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.