In 2019, falls among adults 65 years and older were the leading cause of injury-related death in that age group, accounting for more than 34,000 deaths. Despite an abundance of clinical practice guidelines for preventing falls, death rates increased about 30% between 2007 and 2016, with medical costs totaling about $50 billion. A recent systematic review of guidelines on fall prevention and management in JAMA Network Open explored whether the guidelines were in agreement on how to prevent and manage falls in older adults in various care settings, and identified gaps in the recommendations.

The researchers examined 15 guidelines that met the study criteria, extracting almost 200 recommendations for fall prevention. Agreement among the guidelines was high for risk stratification, assessment tools, fracture and osteoporosis management, and interventions such as physical exercise. Most also strongly recommended measures such as medication review and environment modifications. Guidelines were inconsistent, however, regarding vitamin D supplementation, education on fall prevention, addressing cognitive impairment, and physiotherapy referrals. The authors determined that risk stratification algorithms included in the recommendations warranted more complete descriptions and better evidence for validity. For example, the Timed Up and Go test was most often recommended to evaluate gait and balance, yet it has low predictive validity.

Other deficits found in the guidelines included a lack of recommendations for older adults with cognitive impairment, few tools to help clinicians identify drugs that increase fall risk, and few prevention recommendations for low-risk older adults. The authors suggest these gaps be remedied in future guidelines. In the meantime, they also suggest using the STEADI (Stopping Elderly Accidents, Deaths and Injuries) initiative (http://www.cdc.gov/steadi/index.html), developed by the Centers for Disease Control and Prevention, which focuses on practical implementation of preventive measures and includes useful clinical resources and videos on fall prevention.-Gail M. Pfeifer, MA, RN