An article in the Journal of the American Geriatrics Society summarizes the updated (2010) American Geriatrics Society/ British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. The article provides a flowchart of falls prevention assessment and points out what has been updated since the 2001 guidelines. Changes are based on metanalyses, systematic literature reviews, pre/post studies, longitudinal studies, and randomized controlled trials published since the previous version. The guidelines specify when particular assessments and interventions are recommended, not recommended, or when evidence is mixed or insufficient. Thus, the article is useful for researchers, clinicians, and older adults and their families who want to be familiar with current expert standards for falls prevention.
There are some important changes from the 2001 guidelines. It’s recommended that individuals who report difficulties with gait or balance take part in multifactoral fall risk assessments, in addition to those with a history of two or more falls. For individuals with only one reported fall, without any additional unsteadiness, an assessment is not deemed necessary. Assessment should also consider feet and footwear, more general assessments of mobility and functioning, and environmental context (such as home safety).
As previous research discussed on this blog has suggested, the guidelines recommend an exercise component for all interventions involving community-living older adults. Tai chi has been added since the 2001 recommendations due to the accumulation of sufficient research data, as is the recommendation that programs should include balance, gait, and strength training. Again, these recommendations just apply to adults living in their communities; in contrast to the 2001 findings, there are no recent data to support long-term exercise for older adults with current falls who live in care facilities.
For community-dwelling and facility-dwelling older adults without cognitive impairment, the 2010 recommendations include environmental modification based on the falls risk assessment. Medication reduction is also strongly recommended when possible, as medication side effects are a strong risk factor. This is particularly true for psychotropic medication; although, in 2001, it was thought that selective serotonin reuptake inhibitors (SSRIs) were safer to use (from a falls risk perspective) than the older generation of tricyclic antidepressants, current research suggest that SSRIs are just as likely to increase falls risk.
Falls risk assessments and interventions should include postural hypotension (the “head rush” feeling that can occur when suddenly standing up), heart rate abnormalities, and the use of vitamin D supplements. All interventions should include an education component, particularly those with specific goals (such as increased ability to remove falls hazards from one’s environment). Unfortunately, especially as cognitive impairment and dementia are some of the most significant falls risk factors, there is insufficient evidence supporting any specific interventions for older adults with low cognitive functioning.
The complete guideline is available at the American Geriatrics Society’s Website. The article reviewed here may be a helpful introduction to or review of the guidelines, useful for a variety of clinical, research, and lay readers in need of a primer on current falls prevention standards.
Panel of Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society (2011). “Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons.” Journal of the American Geriatrics Society 59(1):148-157
American Geriatrics Society press release (includes guidelines): http://www.americangeriatrics.org/press/id:1545
Mather LifeWays SAFE-TI Falls Reduction Program: http://www.matherlifeways.com/safeti