Falls are the most common cause of injury to older adults, and a fear of falling keeps many from physical and social activity. Minimizing falls risk is thus a high priority and a potentially important aspect of preventive health, and a way to reduce overall health care burden.
The US Preventive Services Task Force (USPSTF) is a panel of medical experts, appointed by the federal Agency for Healthcare Research and Quality. The purpose of the USPSTF is to systematically review the scientific evidence for the prevention of illness and injury. Recently, the USPSTF issued a recommendation statement on the prevention of falls, which is available in article form and in a summary form for patients.
Based on their review of existing research, there is “convincing evidence” that physical therapy or regular exercise can moderately decrease falls risk for older adults, and adequate evidence for the use of vitamin D supplementation. This recommendation is what the USPSTF terms a “Grade B Recommendation,” which means that there is a moderate to high degree of certainty that the suggested intervention offers at least a moderate benefit. This is particularly true of individuals at a higher risk for falls.
For falls risk assessment, the statement recommends multifactorial risk assessments that include multiple types of assessment—balance and mobility, visual, environmental, and medication use—for individuals with a falling history, or with balance or gait problems. The evidence suggests against performing such in-depth risk assessments for older adults who are not at increased risk for falls—such as those who are not physically frail, without a history of falls—due to a relative lack of benefit. Briefer test that may be useful for risk assessment among a more general population include the Get Up and Go Test and the Functional Reach Test.
The recommendation notes that cost is a barrier to falls risk and management for many individuals at risk for falls, as is a lack of comprehensive insurance coverage. Multifactorial falls risk treatments require the use of multiple services, such as doctors, physical therapists, and social services, and are thus difficult to coordinate and reimburse for community-dwelling older adults. The recommendation also suggests further research on the effectiveness of other possible falls risk treatments such as protein supplementation, home modification, and vision correction.
Moyer VA, U.S. Preventive Services Task Force. Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine (2012); 157(3).