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prevention of falls

Benefit/risk: - number needed to treat (NNT) strength & balance training - 11 elderly persons for 1 year to prevent at least 1 fall - no harm reported [1] Management: - assessment of balance top priority - balance training is a component of successful fall reduction programs [9] - no high-quality studies have been performed to determine if prehospital fall prevention screening can be effective in reducing in hospital falls [2] - no reliable means of preventing falls in demented elderly - individualized exercise program NOT effective - antipsychotics NOT effective - nursing home placement NOT effective [3] - STOPPFALL is a tool for optimizing medication review for fall prevention [12] - bundled fall interventions do not reduce falls in hospitalized elderly [4] - in-hospital Fall Tailoring Interventions for Patient Safety (Fall TIPS) Program reduces falls by 19%, saving > $14,000 per 1,000 patient days [7] - home hazard removal program did not reduce falls in high fall risk elderly living in low-income apartments [8] - see falls in the elderly & prevention of fractures Notes: - World Guidelines for Falls Prevention & Management's risk stratification algorithm in predicting falls with sensitivity score of 34% & specificity of 90% for predicting one or more falls with 24 months [13]

Related

falls in the elderly

General

prophylaxis (prevention, ppx)

References

  1. The NNT: Strength and Balance Training Programs for Preventing Falls in the Elderly. http://www.thennt.com/nnt/strength-and-balance-programs-for-elderly-falls/
  2. Zozula A et al. Prehospital emergency services screening and referral to reduce falls in community-dwelling older adults: A systematic review. Emerg Med J 2016 Jan 11 PMID: 26755748 http://emj.bmj.com/content/early/2016/01/11/emermed-2015-204815.abstract
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  4. Barker AL, Morello RT, Wolfe R, et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ. 2016;352:h6781 PMID: 26813674 Free PMC Article https://psnet.ahrq.gov/resources/resource/30134
  5. Vieira ER, Palmer RC, Chaves PH. Prevention of falls in older people living in the community. BMJ. 2016;353:i1419 PMID: 27125497
  6. Rothaus C. NEJM Resident 360. Feb 19, 2020 Prevention of Falls in the Elderly. https://resident360.nejm.org/clinical-pearls/prevention-of-falls-in-the-elderly
  7. Dykes PC, Curtin-Bowen M, Lipsitz S et al. Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program. JAMA Health Forum. 2023;4(1):e225125. Feb 1. https://psnet.ahrq.gov/issue/cost-inpatient-falls-and-cost-benefit-analysis-implementation-evidence-based-fall-prevention
  8. Krauss MJ, Somerville E, Bollinger RM, et al. Removing home hazards for older adults living in affordable housing: A stepped-wedge cluster-randomized trial. J Am Geriatr Soc. 2023 Dec 16 PMID: 38103187
  9. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ 2013 Oct 29; 347:f6234 PMID: 24169944 Free PMC Article http://www.bmj.com/content/347/bmj.f6234
  10. Ganz DA, Latham NK Prevention of Falls in Community-Dwelling Older Adults. N Engl J Med. 2020 Feb 20;382(8):734-743. PMID: 32074420 Review. No abstract available
  11. Dautzenberg L, Beglinger S, Tsokani S et al Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis. J Am Geriatr Soc. 2021 Oct;69(10):2973-2984. PMID: 34318929 PMCID: PMC8518387 Free PMC article.
  12. Seppala LJ, Petrovic M, Ryg J et al STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs. Age Ageing. 2021 Jun 28;50(4):1189-1199. PMID: 33349863 PMCID: PMC8244563 Free PMC article. https://academic.oup.com/ageing/article/50/4/1189/6043386
  13. Ragusa FS, Di Bella G, Dominguez LJ, The role of the World Guidelines for Falls Prevention and Management's risk stratification algorithm in predicting falls: a retrospective analysis of the Osteoarthritis Initiative. Age Ageing. 2024 Aug 6;53(8):afae187. PMID: 39171386
  14. Centers for Disease Control & Prevention (CDC). 2019 Algorithm for Fall Risk Screening, Assessment, and Intervention https://www.cdc.gov/steadi/pdf/STEADI-Algorithm-508.pdf