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Table of Contents
Vol. 49, No. 2, 2003
Issue release date: March – April
Section title: Clinical Section
Gerontology 2003;49:93–116
(DOI:10.1159/000067948)

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

Moreland J.a,b · Richardson J.b · Chan D.H.c · O’Neill J.a · Bellissimo A.a · Grum R.M.b · Shanks L.d
aSt. Joseph’s Healthcare, Hamilton, Ont., bMcMaster University, and cDepartment of Family Medicine, McMaster University, Hamilton, Ont., and dHamilton Community Care Access Centre, Hamilton, Ont., Canada

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Article / Publication Details

First-Page Preview
Abstract of Clinical Section

Received: August 24, 2001
Accepted: March 13, 2002
Published online: February 19, 2003
Issue release date: March – April

Number of Print Pages: 24
Number of Figures: 0
Number of Tables: 5

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER

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.

© 2003 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Clinical Section

Received: August 24, 2001
Accepted: March 13, 2002
Published online: February 19, 2003
Issue release date: March – April

Number of Print Pages: 24
Number of Figures: 0
Number of Tables: 5

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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