Task force recommends exercise, vitamin D to prevent falls in elderly

The U.S. Preventive Services Task Force (USPSTF) recommends exercise or physical therapy and vitamin D supplementation to prevent falls in at-risk community-dwelling adults aged 65 years or older.

Exercise and vitamin D are Grade B recommendations, meaning there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. The recommendations and patient summary appeared online May 28 at Annals of Internal Medicine.

The USPSTF reviewed 18 studies of exercise or physical therapy in community-dwelling older adults and found these interventions to be associated with a statistically significant reduction in risk for falling (pooled relative risk [RR], 0.87; 95% CI, 0.81 to 0.94). The number needed to treat with exercise or physical therapy (for a median of approximately 12 weeks) to prevent one person from falling was 16. The benefit was greater in high-risk populations (pooled RR, 0.84; 95% CI, 0.78 to 0.91) than in low-risk populations.

Exercise or physical therapy trials included gait, balance or functional training (including a study on tai chi, strength or resistance exercise and general exercise. Treatment intensity (estimated in hours of contact) ranged from 2 to 80 hours.

The USPSTF reviewed nine trials of vitamin D supplementation and found an approximately 17% reduction in risk for falling during six to 36 months of follow-up and a number needed to treat of 10. Several of the studies targeted older adults who were vitamin D-deficient, and the effect of vitamin D supplementation was greater in these populations.

The trials studied a wide range of doses and durations for vitamin D supplementation. The median dose was 800 IU daily, and the median duration was 12 months. Data suggest that benefit from vitamin D supplementation occurs by 12 months; the efficacy of shorter treatment is unknown, the task force said.

The USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls because the likelihood of benefit is small. This is a Grade C recommendation, meaning it should be based on individual circumstances. Assessment would be of benefit to only a small group of patients without signs or symptoms, the task force concluded. Patients and clinicians should consider the balance of benefits and harms based on prior falls, comorbid medical conditions and patient values.