Falls and Fall Prevention _ _____________________________________________________________________
STEADI ALGORITHM FOR FALL RISK SCREENING, ASSESSMENT, AND INTERVENTION AMONG COMMUNITY-DWELLING ADULTS 65 YEARS AND OLDER
Source: [29]
Figure 1
Other interventions for reducing fall risk are guided by the patient’s individual fall risk assessment. Important consider- ations include prescription and over-the-counter medications that may result in side effects such as drowsiness, dizziness, and orthostatic hypotension; regular visual acuity testing at 1- to 2-year intervals, in order to update eyeglasses when needed and manage cataracts in a timely fashion; and improving home safety by eliminating tripping hazards, improving lighting, and adding grab bars in the tub or shower. Routine vitamin D and calcium supplementations have not been found effective, nor are they recommended by the USPSTF, for reducing fall risk in older adults without evidence of deficiency [30]. However, in select older women at risk for hip fracture, it may be prudent to consider calcium and vitamin D supplementation, screening for osteoporosis (recommended for all women older than 65 years of age), and weight-bearing exercises.
Interventions Exercise interventions are the cornerstone for fall risk reduc- tion and prevention of fall-related injury in community- dwelling older adults. According to the U.S. Preventive Services Task Force (USPSTF), both supervised individual and group classes are effective when functional training is included [31]. Older adults should set a weekly goal of 150 minutes of moderate-intensity exercise (or 75 minutes of vigorous physical activity) combined with muscle-strengthening activities twice each week. A meta-analysis of 59 randomized trials found that fall prevention exercise programs are beneficial for adults at average or high risk of falls [32]. The rate of falls in this study was 23% lower among participants in an exercise program compared with those in control groups. Exercise programs effective in reducing falls are those that include functional exercises, balance training, and resistance exercises.
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