The United States Preventative Services Task Force just released a final recommendation about falls prevention strategies in the primary care setting. It’s interesting reading: http://www.uspreventiveservicestaskforce.org/uspstf11/fallsprevention/fallsprevrs.htm
Key take-home points include:
- The USPSTF recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls (B Recommendation).
- More specifically…
- There is high certainty that exercise or physical therapy has moderate net benefit in preventing falls in older adults
- There is moderate certainty that vitamin D supplementation has moderate net benefit in preventing falls in older adults (with meta-analysis showing a number needed to treat of 10 to prevent one fall)
- No single recommended tool or brief approach can reliably identify older adults at increased risk for falls, but several reasonable and feasible approaches are available for primary care clinicians. See the Clinical Considerations section for additional information on risk assessment.
- The USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older because the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values (C Recommendation).
- There is moderate certainty that multifactorial risk assessment with comprehensive management of identified risks has a small net benefit in preventing falls in older adults
Keep in mind that these recommendations apply to screening and prevention for the general population of adults age 65 and older in ambulatory care, and may need to be tailored to the kinds of high-risk patients that are often seen in geriatrics and palliative care practice.
by: Mike Steinman