USPSTF finalizes recommendation on exercise for fall prevention among older adults
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Key takeaways:
- The USPSTF recommends exercise and multifactorial interventions such as education and nutrition therapy to prevent falls.
- Risk factors for falls include drug and alcohol use, sensory problems and medications.
In a final recommendation statement, the U.S. Preventive Services Task Force said health care professionals should advise community-dwelling adults aged 65 years and older who are at risk for falls to participate in exercise interventions.
The recommendation is a B grade.
The USPSTF also issued a C-grade recommendation that health care professionals should talk with their older patients about whether further interventions might help reduce their risk for falling.
The recommendation statement is consistent with the task force’s draft recommendation released last year and its 2018 final recommendation on the topic.
However, the updated recommendation does not address the use of vitamin D to prevent falls, unlike previous recommendations. Instead, the task force said it is reviewing evidence on whether vitamin D, calcium or combined supplementation can help prevent falls in a separate recommendation.
“The task force found that health care professionals can help prevent falls in adults 65 and older at increased risk by recommending structured exercise programs,” Li, MD, PhD, MPH, a USPSTF member and the Walter M. Seward Professor and chair of family medicine at the University of Virginia School of Medicine, said in a press release. “Exercise is important to overall health, and its role in reducing falls is essential.”
According to the CDC, falls are the leading cause of injury in adults aged 65 years and older, with more than 14 million older adults report falling every year.
The task force noted that clinicians should consider age and history of falling when determining who is at greater risk for falls. Other risk factors may include:
- sensory problems;
- certain physical aspects of a person’s home or neighborhood;
- medications that may increase fall risk;
- hazards at home or work; and
- alcohol or drug use.
In the final evidence review, Janelle M. Guirguis-Blake, MD, an investigator at Kaiser Permanente, and colleagues evaluated 83 randomized controlled trials (n = 48,839) to determine the effectiveness of several exercise interventions in preventing falls.
They found that both exercise (incidence rate ratio [IRR] = 0.85; 95% CI, 0.75-0.96) and multifactorial interventions (IRR = 0.84; 95% CI, 0.74-0.95) were associated with a significant reduction in the number of falls.
The types of exercise interventions that were assessed in the trials varied, James Stevermer, MD, MSPH, a USPSTF member, told Healio. Some focused mostly on gait and walking, while others involved strength and resistance training, generalized endurance and even dance and tai chi, he said.
“We were unable to identify if there was a particular difference between one of these interventions or not,” he added. “Most of these were done in groups, but some were done with individuals.”
According to the USPSTF, multifactorial interventions that may reduce the risks for falls include:
- an assessment of an individual’s risk for falling;
- a personalized plan of interventions based on the individual’s specific risks;
- cognitive behavioral therapy;
- education;
- nutrition therapy;
- urinary incontinence management;
- medication management;
- environmental modification;
- social or community services; and
- referral to specialists like cardiologists or neurologists.
The task force identified research gaps on fall prevention interventions. One gap that future research should examine is how “to improve the availability and accessibility of different interventions,” Stevermer noted.
“For instance, whether this could be delivered remotely over telehealth and other ways to be able to provide more options to people,” he said.
In a related editorial, David B. Reuben, MD, a professor at the University of California, Los Angelas, and David A. Ganz, MD, PhD, a professor of medicine at same institution, said that it could be challenging for clinicians to implement exercise in the daily lives of older adults.
“More research needs to be conducted on motivators of exercise initiation and adherence,” they wrote.
Reuben and Ganz added that significant reductions in falls and subsequent injuries among older adults is “still far off” even if the recommendations are implemented.
“Health systems need to establish fall prevention programs that include multifactorial assessments and interventions,” they wrote. “Policymakers need to ensure access to effective exercise programs, including providing insurance coverage.”
References:
- Guirguis-Blake J, et al. JAMA. 2024;doi:10.1001/jama.2024.4166.
- Older adult falls data. https://www.cdc.gov/falls/data-research/index.html. Accessed May 30, 2024.
- Reuben D, Ganz D. JAMA. 2024;doi:10.1001/jama.2024.9063.
- Task Force issues final recommendation statement on interventions to prevent falls in older adults. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/falls-prevention-older-adults-final-rec-bulletin.pdf. Published June 4, 2024. Accessed June 4, 2024.
- USPSTF. JAMA. 2024;doi:10.1001/jama.2024.8481.
Perspective
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I believe many primary care physicians are telling patients that they need to exercise more. Walking is a great place to get started. Eventually, stretching and resistance are also important. Many physicians recommend using the American Heart Association guideline of 150 minutes of moderate intensity aerobic activity every week. Moderate intensity exercise should elevate your heart rate and make you start to sweat. Walking doesn't cost a thing and can be done just about anywhere. It is also important to add in weight and resistance training for muscle and bone health and stretching for flexibility. Weight training or resistance training does not necessarily mean lifting weights in a gym. It can be calisthenics such as push-ups, pull-ups and sit-ups. It can also be using resistance bands or cans and jugs at home to work the muscles. The increased heart rate from walking and exercising will increase blood flow, which in time can help to decrease blood pressure and cholesterol. It will also help to boost your mood and energy by releasing endorphins and increasing oxygen flow to all parts of your body.
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