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USPSTF: Exercise, vitamin D prevented falls in elderly
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Exercise or physical therapy and vitamin D supplementation could prevent falls in community-dwelling adults aged at least 65 years who are at risk for falls, according to the United States Preventive Services Task Force’s new recommendation guidelines.
In 1996, the US Preventive Services Task Force (USPSTF) examined the effectiveness of counseling to prevent household and recreational injuries, such as falls, by age group. Since then, the USPSTF updated its methods, reviews and rating system to evaluate findings.
“Falls are the leading cause of injury in adults aged 65 years or older. Between 30% and 40% of community-dwelling adults aged 65 years or older fall at least once per year,” the report said.
Virginia A. Moyer, MD, MPH, of the USPSTF, and colleagues wrote that they found “convincing evidence that exercise or physical therapy has moderate benefit in preventing falls in older adults.”
The USPSTF examined several studies, with an emphasis on outcomes such as falls, fractures, quality of life and mortality. Moreover, risk assessments conducted by primary care physicians are recommended in older adults at increased risk for falls, they said. Those with a history of falls, history of mobility problems and poor performance on a timed Get-Up-and-Go test (the time it takes a patient to rise from an armchair, walk 3 m, turn, walk back and sit down again) are to be identified before interventions.
Interventions include exercise or physical therapy and vitamin D supplementation. The USPSTF also recommended screenings for osteoporosis as early intervention. Within the report, the CDC and National Institute on Aging recommend similar interventions.
The USPSTF said further studies are needed to validate the substantial risk for falls in older adults. Other trials should examine interventions that evaluate visual correction, medication withdrawal, protein supplementation, education/counseling and home hazard modification as it relates to risk for falls.
Disclosure: Dr. Moyer received travel support to meetings for the study from AHRQ/USPSTF and consultancy fees from AAP. Disclosure forms for all other USPSTF members can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0471.
Perspective
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Donald A. Bergman, MD
This article makes only one point but it is an important point. Thirty to forty percent of community-dwelling adults older than 65 fall at least one a year and five to ten percent of those who fall will sustain an injury including a fracture. Intervention for those at risk for falls helps but only two interventions were recommended routinely: vitamin D and exercise and physical therapy (balance and strength training as well as routine daily physical activity.
Risk of falling was defined a history of falls, a history of mobility problems, and poor performance on the timed Get-UP-and-Go test (the amount of time it takes to get out of a chair, walk 10 feet, return to the chair, and sit down again). The authors did not feel that comprehensive risk assessment and management (including eliminating drugs that call falls, vision testing, orthostatic hypotension testing and management, hip protectors, and home fall protection merited routine incorporation into each patient's evaluation. The article acknowledged that other organizations do support such intervention.
There are some issues with the paper including how much vitamin D and calcium to take (still controversial and unresolved) and the fact that several of the studies quoted involved patients who were vitamin D deficient at the beginning of the study. The paper does acknowledge the dilemma that increased activity among the elderly may result in more falls.
The study does not discuss osteoporosis evaluation and management which was discussed elsewhere. Nevertheless this paper shows that simple measures can reduce morbidity from falls and that is a good thing.
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