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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

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