The 2018 U.S. Preventive Services Task Force (USPSTF) recommendations on preventing falls in older adults: a summary
Citation: Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL, Thompson JH. Interventions to Prevent Falls in Community-Dwelling Older Adults: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 159. AHRQ Publication No. 17-05232- EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2018.
Background: The “Interventions to Prevent Falls in Community-Dwelling Older Adults: A Systematic Review for the U.S. Preventive Services Task Force” article was published in 2018 by the Agency for Healthcare Research and Quality and is an extensive and systematically analyzed review which provides the healthcare providers an updated evidence on interventions and recommendations for fall prevention in the elderly population.
Purpose: Due to the multifactorial nature of falls discussed in the review, authors mainly investigated whether primary care fall prevention interventions when used alone or in combination reduced falls or fall-related injury, improve quality of life, reduce disability, or reduce mortality in community- dwelling older adults at average or high risk for falls. Secondly, the authors described any adverse events reported from primary care interventions within the analyzed studies.
Methods: Studies including randomized placebo- controlled trials (RCTs) and cluster RCTs designs; single, multiple or multifactorial interventions in community-dwelling older adults (aged ≥65 years) were evaluated by independent raters using the USPSTF criteria, DistillerSR, and an overall GRADE quality rating.
Results: The review determined that substantial fall-related benefit (i.e., 11-21% reduction in falls and/or people experiencing a fall) was associated with both multifactorial (26 trials) and exercise (21 trials) interventions, and that evidence is most consistent across multiple fall- related outcomes for the exercise trials. Both, the multifactorial and exercise interventions had no effect on mortality and were underpowered to determine effects on quality of life, and disability within this population. No firm conclusions can be made about other interventions (comprising of vitamin D, environment, medication management, psychological, and other multiple interventions) on their effects on study outcomes due to insufficient data or mixed results. Sub-analysis revealed that participants who were recruited from an emergency setting, or who participated in group exercise, or who were treated with multiple exercise components including strength training had a greater reduction in their fall rate. Lastly, there were limited trials reporting harms due to interventions, although the exercise and multifactorial trials integrating exercise components largely reported minor adverse effects such as muscle soreness. One trial with high dosage of vitamin D reported increased falls and related injuries but these findings weren’t replicated.
Conclusions: Despite the heterogeneity of these findings and the included study designs and protocols, these results significantly contribute to our knowledge and offer a way to enhance our treatment approaches for this population. This review also provides an important public health benefit by highlighting good quality evidence on the effectiveness of multifactorial and exercise interventions in reducing the number of falls and therefore, overall morbidity in older adults at average or high risk for falls.