The American Geriatrics Society and the British Geriatric Society have added a number of new assessments in the first update of the guidelines on preventing falls in older persons since 2001.
The guidelines are based on a systematic review of the randomized controlled trials of fall prevention interventions. They now state that doctors and other health professionals should determine whether their older patients are at risk of falling by asking if they have fallen recently or if they are unsteady walking. If so, health providers should look for the presence of known problems such as muscle weakness, poor balance, or blood pressure that drops too much on standing. If they have these problems, older adults should receive the interventions described in the guidelines, but if there is no evidence of gait problems or recurrent falls, they do not require a risk assessment.
The new recommendations for interventions focus on:
· Multifactorial interventions, which include exercise for balance, gait and strength training, such as Tai Chi or physical therapy.
· Environmental adaptation to reduce fall risk factors in the home and in daily activities.
· Cataract surgery where needed, but they recommend against vision intervention as an individual approach.
· Medication reduction, regardless of the number of medications prescribed (in 2001 this was only recommended for those on at least four) with particular attention to medications that affect the brain such as sleeping medications and antidepressants
· Focus on raising low blood pressure and managing heart rate and rhythm abnormalities
“There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice,” guideline researchers said. “By making fall prevention part of the clinical care of older adults this trend can continue.”