Evidence-Based Guidelines for the Secondary Prevention of Falls in Older Adults

Abstract

Background: Falls are a significant problem for older adults. Individuals who have sustained a fall come to the attention of health care providers and are at risk of further falls. To promote the highest quality of care and reduce variation in care, a practice guideline is needed. Summarization of evidence regarding falls may be useful to researchers in this field. Objectives: To provide evidence-based guidelines of assessment and treatment to prevent falls in older adults and to provide researchers with tables of risk factor studies and randomized controlled trials of falls prevention. Methods: A template for the development of practice guidelines from the Agency for Health Care Policy and Research was used. Evidence for risk factors was accepted from prospective studies with more than 80% follow-up. Potentially modifiable risk factors were selected and a schema for evaluating the importance of each risk factor was used. Evidence for interventions was examined from randomized controlled trials and strength of the evidence was graded. Recommendations for aspects of care where judgment was required were made by panel consensus. Results: Information was drawn from 46 risk factor studies and 37 randomized controlled trials to develop a practice guideline consisting of assessment items and recommended interventions for community-dwelling and institution-dwelling older adults separately. For clinicians, a check list is provided. Summary tables of the results of studies are given to substantiate the recommendations. Conclusions: For community-dwelling older adults, there is strong evidence for multi-factorial specific risk assessment and targeted treatment. Balance exercises are recommended for all individuals who have had a fall and there is evidence for a program of home physiotherapy for women over 80 years of age regardless of risk factor status. For institutional settings, the establishment of a falls program for safety checks, ongoing staff education and monitoring is substantiated by research. Residents who have fallen need to be assessed for specific risk factors and clinical indicators to determine relevant management options.

Prevalência de quedas em idosos asilados do município de Rio Grande, RS

“…A queda é uma dentre outras causas externas que trazem mais problemas aos idosos, sendo considerada por muitas pessoas como um evento normal e próprio do envelhecimento. 2,11 Espera-se que aproximadamente 30 a 40% das pessoas que vivem em asilos de idosos tenham caído ao solo ao menos uma vez na vida 7,8 e que cerca de 25% sofrerão uma queda grave a cada ano. 15 Nesse contexto, o processo de envelhecimento é um fenômeno natural da vida, no qual ocorrem mudanças físicas, como perda de força, diminuição da coordenação e do domínio do corpo e de mudanças cognitivas evocadas por problemas de memória.…”

“…15 Nesse contexto, o processo de envelhecimento é um fenômeno natural da vida, no qual ocorrem mudanças físicas, como perda de força, diminuição da coordenação e do domínio do corpo e de mudanças cognitivas evocadas por problemas de memória. 8 O presente estudo teve como objetivo descrever a prevalência de quedas e fatores associados em uma população de idosos asilados.…”

AST-induced bone loss in men with prostate cancer: exercise as a potential countermeasure

“…Furthermore, exercise can have a major role in modifying falls risk factors and preventing falls in older adults. 62 We propose exercise may also be beneficial for men with prostate cancer on AST where decreased bone density and an increased risk for fracture are well-established treatment side effects.…”

Testes de equilíbrio e mobilidade funcional na predição e prevenção de riscos de quedas em idosos

“…7 A identificação precoce desses fatores de risco é extremamente importante para a prevenção da ocorrência de quedas. 8,9 Dentre os fatores que aumentam o risco de quedas nos idosos, a deterioração do equilíbrio e da mobilidade funcional são considerados muito importantes. [10][11][12] Vários testes têm sido descritos e utilizados para avaliar o equilíbrio e mobilidade funcional dos idosos, com o objetivo de determinar o risco de quedas.…”