Bifocals and Falls - NYTimes.com

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By KAREN STABINER

The first reader to weigh in on a recent post about new fall-prevention guidelines was “h” from Chicago, who wrote: “I also wonder about bifocals causing falls. This is why I’m sticking to two pairs of glasses for now.”

That’s good advice, it turns out.

In a study published last year in the medical journal BMJ, Australian researchers found a decrease in the number of falls among people who switched to single-vision eyeglasses for outdoor activities and stairs.

The results, said the researchers, “demonstrated how multifocal glasses can impair visual abilities needed for detecting obstacles and judging depth.”
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Stemming Falls in the Elderly - South Florida Sun-Sentinel.com

By Judith Graham, Tribune Newspapers

As we age, our risk of falling increases. Our feet may catch on a well-worn rug or we may miss a step going downstairs to the kitchen at night. We lose balance, strength and agility; medications may make us drowsy; or we may become dizzy after getting up from a chair as our blood pressure plummets.

No one has done more to highlight the medical significance of this issue than Dr. Mary Tinetti of Yale University. The recipient of a 2009 MacArthur Foundation "genius" grant, Tinetti has spent almost two decades exploring why seniors fall. Most recently, she co-chaired a committee of American and British experts that helped prepare new guidelines for preventing falls.

Tinetti spoke at length about the guidelines, which were published in January in the Journal of the American Geriatrics Society. An edited version of our discussion follows.
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RealCareNowTV: Staying Balanced and Avoiding Falls

Take Up Tai Chi And And Cut Back On Meds To Reduce Risk Of Falling, Elderly Advised

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Written by: Catharine Paddock, PhD

Taking up Tai Chi and cutting back on medication could form part of a multiple intervention approach to helping elderly people reduce their risk of falling, according to recently updated guidelines from the American Geriatrics Society and the British Geriatric Society, summarized this month in the Journal of the American Geriatrics Society.

In their first update since 2001, the guidelines for preventing falls in the elderly now recommend that interventions be "multifactorial" and include an exercise component and assess feet, footwear, fear of falling, ability to go about daily living, and other factors.

The guidelines also say that fall screening and prevention should be a routine part of healthcare for the elderly.

The new panel that updated the guidelines included members from previous panels and new members with considerable expertise, both in practical and published work, in preventing falls and caring for older people.

Dr Mary Tinetti of Yale University School of Medicine in New Haven, Connecticut in the US, was one of the panel co-chairs. She told the press that:

"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence."

"Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes," she added.

The panel searched and reviewed the literature published between May 2001 and April 2008 for systematic literature reviews, meta-analyses, randomized controlled trials of fall prevention interventions, controlled before-and-after studies, and cohort studies.

They also reviewed randomized controlled trials published between April 2008 and July 2009 and found no reason to change their conclusions and recommendations.

The new guidelines say that doctors should decide whether to assess risk of falling by first asking patients if they have fallen recently or are unsteady when walking.

If patients say they have not experienced a fall recently and are not unsteady when walking then they do not need a risk assessment.

But if they answer yes, then doctors should go ahead with a risk assessment and look for other known problem areas like muscle weakness, poor balance or blood pressure that drops too much on standing.

If this risk assessment shows these problems, patients should then receive interventions as advised in the guidelines.

Tinetti said that they found the most effective fall prevention trials were those involving multiple interventions instead of only one.

She said while previous studies had suggested it is more effective to focus on single interventions, they are confident a multiple intervention approach is better because they looked not only at what was recommended but also what was actually carried out.

"We're confident that multifactorial interventions is the best course of action," stressed Tinetti.

The new guidelines suggest not only that doctors should design "multifactorial" interventions, but these also:

• Include exercise for balance, gait and strength training. A good example is Tai chi or physical therapy.


• Include "environmental adaptation" to reduce factors that increase risk of falling in the home and when carrying out daily activities.


• Include cataract surgery where needed, but not as an individual approach.


• Aim to reduce medication regardless of number of drugs prescribed: this is a departure from the 2001 guideline which said this need only apply to patients on four or more drugs.


• Pay particular attention to drugs that affect the brain, for instance sleeping pills and antidepressants.


• Focus on raising low blood pressure and managing heart rate and rhythm abnormalities.

Tinetti said:

"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice."

"By making fall prevention part of the clinical care of older adults this trend can continue," she added.

"Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons."
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.
Journal of the American Geriatrics Society, Volume 59, Issue 1, pages 148-157, published online 13 January 2011.
DOI: 10.1111/j.1532-5415.2010.03234.x

Additional source: Wiley-Blackwell (press release, 13 Jan 2011).

Vitamin D and Exercise May Help Prevent Falls in Elderly

By Christine S. Moyer, amednews staff.

Prescribing a vitamin D supplement and recommending exercise for patients 65 and older could reduce their risk of falling, according to a recent evidence review.

The review, published in the Dec. 21, 2010, issue of Annals of Internal Medicine, was commissioned by the U.S. Preventive Services Task Force to help the agency update its recommendation for preventing falls in the elderly. Before the guidelines are published, a draft will be posted for public comment online.

The task force does not have recommendations on primary care physicians counseling patients on fall prevention. But in 1996, the task force reviewed the effectiveness of counseling to prevent household and recreational injuries, including falls, by age group.

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Medical News: Vitamins and Exercise Key to Fall Prevention - in Geriatrics, General Geriatrics from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

Exercise and vitamin D supplements top the list for primary care interventions to prevent falls in older adults, according to a review that will be the basis for updated U.S. Preventive Services Task Force (USPSTF) recommendations.

Some comprehensive multifactorial fall assessment and management interventions can be considered safe options to reduce falls in older adults in the community as well, Yvonne L. Michael, ScD, SM, of Drexel University School of Public Health in Philadelphia, and colleagues reported in the Dec. 21 issue of the Annals of Internal Medicine.

The update to USPSTF recommendations on primary care interventions for fall prevention is due in draft form for public comment soon.

The approach represents a shift for the Task Force from its traditional model, which focused on specific diseases, well-defined preventive interventions, and evidence for improved health outcomes before making recommendations, noted an accompanying article by the USPSTF Geriatric Workgroup.

"However, applying this model to prevention for very old patients has been problematic," they wrote in Annals.

Many geriatric disorders are multifactorial, while older adults are often excluded from clinical trials; and important outcomes -- such as functional disability and quality of life -- may not be measured and reported in ways that are conducive to evidence synthesis and interpretation, they pointed out.

An accompanying editorial by Mary E. Tinetti, MD, of Yale, applauded the USPSTF's willingness to change to better address the needs of older adults.

"The timing is excellent," she wrote in Annals, noting that Medicare will soon cover annual health risk assessment visits and customized prevention plans.
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AFA Offering Free Copies of New 'Preventing Falls' DVD

 

National Falls Prevention Awareness Day is an initiative of the Falls Free Coalition, of which AFA is a member, and is observed on the first day of fall each year to increase public awareness about how to prevent and reduce falls among older adults.

 

In line with this objective, AFA's "Preventing Falls" DVD provides insight into why dementia intensifies the incidence of falls and offers practical strategies from experts and family caregivers, including communication techniques, home modifications and lifestyle changes. It was funded in part with a grant from Novartis Pharmaceuticals.

 

For a free copy, call AFA at (toll-free) 866-AFA-8484.