Preventing Falls in Our Elderly: USPSTF Gets It Right!

Not to be too harsh on the US Prventive Services Task Force (USPSTF) but they've come under attack the last several years for many of their recommendations which have gone against conventional wisdom: witness the controversy surrounding screening for breast cancer in 2009 and for prostate cancer just last week.  So it's nice to see that conventional wisdom prevailed when the USPSTF published their Recommendation Statement for Prevention of Falls in Community-Dwelling Older Adults online earlier this week in the Annals of Internal Medicine prior to print release in August.  

In fact, USPSTF specifically recommended exercise or physical therapy along w/vitamin D supplementation to prevent falls in community dwelling older adults at increase risk for said falls, including those who've already fallen.  However, the USPSTF also held back and did not recommend multifactorial risk assessment & management in all community dwelling older adults.

In reality, this new statement shouldn't really be a surprise as a systematic evidence review was published close to 18 months ago in the Annals of Internal Medicine in which the authors noted that 16 randomized controlled trials (RCTs) demonstrated a 13% reduction in falls in those patients who exercised or received physical therapy.  A 17% reduction in falls was noted in those given vitamin D in 9 RCTs.

Granted, these may not be large dramatic reductions but every little bit helps when one out of three community dwelling older adult falls each year of whom one in ten to twenty will sustain an injury requiring medical attention, eg fracture, laceration, and/or brain injury.  The statistics are even worse for those who've sustained a hip fracture as one in four won't live past the anniversary of their fall while only one in two will return to their baseline level of function.  Long story short, the demographics are compelling such that we need to do everything we can to prevent falls in the first place in the growing population of older adults.  After all, we don't want to make the proverbial call, "Help! I've fallen and I can't get up!"

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