Skip to main content

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

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)?

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Delirium: A podcast with Sharon Inouye

In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.

We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.  


You can also find us on Youtube!


Listen to GeriPal Podcasts on:
iTunes…

Are Palliative Care Providers Better Prognosticators? A Podcast with Bob Gramling

Estimating prognosis is hard and clinicians get very little training on how to do it.  Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5.  The question is, aren't we better as palliative care clinicians than others in estimating prognosis?  This is part of our training and we do it daily.   We got to be better, right? 

Well, on todays podcast we have Bob Gramling from the Holly and Bob Miller Chair of Palliative Medicine at the University of Vermont to talk about his paper in Journal of Pain and Symptom Management (JPSM) titled “Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association with End of Life Care”.

Big findings from this JPSM paper include that we, like all other clinicians, are an optimistic bunch and that it actually does impact outcomes.   In particular, the people whose survival was overestimated by a palliative care c…