As I've mentioned in previous posts, the US Preventive Services Task Force (USPSTF) is a stickler for evidence-based medicine. Unless they have enough studies demonstrating cause & effect, they won't make recommendations or at least give strong ones based upon epidemiologic data alone. This is both their strength & their weakness.
When it comes to caring for our elderly, especially when considering healthy aging, optimizing health & preventing debilitation & frailty, the USPSTF concluded last week that it's difficult to arrive at definitive recommendations because there are so many risk factors to take into account, so many interventions & outcomes to consider, and most importantly, a scarcity of elderly participants in many clinical trials.
Which isn't to say they haven't tried. For instance, in the very same issue, USPSTF analyzed 19 randomized controlled trials to determine interventions to prevent falls in the elderly. It's worth noting that they actually had to screen 3423 abstracts and 638 articles to find fair-to-good quality studies.
Their conclusions: exercise & physical therapy can reduce falls by 13% while vitamin D can reduce falls by 17% (take that, IOM!). Multifactorial fall assessment, the geriatrician's bread & butter, showed a non-statistically significant 6% trend towards fall reduction. Unfortunately, the individual components, medication use, visual acuity, home environment, and gait/balance assessment, demonstrated no benefit in isolation. The good news? No serious harm was noted as an outcome of the interventions.
The obvious question: how much exercise and how much vitamin D is necessary? Given the debacle over their recommendations for mammogram screenings, the USPSTF is opening up their draft recommendation statements to public comment at www.uspreventiveservicestaskforce.org/tfcomment.htm prior to making definitive final recommendations. But there's no reason that we can't continue to recommend exercise & vitamin D for our patients now.
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