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BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6234 (Published 19 September 2012) Cite this as: BMJ 2012;345:e6234

Exercises help prevent falls in older adults

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Preventing falls in older people is a public health priority, and the latest synthesis of randomised evidence reports plenty of interventions that work, including exercise classes and exercises for adults to do at home. The most successful exercise interventions included at least two different types of exercise, such as balance training, muscle strengthening, or walking. Tai Chi helped prevent falls, but not for adults at highest risk. The authors found 51 new trials to add to the last review in 2009, bringing the total to 159.

Improvements to home safety and personal mobility aids also worked, particularly when assessments and improvements were led by an occupational therapist. Simple things such as an anti-slip shoe for use on icy pavements reduced the risk of outside falls in one trial. More invasive treatments such as cataract surgery (one trial) and a pacemaker (three trials) were associated with fewer falls in selected adults.

Doubt remains about the effectiveness of rationalising prescribed drugs, educating doctors or patients, and providing new glasses for adults with poor eyesight. Results for complex multifactorial interventions were also mixed. Extra vitamin D, with or without calcium, did not help prevent falls in this review, or the previous one. The authors weren’t able to tell whether any of these interventions helped prevent fractures.

Waning protection after vaccination against whooping cough

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Children in California, US, must have all five doses of an acellular vaccine against Bordetella pertussis (whooping cough) before starting school. Mandatory vaccination has not prevented serious outbreaks, however—the most recent of which was in 2010. Waning protection from the acellular vaccine may be to blame, according to a case-control study.

The authors compared time since last dose among children testing positive and negative …

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