Tuesday, May 29, 2012

USPSTF Recommendations for Falls Prevention

Man Swimming


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

2 comments:

Helen Chen said...

Thanks, Mike for drawing attention to this amidst the sturm und drang of their PSA recommendations. A grumpy specialist (ok urologist) I know asked whether clinicians actually change practice behavior based on USPSTF guidelines. At least in the case of falls, I do hope that more PCPs will, though as you mention, this is probably not enough for the higher risk people we generally see in geriatrics.

Lindsey Yourman said...

Hi GeriPalers, I'm a third year Internal medicine resident that is going to be giving a talk to my classmates about Fall Prevention in Community-Dwelling Elders, and will focus on the USPSTF recommendations of physical therapy and Vitamin D, as well as the December 2013 consensus statement by the AGS society that all older adults should be given 1000IU daily Vitamin D (with some caveats, without even having to check lab tests).

I wanted to question the group whether:
a) any particular physical therapy classes or home exercises have been helpful for preventing falls in their older patients? have people found it easy to get Medicare and/or Medical to cover adequate outpatient physical therapy?

b) any opinions on the new AGS consensus statement that ALL older adults (regardless of fall risk), should receive at least 1000IU daily of Vitamin D (without need to check laboratory tests)?