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DRIVING RISK

Population

  • –Adults with dementia.

Recommendation

AAN 2016

  • –Assess patients with dementia for the following characteristics that place them at increased risk for unsafe driving (Clinical Dementia Rating Scale):

    • Caregiver’s assessment that the patient’s driving ability is marginal or unsafe.

    • History of traffic citations.

    • History of motor vehicle collisions.

    • Reduced driving mileage (<60 miles/wk)

    • Self-reported situational avoidance.

    • Mini-Mental Status Exam score ≤24.

    • Aggression or impulsivity.

    • Alcohol, medications, sleep disorders, visual impairment, motor impairment.

  • Sources

  • Neurology. 2010;74(16):1316.

  • https://www.aan.com/Guidelines/home/GuidelineDetail/396

FALLS IN THE ELDERLY

Population

  • –Older adults.

Recommendations

USPSTF 2018, Cochrane Database of Systematic Reviews 2012

  • –Do not give vitamin D supplementation to community-dwelling older adults without vitamin D deficiency or osteoporosis for fall prevention.

  • –Recommend vitamin D supplementation to elderly patients in care facilities. This reduces the rate of falls by 37%.

  • –Recommend home-hazard modification (eg, adding nonslip tape to rugs and steps, provision of grab bars, etc.) for all homes of persons age >65 y.

  • –Recommend exercise or physical therapy interventions targeting gait and balance training.

  • –Offer selectively a multifactorial assessment and management approach in community-dwelling older adults at increased risk for falls.

Sources

  • –USPSTF. Falls Prevention in Older Adults: Counseling and Preventive Medication. 2018.

  • –Cochrane Collaborative. Interventions for Preventing Falls in Older People in Care Facilities and Hospitals. 2012.

Comments

  1. 30%–40% of all community-dwelling persons age >65 y fall at least once a year.

  2. Falls are the leading cause of fatal and nonfatal injuries among persons age >65 y.

  3. A review and modification of chronic medications, including psychotropic medications, is important although not proven to reduce falls. Please see appendix for Beers List of potentially problematic medications.

OSTEOPOROTIC HIP FRACTURES

Population

  • –Noninstitutionalized postmenopausal women.

Recommendation

USPSTF 2013

  • –Do not supplement daily with ≤400 IU vitamin D and ≤1000 mg calcium for primary prevention of fractures.

Source

  • Ann Intern Med. 2013;158(9):691.

Comment

  1. Insufficient evidence for vitamin D and calcium supplementation in anyone for the primary prevention of fractures.

Population

  • –Postmenopausal women.

Recommendation

USPSTF 2017

  • –Recommends against the routine use of combined estrogen and progestin for the prevention of chronic conditions including osteoporotic fractures.

Population

  • –Postmenopausal women who have had a hysterectomy.

Recommendation

USPSTF 2017

  • –Do not use estrogen routinely to prevent chronic conditions in postmenopausal women who have had a hysterectomy.

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