 56, No. S2, S268–S280

Purpose of the Study: There is a global imperative to increase awareness of the emerging evidence on physical activity (PA) among older adults. “Healthy aging” has traditionally focused on preventing chronic disease, but greater efforts are required to reduce frailty and dependency and to maintain independent physical and cognitive function and mental health and well-being.
Design and Methods: This integrated review updates the epidemiological data on PA, summarizes the existing evidencebased PA guidelines, describes the global magnitude of inactivity, and finally describes the rationale for action. The first section updates the epidemiological evidence for reduced cardiometabolic risk, reduced risks of falls, the burgeoning new evidence on improved cognitive function and functional capacity, and reduced risk of depression, anxiety, and dementia.
This is followed by a summary of population prevalence studies among older adults. Finally, we present a “review of reviews” of PA interventions delivered from community or population settings, followed by a consideration of interventions among the “oldest-old,” where efforts are needed to increase resistance (strength) training and balance.
Results: This review identifies the global importance of considering “active aging” beyond the established benefits attributed to noncommunicable disease prevention alone.
Implications: Innovative population-level efforts are required to address physical inactivity, prevent loss of muscle strength, and maintain balance in older adults. Specific investment in healthy aging requires global policy support from the World Health Organization and is implemented at the national and regional levels, in order to reduce the burden of disease and disability among older adults.