The Association between Hearing Impairment and Postural Stability in Older Adults: A Systematic Review and Meta-analysis.

There is growing evidence linking hearing impairment to higher falls risk through alterations in postural stability, with studies showing mixed results. The primary aim of this systematic review and meta-analysis was to determine the association between hearing impairment and postural instability in older adults, including differences based on severity of hearing impairment. This review was pre-registered in PROSPERO and performed in accordance with PRISMA guidelines across six databases. Primary research on adults aged 60 years and older with hearing loss and an objective measure of postural stability or gait were eligible for inclusion. Methodological quality was assessed using the modified Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Data were analysed using meta-analyses and a narrative synthesis. Inclusion in the meta-analyses required clearly defined audiometrically-assessed hearing impairment, and two subgroups of participants: mild (25-40 dB HL) and moderate to-severe (>40 dB HL) hearing impairment. Twenty-five eligible studies (n = 27,847) were included in the narrative synthesis, with quality ratings ranging from unsatisfactory to very good on the modified NOS. Eight studies were included in the meta-analysis which showed individuals with moderate to-severe hearing impairment were significantly slower on the 5 x sit-to-stand test (mean difference[95%CI] = 0.50 s [0.04, 0.97], p = .03), had a slower gait speed (mean difference[95%CI] = -0.11 s [-0.16, -0.05], p < .001) and had lower total Short Physical Performance Battery scores (mean difference[95%CI] = -0.79[-1.17, -0.41], p < .001) than those with normal hearing. This review provides evidence there is an inverse association between increasing severity of hearing impairment and poorer postural stability across both the meta-analysis and narrative synthesis.

Concurrent Validity of the Garmin Vivofit®4 to Accurately Record Step Count in Older Adults in Challenging Environments.

There is little evidence of the concurrent validity of commercially available wrist-worn long battery life activity monitors to measure steps in older adults at slow speeds and with real-world challenges. Forty adults aged over 60 years performed a treadmill protocol at four speeds, a 50-m indoor circuit, and a 200-m outdoor circuit with environmental challenges while wearing a Garmin Vivofit®4, the activPAL3™, and a chest-worn camera angled at the feet. The Garmin Vivofit®4 showed high intraclass correlation coefficients2,1 (.98-.99) and low absolute percentage error rates (<2%) at the fastest treadmill speeds and the outdoor circuit. Step counts were underestimated at the slowest treadmill speed and the indoor circuit. The Garmin Vivofit®4 is accurate for older adults at higher walking speeds and during outdoor walking. However, it underestimates steps at slow speeds and when walking indoors with postural transitions.