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

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

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 …

Does “compassionate deception” have a place in palliative care?

by: Olivia Gamboa (@Liv_g_g)

There is broad consensus in the medical community that lying to patients is unethical.  However, in the care of patients with dementia, the moral clarity of this approach blurs.  In her recent New Yorker article, “The Memory House,”  Larissa MacFarquhar provides an excellent portrait of the common devices of artifice, omission and outright deception that are frequently deployed in the care of patients with dementia.  She furthermore explores the historical and ethical underpinnings of the various approaches used in disclosing (or not) information to patients living with dementia.

Ms. MacFarquhar introduces the idea of “compassionate deception,” or the concept that withholding truths, or even promoting outright falsehoods, is a reasonable and even ethical choice for those caring for patients with dementia.  To the extent that it helps a person with dementia feel happier and calmer, allowing them to believe in a gentler reality (one in which, say, their spo…