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Clinician Article

Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement.



  • Grossman DC
  • Curry SJ
  • Owens DK
  • Barry MJ
  • Caughey AB
  • Davidson KW, et al.
JAMA. 2018 Apr 24;319(16):1696-1704. doi: 10.1001/jama.2018.3097. (Review)
PMID: 29710141
Read abstract Read evidence summary Read full text
Disciplines
  • Geriatrics
    Relevance - 7/7
    Newsworthiness - 4/7
  • Public Health
    Relevance - 7/7
    Newsworthiness - 4/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7

Abstract

Importance: Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls (37.5% of which needed medical treatment or restricted activity for a day or longer) and an estimated 33?000 deaths in 2015.

Objective: To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the prevention of falls in community-dwelling older adults.

Evidence Review: The USPSTF reviewed the evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling older adults 65 years or older who are not known to have osteoporosis or vitamin D deficiency.

Findings: The USPSTF found adequate evidence that exercise interventions have a moderate benefit in preventing falls in older adults at increased risk for falls and that multifactorial interventions have a small benefit. The USPSTF found adequate evidence that vitamin D supplementation has no benefit in preventing falls in older adults. The USPSTF found adequate evidence to bound the harms of exercise and multifactorial interventions as no greater than small. The USPSTF found adequate evidence that the overall harms of vitamin D supplementation are small to moderate.

Conclusions and Recommendation: The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation) The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older. (D recommendation) These recommendations apply to community-dwelling adults who are not known to have osteoporosis or vitamin D deficiency.


Clinical Comments

General Internal Medicine-Primary Care(US)

As an internist who does locum tenens, I see many, many women taking huge doses of vitamin D and calcium for no known reason. Although we know to advise against this, it is helpful to have the Task Force recommendations to refer to.

General Internal Medicine-Primary Care(US)

Further refinement of our understanding of useful interventions to prevent falls. Helpful clarification that correcting Vitamin D deficiency remains appropriate, while a blanket recommendation to supplement all adults in this population is not clearly beneficial.

General Internal Medicine-Primary Care(US)

USPSTF guidelines are always highly relevant and important to disseminate. This is one of the least biased groups in the US because they are not attached to any particular field of medicine/professional society. Broad relevance for anyone in primary care but also geriatrics, endocrine, and others given the vitamin D recommendation. Perhaps not all of the findings are absolutely new, but the endorsement of these by the USPSTF is what is new/relevant and important.

General Internal Medicine-Primary Care(US)

Important update that doesn’t necessarily reverse but clarifies recommendations not to routinely prescribe vitamin D for fall prevention in community-dwelling older adults. The question remains whether all older adults with falls have vitamin D testing. The literature seems to suggest treatment for insufficiency or deficiency, but optimal dosing is not known.

Geriatrics

Recommendations for exercise should be a standard of practice for all patients at all ages, well before they reach the age of increased falls risk.

Public Health

Vitamin D deficiency/insufficiency - <30 ng/ml - was not fully excluded from the study population. The Vitamin D levels achieved in persons who had adverse events is not known. The recommendation not to offer vitamin D supplementation as part of fall prevention therefore needs clarification.

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