Preventing Falls in Our Elderly: USPSTF Gets It Right!
Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
Not to be too harsh on the US Preventive Services Task Force (USPSTF) but they've come under attack the last several years for many of their recommendations which have gone against conventional wisdom: witness the controversy surrounding screening for breast cancer in 2009 and for prostate cancer just last week. So it's nice to see that conventional wisdom prevailed when the USPSTF published their Recommendation Statement for Prevention of Falls in Community-Dwelling Older Adults online earlier this week in the Annals of Internal Medicine prior to print release in August.
In fact, USPSTF specifically recommended exercise or physical therapy along with vitamin D supplementation to prevent falls in community dwelling older adults at increase risk for said falls, including those who've already fallen. However, the USPSTF also held back and did not recommend multifactorial risk assessment and management in all community-dwelling older adults.
In reality, this new statement shouldn't really be a surprise as a systematic evidence review was published close to 18 months ago in the Annals of Internal Medicine in which the authors noted that 16 randomized controlled trials (RCTs) demonstrated a 13% reduction in falls in those patients who exercised or received physical therapy. A 17% reduction in falls was noted in those given vitamin D in 9 RCTs.
Granted, these may not be large dramatic reductions but every little bit helps when one out of three community-dwelling older adult falls each year of whom 1 in 10 to 20 will sustain an injury requiring medical attention (eg fracture, laceration, and/or brain injury). The statistics are even worse for those who've sustained a hip fracture as 1 in 4 won't live past the anniversary of their fall while only 1 in 2 will return to their baseline level of function. Long story short: the demographics are compelling such that we need to do everything we can to prevent falls in the first place in the growing population of older adults. After all, we don't want to make the proverbial call, "Help! I've fallen and I can't get up!"