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

The Future of Palliative Care: A Podcast with Diane Meier

There are few names more closely associated with palliative care than Diane Meier.  She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC).  We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including:
What keeps her up at night?Does palliative care need a national strategy and if so why and what would it look like?The history of CAPC and the leadership centersAdvice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careersWhat she imagines palliative care will look like in 10 or 15 years?What is the biggest threat facing palliative care? So take a listen and if you want to dive a little deeper, here are two articles that we discussed during the podcast:
A National Strategy For Palliative Care. Health Affairs 2017Palliative Care Leadership…

Advance Care Planning before Major Surgery: A Podcast with Vicky Tang

This week's podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang.  Vicky is an assistant professor and researcher here at UCSF.  We talk about her local and national efforts focused on this intersection, including:
Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. Prehab clinics and how ACP fits into these clinicsThe Geriatric Surgery Verification Quality Improvement Program whose goal is to set the standards for geriatric surgical care including ACP discussions prior to surgeryHow frailty fits in and how to assess it (including this paper from JAGS on the value of the chair raise test) So take a listen and check out some of those links.  For those who want to take a deeper dive into how GeriPal and surgery fit together, check out these other podcasts: Zara Cooper on Trauma Surgery, Geriatrics, and Palliative Car…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …