Rosanne M. Leipzig, MD, PhD; Evelyn P. Whitlock, MD, MPH; Tracy A. Wolff, MD, MPH; Mary B. Barton, MD, MPP; Yvonne L. Michael, ScD, SM; Russell Harris, MD, MPH; Diana Petitti, MD, MPH; Timothy Wilt, MD, MPH; Al Siu, MD; for the U.S. Preventive Services Task Force Geriatric Workgroup
Leipzig RM, Whitlock EP, Wolff TA, Barton MB, Michael YL, Harris R, et al. Reconsidering the Approach to Prevention Recommendations for Older Adults. Ann Intern Med. 2010;153:809-814. doi: 10.7326/0003-4819-153-12-201012210-00007
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Published: Ann Intern Med. 2010;153(12):809-814.
The U.S. Preventive Services Task Force (USPSTF) bases its recommendations on an evidence-based model of clinical prevention that focuses on specific diseases, well-defined preventive interventions, and evidence of improved health outcomes. Applying this model to prevention for very old patients has been problematic for several reasons: Many geriatric disorders have multiple risk factors, interventions, and expected outcomes; older adults are not often represented in clinical trials; and important outcomes may not be measured and reported in ways that are conducive to evidence synthesis and interpretation. In 2005, the USPSTF convened a geriatrics workgroup to refine USPSTF methodology and processes to better address the preventive needs of older adults. The USPSTF has begun to apply these new approaches to the review and recommendation on interventions to prevent falls in older adults.
U.S. Preventive Services Task Force (USPSTF) recommendations focus on specific diseases, well-defined interventions, and traditional health outcomes.
USPSTF recommendations are developed by using an evidence-based model (or framework) that relies on systematic reviews of appropriate evidence.
Developing recommendations for the geriatric population has been problematic because adverse clinical events that affect the geriatric population (such as falls or fall-related fractures) are:
Multifactorial in nature
Require interventions with multiple and sometimes disparate components
Include multiple domains of functional status and quality of life that are not easily expressed as discrete events
Older adults are not often represented in clinical trials
Important outcomes in the geriatric population may not be measured and reported in ways that are conducive to evidence synthesis and interpretation
The USPSTF is developing new methods to review evidence and make recommendations for the geriatric population:
Addressing aging-specific issues for diseases prevalent in older adults
Expanding and adapting its typical analytic framework to better recognize the multifactorial nature of selected geriatric syndromes and their interventions
Addressing the outcomes that are important to patients (including nontraditional outcomes, such as effect on caregivers)
Bundling recommendations on related topics
KQ = key question; USPSTF = U.S. Preventive Services Task Force.
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