Fall-related psychological concerns and anxiety among community-dwelling older adults: systematic review and meta-analysis
Payette MC, Belanger C, Léveillé V, Grenier S.
PLoS One 2016; 11(4)

Abstract
Fear of falling and other fall-related psychological concerns (FRPCs), such as falls-efficacy and balance confidence, are highly prevalent among community-dwelling older adults. Anxiety and FRPCs have frequently, but inconsistently, been found to be associated in the literature. The purpose of this study is to clarify those inconsistencies with a systematic review and meta-analysis and to evaluate if the strength of this relationship varies based on the different FRPC constructs used (e.g., fear of falling, falls-efficacy or balance confidence). A systematic review was conducted through multiple databases (e.g., MEDLINE, PsycINFO) to include all articles published before June 10th 2015 that measured anxiety and FRPCs in community-dwelling older adults. Active researchers in the field were also contacted in an effort to include unpublished studies. The systematic review led to the inclusion of twenty relevant articles (n = 4738). A random-effect meta-analysis revealed that the mean effect size for fear of falling and anxiety is r = 0.32 (95% CI: 0.22-0.40), Z = 6.49, p < 0.001 and the mean effect size for falls-efficacy or balance confidence and anxiety is r = 0.31 (95% CI: 0.23-0.40), Z = 6.72, p < 0.001. A Q-test for heterogeneity revealed that the two effect sizes are not significantly different (Q(19) = 0.13, p = n.s.). This study is the first meta-analysis on the relationship between anxiety and FRPCs among community-dwelling older adults. It demonstrates the importance of considering anxiety when treating older adults with FRPCs.

Fear of falling as a risk factor of mobility disability in older people at five diverse sites of the IMIAS study
Auais M, Alvarado BE, Curcio CL, Garcia A, Ylli A, Deshpande N.
Arch. Gerontol. Geriatr. 2016; 66: 147-153

Abstract
BACKGROUND: Fear of falling (FoF) is a common health problem among older adults. Although the relationship between FoF and limitation in daily activities has been reported, FoF’s relationship to mobility disability, a transitional phase to end-stage disability, is not yet understood. We examined the relationship between FoF and mobility disability among community-dwelling older adults and explored the differences in this relationship among socio-culturally diverse sites. DESIGN: Cross-sectional study.
SETTING: Community.
PARTICIPANTS: 1875 participants (65-74 years) were recruited from five sites and included in the analysis (Kingston, Canada: 394; St-Hyacinthe, Canada: 397; Tirana, Albania: 359; Manizales, Colombia: 341; and Natal, Brazil: 384).
MEASUREMENT: FoF was quantified using the Falls Efficacy Scale-International (FES-I, range: 16-64). Mobility disability was defined as difficulty climbing a flight of stairs or walking 400m without assistance. RESULTS: Overall, 21.5% of participants reported high FoF (FES-I>27). The average FoF scores were significantly different between the sites (p<0.001) and higher in women (p<0.001). In general, 36.2% of participants reported mobility disability. The distribution of mobility disability was significantly different at the five study sites (ranged from 19.8% at Kingston, Canada to 50.7% at Tirana, Albania, p<0.001). After adjusting for covariates, those with high and moderate FoF had about 3 times (95% CI: 2.59-3.83) and 2.5 times (95% CI: 1.99-2.91) higher risk of mobility disability, respectively, compared to those with no/low FoF.
CONCLUSIONS: FoF was significantly associated with risk of mobility disability across the sites. The strength of this relationship appears to be different between the five sites.

Interventions incorporating physical and cognitive elements to reduce falls risk in cognitively impaired older adults
Booth V, Hood V, Kearney F.
JBI Database Syst. Rev Implement. Rep. 2016; 14(5): 110-135

Abstract
BACKGROUND: Cognitive impairment is a risk factor for falls. Older adults with cognitive impairment (such as dementia) have an increased risk of falling compared with age-matched individuals without a cognitive impairment. To reduce falls in this population, interventions could theoretically target and train both physical and cognitive abilities. Combining and addressing cognitive components in falls rehabilitation is a novel and emerging area of healthcare. OBJECTIVES: The objective of this review was to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Older persons who were 65 years or older and identified as having a cognitive impairment either through diagnosis or assessment of global cognition. TYPES OF INTERVENTION(S): Multifactorial or multiple interventions where physical and cognitive elements were combined was compared against standard care or a single element intervention. TYPES OF STUDIES: Randomized controlled trials (RCTs), controlled clinical trials and experimental studies in which randomization was used. OUTCOMES: Outcomes related to falls, including falls rate, specific falls risk measures (i.e. Physiological Profile Assessment) or related clinical outcome measures (i.e. Timed Up and Go test, Tinetti and gait speed). SEARCH STRATEGY: A three-step search strategy was utilized in this review, including search of electronic databases: CENTRAL, JBISRIR, MEDLINE, EMBASE, AMED, CINAHL and PsychINFO. Initial keywords used were dementia, cognitive impairment, memory loss, exercise, rehabilitation and accidental falls. Grey literature (Google Scholar) and trials registers (Current Controlled Trials) searches were also completed. METHODOLOGICAL QUALITY: The methodological quality of included studies was assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) software. DATA EXTRACTION: Data was extracted from articles included in the review using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS: A quantitative meta-analysis was performed where possible. Otherwise, data synthesis was in the form of narrative review. Sub-group analysis according to level of cognitive impairment was completed where possible. RESULTS: Eight RCTs were included in this review; they evaluated the effectiveness of multicomponent exercise programs, including physical and cognitive activities, music-based group exercise and mind-body tai chi on falls related outcomes. Most of the studies were of good quality with an average quality score of 7.5. Four studies reported effectiveness based on the number of falls, half of which reported a significant difference between the groups, but pooling of results into meta-analysis was not possible because of differences in reporting of the outcome. Falls related outcomes that were combined in meta-analysis included balance (Berg balance scale), functional mobility (Timed Up and Go) and gait speed (m/s). There was a statistically significant improvement in balance and gait speed following the intervention; however, the studies were too heterogeneous to be included in the analysis from the functional mobility results.
CONCLUSION: Overall, multicomponent interventions incorporating both physical and cognitive components demonstrated positive effects on balance, functional mobility and gait speed when compared with a control and had significantly better effect on balance and gait speed within mild cognitive impairment populations.