Citation

Reuben DB, Ganz DA. J. Am. Med. Assoc. JAMA 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, American Medical Association)

DOI

10.1001/jama.2024.9063

PMID

38833266

Abstract

Among older persons, falls are common (about 25% of older US adults fall each year), injurious (approximately 37% of those who fall require medical treatment or restrict their activity for at least 1 day), expensive (approximately $50 billion per year is spent on medical costs related to falls), and are a worsening problem. In fact, age-adjusted rates of fatal falls increased 41% in the US from 2012 to 2021.1 Moreover, because the incidence of falls rises with increasing age, the absolute number of older adults who fall will increase dramatically as the next generation enters the highest-risk age groups.

In response to the burden of falls, substantial research efforts have been undertaken. The US Preventive Services Task Force (USPSTF) updated Evidence Report and Systematic Review published in this issue of JAMA2 identified 83 fair- to good-quality randomized clinical trials to inform the USPSTF updated Recommendation Statement,3 32 of which were new since the previous review. These trials support exercise for fall prevention (incidence rate ratio [IRR], 0.85 [95% CI, 0.75-0.96] for falls and IRR, 0.84 [95% CI, 0.74-0.95] for injurious falls). The evidence for multifactorial interventions demonstrated similar reductions in falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]).

On this basis, the USPSTF reiterated its 2018 recommendations for fall prevention with a B recommendation for exercise (recommended for all over 65 years of age at increased risk of falls) and a C recommendation for multifactorial interventions (individualized decision based on the circumstances of patient's prior falls, comorbid medical conditions, and values and preferences).3 Although the USPSTF recommendations are sound, the devil is in the details.

Language: en