Virginia A. Moyer, MD, MPH; on behalf of the U.S. Preventive Services Task Force*
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Potential Conflicts of Interest: Dr. Moyer: Support for travel to meetings for the study or other purposes: AHRQ/USPSTF; Consultancy: AAP. Disclosure forms from USPSTF members can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0471.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.uspreventiveservicestaskforce.org).
Update of the 1996 U.S. Preventive Services Task Force (USPSTF) recommendation statement on counseling to prevent household and recreational injuries, including falls.
The USPSTF reviewed new evidence on the effectiveness and harms of primary care–relevant interventions to prevent falls in community-dwelling older adults. The interventions were grouped into 5 main categories: multifactorial clinical assessment (with or without direct intervention), clinical management (with or without screening), clinical education or behavioral counseling, home hazard modification, and exercise or physical therapy.
The USPSTF recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls. (Grade B recommendation)
The USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older because the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values. (Grade C recommendation)
Prevention of falls in community-dwelling older adults: clinical summary of U.S. Preventive Services Task Force recommendation.
What the USPSTF Grades Mean and Suggestions for Practice
USPSTF Levels of Certainty Regarding Net Benefit
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Roger A. Renfrew, MD, FACP
Redington Medical Primary Care, Skowhegan, MD
August 20, 2012
Practical Approach Needed to Deal With Aging Population
To the Editor,
The recent article on the USPSTF recommendations regarding Prevention of Falls in Community Dwelling Older Adults (1) and its variance from the Assessing Care of Vulnerable Elders (ACOVE) indicators (2) raise the challenge of trying to develop a practical approach to deal with an aging population in primary care.
Most Geriatric Care for the near and intermediate future will be provided by primary care providers. There are an estimated 222,000 primary care physicians in the country while there are only 7,000 geriatricians (3). The challenge is to find a practical commonsense approach to provision of care for the ageing population that can work in the primary care office.
The ACOVE indicators provide a logical structure for organizing an approach to geriatric care and are amenable to a Q/I processes. They are designed through a literature review and consensus. They are meant to be "a low bar" (4).
The challenge with these indicators is that we do not do well with them. Even in academic geriatric practices, the demands of chronic care management leads to failure to meet these indicators for geriatric syndromes unless specific processes are in place and a Nurse Practitioner is specifically committed to this work (5).
I recently presented a talk to our medical staff on the use of the ACOVE indicators in designing an approach to falls. An astute family practitioner asked, "So if we identify those patients at risk and refer to PT, won't we have done most of what we need to do?" I will now tell him to also check the Vitamin D level. This approach leads to a simple intervention which is easy to implement and if spread can have greater impact than a more complicated set of expectations.
The ACOVE indicators can provide a path for those who wish to go deeper. For instance, in my practice we have redesigned process for dementia care based on areas of weakness we delineated by reviewing our performance against these QIs.
We need to define what works well in the PCP office. We need to find practical
solutions today. I believe this is work that organizations such as ACP, AGS and AAFP
should bngaged in an ongoing basis.
Moyer VA, on behalf of the U.S. Preventive Services Task Force*. Prevention of Falls in Community-Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2012;157:197–204. doi: 10.7326/0003-4819-157-3-201208070-00462
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Published: Ann Intern Med. 2012;157(3):197-204.
Geriatric Medicine, Guidelines, Prevention/Screening.
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