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JAMA. 2018 Apr 24;319(16):1696-1704. doi: 10.1001/jama.2018.3097.

Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement.

Author information

1
Kaiser Permanente Washington Health Research Institute, Seattle.
2
University of Iowa, Iowa City.
3
Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
4
Stanford University, Stanford, California.
5
Harvard Medical School, Boston, Massachusetts.
6
Oregon Health & Science University, Portland.
7
Columbia University, New York, New York.
8
University of Pennsylvania, Philadelphia.
9
Virginia Tech Carilion School of Medicine, Roanoke.
10
Nationwide Children's Hospital, Columbus, Ohio.
11
Fairfax Family Practice Residency, Fairfax, Virginia.
12
Virginia Commonwealth University, Richmond.
13
Temple University, Philadelphia, Pennsylvania.
14
University of Alabama at Birmingham.
15
University of California, Los Angeles.
16
University of Texas at Austin.
17
Boston University, Boston, Massachusetts.
18
Northwestern University, Evanston, Illinois.
19
University of Hawaii, Honolulu.
20
Pacific Health Research and Education Institute, Honolulu, Hawaii.

Abstract

Importance:

Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls (37.5% of which needed medical treatment or restricted activity for a day or longer) and an estimated 33 000 deaths in 2015.

Objective:

To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the prevention of falls in community-dwelling older adults.

Evidence Review:

The USPSTF reviewed the evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling older adults 65 years or older who are not known to have osteoporosis or vitamin D deficiency.

Findings:

The USPSTF found adequate evidence that exercise interventions have a moderate benefit in preventing falls in older adults at increased risk for falls and that multifactorial interventions have a small benefit. The USPSTF found adequate evidence that vitamin D supplementation has no benefit in preventing falls in older adults. The USPSTF found adequate evidence to bound the harms of exercise and multifactorial interventions as no greater than small. The USPSTF found adequate evidence that the overall harms of vitamin D supplementation are small to moderate.

Conclusions and Recommendation:

The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls in community-dwelling adults 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. (C recommendation) The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older. (D recommendation) These recommendations apply to community-dwelling adults who are not known to have osteoporosis or vitamin D deficiency.

Summary for patients in

PMID:
29710141
DOI:
10.1001/jama.2018.3097
[Indexed for MEDLINE]

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