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–ICSI. Preventive Services for Adults. 20th ed. 2014.
–CMAJ. 2016;188(1):37-46.
–Ann Intern Med. 2014;160(11):791-797.
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False-positive rate for screening is high, and treatment interventions do not show consistent benefits.
Early recognition of cognitive impairment allows clinicians to anticipate problems that patients may have in understanding and adhering to recommended therapy, and help patients and their caregivers anticipate and plan for future problems related to progressive cognitive decline.
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NICE 2013, AAOS 2001, AGS 2010, British Geriatrics Society 2001
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–Do not use vitamin D supplementation to prevent falls (Grade D).
–Encourage exercise interventions to prevent falls in older adults at increased risk for falls (Grade B).
–Selectively offer multifactorial interventions to prevent falls in older adults at increased risk for falls (Grade C).
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Individuals are at increased risk if they report at least 2 falls in the previous year, or 1 fall with injury. Risk factors: Intrinsic: lower-extremity weakness, poor grip strength, balance disorders, functional and cognitive impairment, visual deficits. Extrinsic: polypharmacy (≥4 prescription medications), environment (poor lighting, loose carpets, lack of bathroom safety equipment).
A fall prevention clinic appears to reduce the number of falls among the elderly. (Am J Phys Med Rehabil. 2006;85:882)
Effective exercise interventions include supervised individual and group classes and physical therapy.
Multifactorial interventions include initial assessment of modifiable fall risk factors (balance, vision, postural blood pressure, gait, medication, environment, cognition, psychological health) and interventions (nurses, clinicians, physical/occupational therapy, dietitian/nutritionist, CBT, education, medication management, urinary incontinence management, environmental modification, social/community resources, referral to specialist “ophthalmologist, neurologist, etc.”).
All who report a single fall should be observed as they stand up from a chair without using their arms, ...