The U.S. Preventive Services Task Force (USPSTF) has released its draft recommendations for fall prevention in those age 65 or older, and some of its findings may shake up senior care protocols. Falls are the leading cause of injury in people age 65 or older, and about one-third of older adults residing in senior care communities will fall at least once each year.
The USPSTF, an independent agency whose primary function is to determine which screenings, interventions and tests are most beneficial for specific conditions, has determined that exercise—including balance, gait and functional training—gets a grade of “B” in its effectiveness in reducing falls risks. In general, the recommendations are for balance training at least three times a week and 150 minutes per week of moderate exercise and muscle-strengthening activities.
However, vitamin D supplements, often given to seniors who have a history of falls, don’t seem to be effective at all, earning a preventive grade of “D.”
History matters when trying to identify people at risk, since if a person has fallen before the chances of falling again rise considerably. If a resident has a history of falling, it becomes the number one risk predictor, the draft recommendation notes. “Although many studies used a variety of risk factors and/or functional tests of gait, balance, or mobility to identify study participants, history of falls was the one factor that consistently identified persons at high risk for falls.”
The nation’s highest preventive care analyzer gives a “C” recommendation to multifactorial interventions—such as interventions from dietitians, medication management, environmental settings, physical or occupational therapy—saying they have some benefits but primarily when used together and assessed frequently in a standardized way.
“The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls to community-dwelling adults age 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient’s values and preferences.”
The draft recommendations are open for public comment until October 23, 2017. The USPSTF urges all senior care providers to participate in comments about the draft via the online comments form.
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