Molly MoncrieffDoctor of Pharmacy Candidate University of Georgia

College of Pharmacy Class of 2013Preceptor: Dr. Ali Rahimi

Prevention of Falls in Community-Dwelling Older Adults: U.S.

Preventative Services Task Force Recommendation Statement

Background Falls are the leading cause of injury in adults 65

years old or older 30-40% of community-dwelling adults 65 years or

older fall at least once per year 5-10% of adults who fall will have a fracture,

laceration or head injury The burden of falls on patients and the health

care system is large

Purpose There are various approaches used to identify

persons at increased risk for falls and no evidence-based instrument exists that can accurately identify older adults at an increased risk for falling

There are several reasonable and feasible preventative interventions available for older adults o Which one is best?

Risk Factors Age History of falls

o Used most often to identify high risks patients History of mobility factors Poor performance on the times Get-Up-and-Go

testo Time it takes a person to rise from an armchair, walk 10

feet, turn, walk back and sit down again o Average for a healthy adult >60 years old is 10 seconds

Prevention Exercise and physical therapy

o HHS recommends 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity

o Muscle-strengthening exercises twice per weeko Balance training 3 or more days per week for patients at

risk for falling due to recent fall or difficulty walking Vitamin D supplementation

o Institute of Medicine recommends daily allowance for vitamin D of 600 IU for patients aged 51 to 70 and 800 IU for patients older than 70 years old

o AGS recommends 800 IU per day for persons at increased risk for falls

Prevention Multifactorial risk assessment with

comprehensive managemento Evaluations of balance and mobility, vision, orthostatic

and postural hypotension, review of medication use and home environment

o Providing medical and social care to address factors identified during the assessment • Vision correction• Medication discontinuation• Protein supplementation• Education or counseling• Home hazard modification

Evidence Exercise or physical therapy has a moderate net benefit

in preventing falls in older adultso Reduce the risk of falls by 13%o Number needed to treat = 16

Vitamin D supplementation has a moderate net benefit in preventing falls in older adultso Reduce the risk of falls by 17%o Number needed to treat = 10

Multi-factorial risk assessment with comprehensive management has a small net benefit in preventing falls in older adults o Vision correction, medication discontinuation, protein

supplementation, education or counseling and home hazard modification lack sufficient evidence

Harms Harms of physical therapy or exercise are small

o Paradoxical increase in fallso Increase in physician visits

Harms of vitamin D supplementation are no greater than small

Harms of multifactorial risk assessment with comprehensive management of identifies risks are no greater than small

USPSTF Recommendations

Exercise and Physical Therapyo B Recommendation

Vitamin D Supplementationo B Recommendation

Do not automatically perform an in-depth Multifactorial Risk Assessment in conjunction with comprehensive management of identified risks o Consider the balance of benefits and harms on the basis

of the circumstance of previous falls, comorbid conditions and patient values

o C Recommendation

USPSTF Recommendations

USPSTF Recommendations

Biological Understanding

Exercise and Physical Therapyo Improve strength and balance therefore resulting in

fewer falls Vitamin D Supplementation

o Vitamin D receptors have been identified in various cell types including skeletal muscle and stimulation of these receptors promotes protein synthesis

o Vitamin D receptors decline with age o Vitamin D and its metabolites have a beneficial effect on

muscle strength and balance

References Moyer V.A, et al. Prevention of Falls in

Community-Dwelling Older Adults- U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2012 August 7;157(3):197-204.