Interventions to prevent falls in community-dwelling older adults us Preventive Services Task Force recommendation statement

David C. Grossman, Susan J. Curry, Douglas K. Owens, Michael J. Barry, Aaron Caughey, Karina W. Davidson, Chyke A. Doubeni, John W. Epling, Alex R. Kemper, Alex H. Krist, Martha Kubik, Seth Landefeld, Carol M. Mangione, Michael Pignone, Michael Silverstein, Melissa A. Simon, Chien Wen Tseng

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Abstract

IMPORTANCE: Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls (37.5% of which needed medical treatment or restricted activity for a day or longer) and an estimated 33 000 deaths in 2015. OBJECTIVE: To update the 2012US Preventive Services Task Force (USPSTF) recommendation on the prevention of falls in community-dwelling older adults. EVIDENCE REVIEW: The USPSTF reviewed the evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling older adults 65 years or older who are not known to have osteoporosis or vitamin D deficiency. FINDINGS: The USPSTF found adequate evidence that exercise interventions have a moderate benefit in preventing falls in older adults at increased risk for falls and that multifactorial interventions have a small benefit. The USPSTF found adequate evidence that vitamin D supplementation has no benefit in preventing falls in older adults. The USPSTF found adequate evidence to bound the harms of exercise and multifactorial interventions as no greater than small. The USPSTF found adequate evidence that the overall harms of vitamin D supplementation are small to moderate. CONCLUSIONS AND RECOMMENDATION: The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation) The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 yearsor older. (D recommendation) These recommendations apply to community-dwelling adults who are not known to have osteoporosis or vitamin D deficiency.

Original languageEnglish (US)
Pages (from-to)1696-1704
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume319
Issue number16
DOIs
StatePublished - Apr 24 2018

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Independent Living
Advisory Committees
Vitamin D
Vitamin D Deficiency
Exercise
Osteoporosis
Morbidity
Mortality
Patient Preference
Primary Health Care

ASJC Scopus subject areas

  • Medicine(all)

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Interventions to prevent falls in community-dwelling older adults us Preventive Services Task Force recommendation statement. / Grossman, David C.; Curry, Susan J.; Owens, Douglas K.; Barry, Michael J.; Caughey, Aaron; Davidson, Karina W.; Doubeni, Chyke A.; Epling, John W.; Kemper, Alex R.; Krist, Alex H.; Kubik, Martha; Landefeld, Seth; Mangione, Carol M.; Pignone, Michael; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien Wen.

In: JAMA - Journal of the American Medical Association, Vol. 319, No. 16, 24.04.2018, p. 1696-1704.

Research output: Contribution to journalArticle

Grossman, DC, Curry, SJ, Owens, DK, Barry, MJ, Caughey, A, Davidson, KW, Doubeni, CA, Epling, JW, Kemper, AR, Krist, AH, Kubik, M, Landefeld, S, Mangione, CM, Pignone, M, Silverstein, M, Simon, MA & Tseng, CW 2018, 'Interventions to prevent falls in community-dwelling older adults us Preventive Services Task Force recommendation statement', JAMA - Journal of the American Medical Association, vol. 319, no. 16, pp. 1696-1704. https://doi.org/10.1001/jama.2018.3097
Grossman, David C. ; Curry, Susan J. ; Owens, Douglas K. ; Barry, Michael J. ; Caughey, Aaron ; Davidson, Karina W. ; Doubeni, Chyke A. ; Epling, John W. ; Kemper, Alex R. ; Krist, Alex H. ; Kubik, Martha ; Landefeld, Seth ; Mangione, Carol M. ; Pignone, Michael ; Silverstein, Michael ; Simon, Melissa A. ; Tseng, Chien Wen. / Interventions to prevent falls in community-dwelling older adults us Preventive Services Task Force recommendation statement. In: JAMA - Journal of the American Medical Association. 2018 ; Vol. 319, No. 16. pp. 1696-1704.
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AU - Caughey, Aaron

AU - Davidson, Karina W.

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AU - Kemper, Alex R.

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N2 - IMPORTANCE: Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls (37.5% of which needed medical treatment or restricted activity for a day or longer) and an estimated 33 000 deaths in 2015. OBJECTIVE: To update the 2012US Preventive Services Task Force (USPSTF) recommendation on the prevention of falls in community-dwelling older adults. EVIDENCE REVIEW: The USPSTF reviewed the evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling older adults 65 years or older who are not known to have osteoporosis or vitamin D deficiency. FINDINGS: The USPSTF found adequate evidence that exercise interventions have a moderate benefit in preventing falls in older adults at increased risk for falls and that multifactorial interventions have a small benefit. The USPSTF found adequate evidence that vitamin D supplementation has no benefit in preventing falls in older adults. The USPSTF found adequate evidence to bound the harms of exercise and multifactorial interventions as no greater than small. The USPSTF found adequate evidence that the overall harms of vitamin D supplementation are small to moderate. CONCLUSIONS AND RECOMMENDATION: The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation) The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 yearsor older. (D recommendation) These recommendations apply to community-dwelling adults who are not known to have osteoporosis or vitamin D deficiency.

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