Fall Prevention Guidelines Highlight Vitamin D Article from Medscape Medical News

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Fall Protection Guidelines From USPSTF Highlight Vitamin D

Jenni Laidman

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May 29, 2012 — Exercise or physical therapy, along with vitamin D

supplementation, are the best medicine for fall prevention among older

adults, according to a report by the US Preventive Services Task Force

(USPSTF). The new clinical guideline was published online May 28 in

the ls of Internal Medicine.

Virginia A. Moyer, MD, MPH, on behalf of the USPSTF, reported new

recommendations for fall prevention among community-dwelling adults

aged 65 years and older after reviewing evidence on both the efficacy

and possible harm from interventions. Dr. Moyer and colleagues

reviewed data on multifactorial clinical assessment, clinical

management, clinical education or behavioral counseling, home hazard

modification, and exercise or physical therapy.

Falls are the leading cause of injury in adults aged 65 years and

older, with 30% to 40% of community-dwelling adults older than 65

years falling at least once each year. Among these patients, 5% to 10%

incur a fracture, laceration, or head injury from a fall.

The task force called its recommendation for exercise or physical

therapy a grade B recommendation, meaning the service is recommended

with a high certainty of moderate benefit. On the basis of a review of

18 studies that tested exercise or physical therapy, the USPSTF

estimated the risk for falls would be reduced 13% (pooled relative

risk [RR], 0.87; 95% confidence interval [CI], 0.81 - 0.94). To

prevent 1 person from falling, 16 people needed to undergo physical

therapy or undertake exercise for 12 weeks. High-risk populations

benefited most (pooled RR, 0.84; 95% CI, 0.78 - 0.91).

Similarly, vitamin D supplementation was also a grade B

recommendation, with the USPSTF concluding it has moderate certainty

of moderate net benefit among older adults. In a review of 9 trials

involving vitamin D supplementation, the authors estimated there was a

17% reduction in the risk of falling over the course of 6 to 36 months

of follow-up, with a number needed to treat of 10. When studies

targeted those who were vitamin D deficient, the effect was greater

yet.

In contrast, the task force did not recommended multifactorial risk

assessment with comprehensive management of identified risk for the

general population of older adults. The authors stressed that the

service would likely be beneficial only to selected patients,

depending on individual symptoms.

Specifically, a combined analysis of 6 studies on multifactorial

clinical assessment with comprehensive management resulted in a

non–statistically significant reduction of risk after 12 months, with

a pooled RR of 0.89 (95% CI, 0.76 - 1.0). The largest of these studies

involved 1559 adults with a mean age of 72.5 years reporting a 25%

reduction in the risk of falling in the intervention group compared

with control patients (RR, 0.75; 95% CI, 0.64 - 0.88). Multifactorial

clinical assessment with less-than-comprehensive follow-up was

ineffective in reducing the risk for falls (pooled RR, 0.994; 95% CI,

0.917 - 1.076).

In addition, 4 studies that looked at vision correction failed to

report a reduced risk of falling, and evidence for wearing hip

protection was mixed. Although 1 study of 4169 women with an average

age of 78 years reported a reduced risk of falling after 12 months, a

smaller study found no benefit. Evidence of the benefits of protein

supplementation was limited, as was evidence for clinical education or

behavioral counseling. Three studies examining home hazard

modification produced results that fell short of statistical

significance.

The author has disclosed no relevant financial relationships.

Ann Intern Med. Published online May 28, 2012. Full text