[Skip to Content]
[Skip to Content Landing]

Interventions to Prevent Falls in Community-Dwelling Older AdultsUS Preventive Services Task Force Recommendation Statement

Educational Objective
To review the US Preventive Services Task Force (USPSTF) recommendations regarding interventions to prevent falls in older adults.
1 Credit CME
Abstract

Importance  Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls (37.5% of which needed medical treatment or restricted activity for a day or longer) and an estimated 33 000 deaths in 2015.

Objective  To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the prevention of falls in community-dwelling older adults.

Evidence Review  The USPSTF reviewed the evidence on the effectiveness and harms of primary care–relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling older adults 65 years or older who are not known to have osteoporosis or vitamin D deficiency.

Findings  The USPSTF found adequate evidence that exercise interventions have a moderate benefit in preventing falls in older adults at increased risk for falls and that multifactorial interventions have a small benefit. The USPSTF found adequate evidence that vitamin D supplementation has no benefit in preventing falls in older adults. The USPSTF found adequate evidence to bound the harms of exercise and multifactorial interventions as no greater than small. The USPSTF found adequate evidence that the overall harms of vitamin D supplementation are small to moderate.

Conclusions and Recommendation  The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient’s values and preferences. (C recommendation) The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older. (D recommendation) These recommendations apply to community-dwelling adults who are not known to have osteoporosis or vitamin D deficiency.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: David C. Grossman, MD, MPH (chair@uspstf.net)

Accepted for Publication: March 5, 2018.

Published Online: April 17, 2018. doi:10.1001/jama.2018.3097

The US Preventive Services Task Force (USPSTF) members: David C. Grossman, MD, MPH; Susan J. Curry, PhD; Douglas K. Owens, MD, MS; Michael J. Barry, MD; Aaron B. Caughey, MD, PhD; Karina W. Davidson, PhD, MASc; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Alex R. Kemper, MD, MPH, MS; Alex H. Krist, MD, MPH; Martha Kubik, PhD, RN; Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Michael Pignone, MD, MPH; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Kaiser Permanente Washington Health Research Institute, Seattle (Grossman); University of Iowa, Iowa City (Curry); Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Owens); Stanford University, Stanford, California (Owens); Harvard Medical School, Boston, Massachusetts (Barry); Oregon Health & Science University, Portland (Caughey); Columbia University, New York, New York (Davidson); University of Pennsylvania, Philadelphia (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling); Nationwide Children’s Hospital, Columbus, Ohio (Kemper); Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Temple University, Philadelphia, Pennsylvania (Kubik); University of Alabama at Birmingham (Landefeld); University of California, Los Angeles (Mangione); University of Texas at Austin (Pignone); Boston University, Boston, Massachusetts (Silverstein); Northwestern University, Evanston, Illinois (Simon); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng).

Author Contributions: Dr Grossman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Tina Fan, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

References
1.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). http://www.cdc.gov/injury/wisqars/. 2016. Accessed November 8, 2017.
2.
Bergen  G, Stevens  M, Burnes  E.  Falls and fall injuries among adults aged ≥65 years—United States, 2014.  MMWR Morb Mortal Wkly Rep. 2016;65(37):993-998. PubMedGoogle ScholarCrossref
3.
Sterling  DA, O’Connor  JA, Bonadies  J.  Geriatric falls: injury severity is high and disproportionate to mechanism.  J Trauma. 2001;50(1):116-119.PubMedGoogle ScholarCrossref
4.
Alexander  BH, Rivara  FP, Wolf  ME.  The cost and frequency of hospitalization for fall-related injuries in older adults.  Am J Public Health. 1992;82(7):1020-1023.PubMedGoogle ScholarCrossref
5.
Thomas  J, Lane  J.  A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients.  Arch Phys Med Rehabil. 2005;86(8):1636-1640. PubMedGoogle ScholarCrossref
6.
Arnold  C, Faulkner  R.  The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis.  BMC Geriatr. 2007;7:17. PubMedGoogle ScholarCrossref
7.
Barry  E, Galvin  R, Keogh  C,  et al.  Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis.  BMC Geriatr. 2014;14:14. PubMedGoogle ScholarCrossref
8.
Guirguis-Blake  JM, Michael  YL, Perdue  LA, Coppola  EL, Beil  TL, Thompson  JH.  Interventions to Prevent Falls in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force: Evidence Synthesis No. 159. Rockville, MD: Agency for Healthcare Research and Quality; 2018. AHRQ publication 17-05230-EF-1.
9.
US Department of Health and Human Services.  2008 Physical Activity Guidelines for Americans. Washington, DC: US Dept of Health and Human Services; 2008.
10.
Guirguis-Blake  JM, Michael  YL, Perdue  LA, Coppola  EL, Beil  TL.  Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force  [published online April 17, 2018].  JAMA. doi:10.1001/jama.2017.21962Google Scholar
11.
U.S. Preventive Services Task Force.  Screening for osteoporosis: U.S. preventive services task force recommendation statement.  Ann Intern Med. 2011;154(5):356-364.PubMedGoogle ScholarCrossref
12.
US Preventive Services Task Force.  Vitamin D, calcium, or combined supplementation for primary prevention of fractures in community-dwelling adults: US Preventive Services Task Force recommendation statement  [published online April 17, 2018].  JAMA. doi:10.1001/jama.2018.3185Google Scholar
13.
National Center for Injury Prevention and Control.  Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs. 2nd ed. Atlanta, Ga: Centers for Disease Control and Prevention; 2015.
14.
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.  Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.  J Am Geriatr Soc. 2011;59(1):148-157.PubMedGoogle ScholarCrossref
15.
Kochanek  KD, Murphy  SL, Xu  J, Tejada-Vera  B.  Deaths: final data for 2014.  Natl Vital Stat Rep. 2016;65(4):1-122.PubMedGoogle Scholar
16.
Parkkari  J, Kannus  P, Palvanen  M,  et al.  Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients.  Calcif Tissue Int. 1999;65(3):183-187.PubMedGoogle ScholarCrossref
17.
Fuller  GF.  Falls in the elderly.  Am Fam Physician. 2000;61(7):2159-2174.PubMedGoogle Scholar
18.
Gallagher  JC, Fowler  SE, Detter  JR, Sherman  SS.  Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss.  J Clin Endocrinol Metab. 2001;86(8):3618-3628.PubMedGoogle ScholarCrossref
19.
Sanders  KM, Stuart  AL, Williamson  EJ,  et al.  Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial.  JAMA. 2010;303(18):1815-1822.PubMedGoogle ScholarCrossref
20.
Uusi-Rasi  K, Patil  R, Karinkanta  S,  et al.  Exercise and vitamin D in fall prevention among older women: a randomized clinical trial.  JAMA Intern Med. 2015;175(5):703-711.PubMedGoogle ScholarCrossref
21.
El-Khoury  F, Cassou  B, Latouche  A, Aegerter  P, Charles  MA, Dargent-Molina  P.  Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial.  BMJ. 2015;351:h3830.PubMedGoogle ScholarCrossref
22.
Gill  TM, Pahor  M, Guralnik  JM,  et al; LIFE Study Investigators.  Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study).  BMJ. 2016;352:i245.PubMedGoogle ScholarCrossref
23.
Kahwati  LC, Weber  RP, Pan  H,  et al.  Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Adults: An Evidence Review for the U.S. Preventive Services Task Force: Evidence Synthesis No. 160. Rockville, MD: Agency for Healthcare Research and Quality; 2018. AHRQ publication 17-05231-EF-1.
24.
Kahwati  LC, Palmieri Weber  R, Pan  H,  et al.  Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: evidence report and systematic review for the US Preventive Services Task Force  [published online April 17, 2018].  JAMA. doi:10.1001/jama.2017.21640Google Scholar
25.
Zijlstra  GA, van Haastregt  JC, Ambergen  T,  et al.  Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial.  J Am Geriatr Soc. 2009;57(11):2020-2028.PubMedGoogle ScholarCrossref
26.
Pike  JW.  Closing in on vitamin D action in skeletal muscle: early activity in muscle stem cells?  Endocrinology. 2016;157(1):48-51.PubMedGoogle ScholarCrossref
27.
Pojednic  RM, Ceglia  L, Olsson  K,  et al.  Effects of 1,25-dihydroxyvitamin D3 and vitamin D3 on the expression of the vitamin D receptor in human skeletal muscle cells.  Calcif Tissue Int. 2015;96(3):256-263.PubMedGoogle ScholarCrossref
28.
Bischoff-Ferrari  HA, Orav  EJ, Dawson-Hughes  B.  Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial.  Arch Intern Med. 2006;166(4):424-430.PubMedGoogle Scholar
29.
Institute of Medicine.  Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press; 2011.
30.
National Institute on Aging. Prevent falls and fractures. https://www.nia.nih.gov/health/prevent-falls-and-fractures. 2017. Accessed February 23, 2018.
31.
Centers for Disease Control and Prevention. STEADI materials for health care providers. https://www.cdc.gov/steadi/materials.html. Accessed March 8, 2018.
32.
American Academy of Family Physicians. Clinical preventive service recommendation: fall prevention in older adults. https://www.aafp.org/patient-care/clinical-recommendations/all/fall-prevention.html. 2012. Accessed February 23, 2018.
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close