Antidepressant use and recurrent falls in community-dwelling older adults: findings from the Health ABC Study
Marcum ZA, Perera S, Thorpe JM, Switzer GE, Castle NG, Strotmeyer ES, Simonsick EM, Ayonayon HN, Phillips CL, Rubin S, Zucker-Levin AR, Bauer DC, Shorr RI, Kang Y, Gray SL, Hanlon JT.
Ann. Pharmacother. 2016; ePub(ePub): ePub.

Abstract
BACKGROUND: Few studies have compared the risk of recurrent falls across various antidepressant agents-using detailed dosage and duration data-among community-dwelling older adults, including those who have a history of a fall/fracture. OBJECTIVE: To examine the association of antidepressant use with recurrent falls, including among those with a history of falls/fractures, in community-dwelling elders. METHODS: This was a longitudinal analysis of 2948 participants with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Any antidepressant medication use was self-reported at years 1, 2, 3, 5, and 6 and further categorized as (1) selective serotonin reuptake inhibitors (SSRIs), (2) tricyclic antidepressants, and (3) others. Dosage and duration were examined. The outcome was recurrent falls (≥2) in the ensuing 12-month period following each medication data collection. RESULTS: Using multivariable generalized estimating equations models, we observed a 48% greater likelihood of recurrent falls in antidepressant users compared with nonusers (adjusted odds ratio [AOR] = 1.48; 95% CI = 1.12-1.96). Increased likelihood was also found among those taking SSRIs (AOR = 1.62; 95% CI = 1.15-2.28), with short duration of use (AOR = 1.47; 95% CI = 1.04-2.00), and taking moderate dosages (AOR = 1.59; 95% CI = 1.15-2.18), all compared with no antidepressant use. Stratified analysis revealed an increased likelihood among users with a baseline history of falls/fractures compared with nonusers (AOR = 1.83; 95% CI = 1.28-2.63). CONCLUSION: Antidepressant use overall, SSRI use, short duration of use, and moderate dosage were associated with recurrent falls. Those with a history of falls/fractures also had an increased likelihood of recurrent falls.

Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis
Kumar A, Delbaere K, Zijlstra GA, Carpenter H, Iliffe S, Masud T, Skelton D, Morris R, Kendrick D.
Age Ageing 2016; 45(3): 345-352.

Abstract
OBJECTIVE: to determine the effect of exercise interventions on fear of falling in community-living people aged ≥65. DESIGN: systematic review and meta-analysis. Bibliographic databases, trial registers and other sources were searched for randomised or quasi-randomised trials. Data were independently extracted by pairs of reviewers using a standard form. RESULTS: thirty trials (2,878 participants) reported 36 interventions (Tai Chi and yoga (n = 9); balance training (n = 19); strength and resistance training (n = 8)). The risk of bias was low in few trials. Most studies were from high-income countries (Australia = 8, USA = 7). Intervention periods (<12 weeks = 22; 13-26 weeks = 7; >26 weeks = 7) and exercise frequency (1-3 times/week = 32; ≥4 times/week = 4) varied between studies. Fear of falling was measured by single-item questions (7) and scales measuring falls efficacy (14), balance confidence (9) and concern or worry about falling (2). Meta-analyses showed a small to moderate effect of exercise interventions on reducing fear of falling immediately post-intervention (standardised mean difference (SMD) 0.37, 95% CI 0.18, 0.56; 24 studies; low-quality evidence). There was a small, but not statistically significant effect in the longer term (<6 months (SMD 0.17, 95% CI -0.05, 0.38 (four studies) and ≥6 months post-intervention SMD 0.20, 95% CI -0.01, 0.41 (three studies)). CONCLUSIONS: exercise interventions probably reduce fear of falling to a small to moderate degree immediately post-intervention in community-living older people. The high risk of bias in most included trials suggests findings should be interpreted with caution. High-quality trials are needed to strengthen the evidence base in this area.

Factors associated with injurious falls in residential care facilities
Towne SD, Cho J, Smith ML, Ory MG.
J. Aging Health 2016; ePub(ePub): ePub.

Abstract
OBJECTIVE: Despite a growing literature on the epidemiology of falls, little is known about injurious falls in residential care facilities (RCFs). Addressing this gap, this study examined demographic, interpersonal, institutional, and community factors associated with injurious falls in RCFs. METHOD: We conducted analyses using a nationally representative sample (n = 733,309) of RCF residents (2010) examining whether or not a resident experienced a fall that resulted in any injury (past year). RESULTS: Overall, 15% of RCF residents experienced an injurious fall. Residents needing assistance with activities of daily living were more likely to experience injurious falls (adjusted-OR = 1.85), whereas males (adjusted-OR = 0.74) and those residing in smaller facilities (adjusted-OR = 0.68) were less likely. Other resident sociodemographic characteristics, payment status, social connectedness, and rurality were not significant independent predictors. DISCUSSION: Research further exploring multifactorial fall prevention screening and treatment programs in RCFs is recommended for reducing injurious falls in this understudied setting.

Comparison of two different exercise approaches: tai chi versus Otago, in community-dwelling older women
Son NK, Ryu YU, Jeong HW, Jang YH, Kim HD.
J. Geriatr. Phys. Ther. 2016; 39(2): 51-57.

Abstract
BACKGROUND AND PURPOSE: Regular exercise can delay age-related risk factors and can maintain or improve physical health and activity in older adults leading to a decrease in fall risk. The purpose of this study was to compare 2 different interventions for fall prevention, tai chi (TC) and Otago, by examining lower extremity strength, balance, and spatiotemporal gait parameters in community-dwelling older women. METHODS: We performed a randomized trial in which subjects were assigned to 1 of 2 groups: the TC group (n = 21; age, 72.8 ± 4.7 years, range: 65-83 years), which participated in a modified Sun-style TC exercise program; and the Otago group (n = 24; age, 71.5 ± 3.6 years, range: 65-79 years), which participated in the Otago exercise program. The Timed Up and Go (TUG) test, functional reach (FR) test, one-leg standing (OLS) test, 5 times sit-to-stand test (5×STS), 30-second sit-to-stand (30s STS) test, and gait parameters (gait velocity, step length, step width, stride time, and cadence) were measured before and after the intervention. RESULTS: Both groups showed statistically significant improvements in balance (TUG and OLS tests), lower extremity strength (5×STS and 30s STS tests), and spatiotemporal gait parameters, except for step width and step length (P <.05). The Otago group showed a significantly improved FR, whereas the TC group showed a significantly improved step length after the intervention (P <.05). Furthermore, the Otago group exhibited greater improvements in the TUG (P <.001), FR (P <.001), 5×CST (P <.01), and 30-second CST (P <.01) tests: a faster cadence (P <.001) and shorter stride time (P <.001) when compared with the TC group. The TC group showed greater improvements in the OLS test, step length, and step width (P <.01) and faster gait velocity (P <.05) than the Otago group. DISCUSSION AND CONCLUSIONS: The findings from this study support the efficacy of the TC and Otago exercise programs in improving mobility in this sample of subjects. Furthermore, the Otago group showed greater improvement in lower extremity strength, whereas the TC group showed greater improvement in balance (OLS test). Also, the TC group showed a greater improvement in gait velocity after TC training program compared with the Otago exercise program. However, this study does not elucidate which exercise program is a more effective intervention method with older women for fall prevention.

Sedentary behavior and physical activity patterns in older adults after hip fracture: a call to action
Fleig L, McAllister MM, Brasher P, Cook WL, Guy P, Puyat JH, Khan KM, McKay HA, Ashe MC.
J. Aging Phys. Act. 2016; 24(1): 79-84.

Abstract
OBJECTIVES: To characterize patterns of sedentary behavior and physical activity in older adults recovering from hip fracture and to determine characteristics associated with activity. METHODS: Community-dwelling, Canadian adults (65 years+) who sustained hip fracture wore an accelerometer at the waist for seven days and provided information on quality of life, falls self-efficacy, cognitive functioning, and mobility. RESULTS: There were 53 older adults (mean age [SD] 79.5 [7.8] years) enrolled in the study; 49 had valid data and demonstrated high levels of sedentary time (median [p10, p90] 591.3 [482.2, 707.2] minutes/day), low levels of light activity (186.6 [72.6, 293.7]), and MVPA (2 [0.1, 27.6]), as well as few daily steps (2467.7 [617.1, 6820.4]). Regression analyses showed that age, gender, gait speed, and time since fracture were associated with outcomes. CONCLUSIONS: Older adults have long periods of sedentary time with minimal activity. Results are a call to action to encourage people to sit less and move more.

The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: A systematic review for future exercise prescription
Bullo V, Bergamin M, Gobbo S, Sieverdes JC, Zaccaria M, Neunhaeuserer D, Ermolao A.
Prev. Med. 2015; 75: 1-11.

Abstract
This systematic review aims to summarize the effects of Pilates exercise training (PET) in elderly population on physical fitness, balance and fall prevention, and its effects on mood states, quality of life and independence in the daily living activities. METHODS: Keyword “Pilates” associated with “elderly”, “aging” and “old subjects” were identified as terms for the literature research in MEDLINE, Embase, PubMed, Scopus, PsycINFO and SPORTDiscus. Only studies published in peer-reviewed journals written in English language were considered. A meta-analysis was performed and effect sizes (ES) calculated. RESULTS: 10 studies were identified (6 RCTs and 4 uncontrolled trials); age ranged from 60 to 80years. Overall, PET showed large ES to improve muscle strength (ES=1.23), walking and gait performances (ES=1.39), activities of daily living, mood states and quality of life (ES=0.94), moderate to high effect on dynamic balance (ES=0.77), small effects on static balance (ES=0.34) and flexibility (ES=0.31), while a small effect on cardio-metabolic outcomes (ES=0.07). CONCLUSIONS: PET should be taken into account as a way to improve quality of life in the elderly, due to the imparted benefits of fall prevention, physical fitness, and mood states. In this context, physicians might include PET as a tool for exercise prescriptions for the elderly.

Yoga-based exercise improves balance and mobility in people aged 60 and over: a systematic review and meta-analysis
SABRINA YOUKHANA, CATHERINE M. DEAN, MOAWOLFF, CATHERINE SHERRINGTON, ANNE TIEDEMANN
Age and Ageing 2016; 0: 1–9

Abstract
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

Abstract
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.