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Guideline Summary
Guideline Title
AGS/BGS clinical practice guideline: prevention of falls in older persons.
Bibliographic Source(s)
American Geriatrics Society, British Geriatrics Society. AGS/BGS clinical practice guideline: prevention of falls in older persons. New York (NY): American Geriatrics Society; 2010. Various p. [116 references]
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: American Geriatric Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001 May;49(5):664-72.

Scope

Disease/Condition(s)

Falls in older persons

Note: The guideline algorithm is not intended to address fall injuries per se or falls that occur in the hospital.

Guideline Category
Evaluation
Management
Prevention
Risk Assessment
Screening
Clinical Specialty
Emergency Medicine
Family Practice
Geriatrics
Internal Medicine
Nursing
Physical Medicine and Rehabilitation
Intended Users
Advanced Practice Nurses
Allied Health Personnel
Health Care Providers
Nurses
Occupational Therapists
Physical Therapists
Physician Assistants
Physicians
Guideline Objective(s)
  • To update the earlier guideline by evaluating evidence and analyses that have become available since 2001 and by providing revised recommendations based on these evaluations
  • To assist health care professionals in their management of older adults who have fallen or are at risk of falling
  • To optimize assessment and interventions for reducing the number of falls in older people
Target Population
  • Community-residing older persons (>65 years)
  • Older persons in long-term care facilities
  • Older persons with cognitive impairment
Interventions and Practices Considered

Screening/Evaluation/Risk Assessment

  1. Asking older patients about falls in past year
  2. Determining frequency and cause of fall(s)
  3. Asking about gait and balance problems
  4. Gait and balance testing, as indicated (see the original guideline document for a list of recommended tests)
  5. Multifactorial fall risk assessment
    • Focused evaluation (fall history, medications, other risk factors)
    • Physical examination (gait, balance, joint function, neurologic function, muscle strength, cardiovascular status, visual acuity, feet and footwear)
    • Functional assessment (activities of daily living [ADL], patient perception of ADL)
    • Environmental assessment
  6. Referral to specialist for more comprehensive and detailed fall evaluation as needed

Management/Prevention

  1. Adaptation of modification of home environment
  2. Review of all medications and stopping or reducing psychoactive or other medications
  3. Management of postural hypotension
  4. Management of foot problems and footwear
  5. Development of individually tailored exercise program
    • Balance, strength, and gait training (e.g., tai chi or physical therapy)
    • Flexibility and endurance training (not recommended as the sole component of an exercise program)
  6. Patient education as part of the intervention
  7. Management by qualified interventionists
  8. Treatment of vision impairment
    • Expediting cataract surgery
    • Not using multifocal glasses while walking
  9. Treatment of bradyarrhythmia
  10. Vitamin D supplementation

Note: The following were considered but not recommended: vision interventions with multifactorial prevention interventions, vision assessment or intervention alone, interventions for patients with dementia.

Major Outcomes Considered
  • Sensitivity, specificity and predictive ability of tests for assessment of gait and balance
  • Incidence of falls, slips, trips, injuries, and/or fractures
  • Time to first fall
  • Resource/health service utilization
  • Quality of life
  • Strength, aerobic capacity, balance, gait, and physical health in relationship to training programs
  • Functional capacity and ability to participate in activities of daily living (ADLs)

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

The panel collected evidence via a three-step process. First, an experienced researcher carried out a literature search to identify meta-analyses, systematic literature reviews, randomized controlled trials, controlled before-and-after studies, and cohort studies published between May 2001 and April 2008. The researcher also examined reference lists of included articles, and utilized the expert knowledge and experience of panel members to locate additional relevant publications.

In addition to Medline/PubMed, the following databases were searched: Database of Abstracts of Reviews of Effectiveness, Centre for Reviews and Dissemination/Health Technology Assessment, and the Cochrane Central Register of Controlled Trials. For Medline/PubMed searches, the investigator utilized a combination of subject heading and free text searches with the following search terms: "falls," "fallers" and "time to first fall." Limits were set for language (English), type of research (randomized controlled trial, systematic review – including Health Technology Assessment review, clinical trial, controlled clinical trial, and meta-analysis) and age ≥65 years. Intermediate outcome studies, inpatient or hospital studies, and studies of fracture outcomes were excluded. The search selected evidence from original clinical trials that a) provided sufficient detail regarding methods and results to enable use and adjustment of the data; and b) allowed relevant outcomes to be abstracted from the data presented in the article.

In addition to studies identified by these methods, a number of seminal studies published prior to May 2001 were also included if more recent updates in these areas of research or analysis were not yet available. In the second stage of the search process, three panel members performed a title review of the collected publications and requested abstracts from relevant randomized controlled trial reports. The review of abstracts and the exclusion/inclusion process identified 91 studies that met the inclusion criteria.

The panel has excluded discussion of interventions aimed at bone health (e.g., medications for osteoporosis), and has chosen not to address the topics of syncope, restraints, bone protection (e.g., hip protectors), or in-patient hospital-based fall prevention. Syncope in the context of falls is fully addressed in the 2004 European Falls Guidelines (Brignole, 2004).

Number of Source Documents
  • Multifactorial Studies - Effective: 12
  • Multifactorial Studies - Not Effective: 10
  • Studies Evaluating Exercise Interventions: 29
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Quality of Evidence (QE)

I At least one properly done randomized controlled trial (RCT)
II-1 Well-designed controlled trial without randomization
II-2 Well-designed cohort or case-control analytic study, preferably from more than one source
II-3 Multiple time series evidence with/without intervention, dramatic results of uncontrolled experiment
III Opinion of respected authorities, descriptive studies, case reports, and expert committees

Overall Quality

Good High grade evidence (I or II-1) directly linked to health outcome
Fair High grade evidence (I or II-1) linked to intermediate outcome;
or
Moderate grade evidence (II-2 or II-3) directly linked to health outcome
Poor Level III evidence or no linkage of evidence to health outcome

Net Effect of the Intervention

Substantial More than a small relative impact on a frequent condition with a substantial burden of suffering;
or
A large impact on an infrequent condition with a significant impact on the individual patient level.
Moderate A small relative impact on a frequent condition with a substantial burden of suffering;
or
A moderate impact on an infrequent condition with a significant impact on the individual patient level.
Small A negligible relative impact on a frequent condition with a substantial burden of suffering;
or
A small impact on an infrequent condition with a significant impact on the individual patient level.
Zero or Negative Negative impact on patients;
or
No relative impact on either a frequent condition with a substantial burden of suffering; or an infrequent condition with a significant impact on the individual patient level.
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

In the final evaluation stage, full texts of the included studies were retrieved and abstracted to evidence tables. The abstracted data and the full texts were made available to the members of the panel during the development of the update.

The search and evaluation process allowed panel members to comprehensively summarize the last decade of evidence regarding the risk of falling and the interventions that have been investigated for the purpose of reducing falls in older adults. However, because definitions of interventions differ from study to study, and are often not clearly elaborated, the panel chose to emphasize outcomes from individual studies rather than stressing the results of meta-analyses. The panel did, however, refer to five recent meta-analyses and evidence-based guidelines in its deliberations.

Note: The panel reviewed the randomized controlled trials (RCTs) published between April 2008 and July 2009 and concluded that the additional evidence did not change the ranking of the evidence or the guideline recommendations. Of note, the negative RCTs of multifactorial interventions all involved risk factor assessment with referral without direct intervention or ensuring that the interventions were instituted.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

The development of this guideline update began by convening a panel comprising members from the previous panels and new members with substantial knowledge, experience, and publications in fall prevention and care of older patients. Panel members included experts in physical therapy, pharmacy, orthopedics, emergency medicine, occupational therapy, nursing, home care, and geriatric clinical practice. The multidisciplinary panel that developed this update was led jointly by representatives of the American Geriatrics Society and the British Geriatrics Society. Panel participants included members of the American Academy of Orthopaedic Surgeons, the American Board of Internal Medicine, the American College of Emergency Physicians, the American Geriatrics Society, the American Medical Association, the American Occupational Therapy Association, the American Physical Therapy Association, the American Society of Consultant Pharmacists, the British Geriatrics Society, the John A. Hartford Foundation Institute for Geriatric Nursing at New York University, and the National Association for Home Care and Hospice. The panel met in one face-to-face meeting, and thoroughly evaluated the content and validity of each section of the update in a series of subsequent conference calls. An experienced moderator facilitated these meetings. The resulting update is the product of many months of discussion and consensus building.

Grading the Strength of Recommendations

A standardized format based on an evidence rating system used by the U.S. Preventative Services Task Force was used to critically analyze the literature and grade the evidence for this document (see the "Rating Scheme for the Strength of the Evidence" field). In this approach, the grade for the strength of a recommendation depends on the overall quality of evidence and on the magnitude of net benefit. Net benefit (benefit minus harm) was rated as "substantial," "moderate," "small," or "zero or negative" (see the "Rating Scheme for the Strength of the Evidence" field). Based on the determinations of overall quality of evidence and magnitude of benefit for each intervention, the panel assigned a grade for each recommendation (see the "Rating Scheme for the Strength of the Recommendations" field).

For some interventions, outcome data were insufficient to allow evidence-based recommendations to be made, or the existing literature was ambiguous or conflicting. In these cases, the panel made recommendations based on consensus after intensive discussion.

Rating Scheme for the Strength of the Recommendations

Strength of Recommendation Rating System

A A strong recommendation that the clinicians provide the intervention to eligible patients.
Good evidence was found that the intervention improves important health outcomes; the conclusion is made that benefits substantially outweigh harm.
B A recommendation that clinicians provide this intervention to eligible patients.
At least fair evidence was found that the intervention improves health outcomes; the conclusion is made that benefits outweigh harm.
C No recommendation for or against the routine provision of the intervention is made.
At least fair evidence was found that the intervention can improve health outcomes, but benefits and harms are too closely balanced to justify a general recommendation.
D Recommendation is made against routinely providing the intervention to asymptomatic patients.
At least fair evidence was found that the intervention is ineffective or the conclusion is made that harms outweigh benefits.
I Evidence is insufficient to recommend for or against routinely providing the intervention.
Evidence shows that the effectiveness of the intervention lacking, is of poor quality, or is conflicting; the conclusion is that the balance of benefits and harms cannot be determined.
Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

The following organizations with special interest and expertise in the prevention of falls in older persons provided peer review of a preliminary draft of this guideline: American Academy of Family Physicians, American Academy of Home Care Physicians, American Academy of Ophthalmology, American Academy of Otolaryngology, American Academy of Physical Medicine and Rehabilitation, American College of Emergency Physicians, American College of Physicians, American Medical Association, American Occupational Therapy Association, American Physical Therapy Association, British Association for Emergency Medicine, Chartered Society of Physiotherapy, College of Occupational Therapists (UK), National Association for Home Care and Hospice, Gerontological Advanced Practice Nurses Association, Royal Pharmaceutical Society of Great Britain, Society for Academic Emergency Medicine, and the Society for General Internal Medicine.

The final document has been reviewed and approved by all organizations participating in the panel.

Recommendations

Major Recommendations

Note from the American Geriatric Society (AGS) and the National Guideline Clearinghouse (NGC): The recommendations for prevention of falls in older persons are presented in the form of an algorithm accompanied by annotations. The recommendations are provided below. See the original guideline document External Web Site Policy for the algorithm and evidence tables associated with selected recommendations, including level and quality of evidence, strength of recommendation, and supporting evidence citations.

The strength of recommendation grading (A, B, C, D, I) is defined at the end of the "Major Recommendations" field.

Screening and Assessment

Annotation B: Screen for Falls or Risk for Falling

  1. All older individuals should be asked whether they have fallen (in the past year).
  2. An older person who reports a fall should be asked about the frequency and circumstances of the fall(s).
  3. Older individuals should be asked if they experience difficulties with walking or balance.

Annotation C: Screen Positive for Falls or Risk for Falling?

  1. Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or report difficulties in walking or balance (with or without activity curtailment) should have a multifactorial fall risk assessment.
  2. Older persons who cannot perform or perform poorly on a standardized gait and balance test should be given a multifactorial fall risk assessment.

Annotation D: Does the Person Report a Single Fall in the Past 12 Months?

  1. Older persons who report a single fall in the past 12 months should be evaluated for gait and balance.

Annotation E: Evaluate Gate and Balance

  1. Older persons who have fallen should have an assessment of gait and balance using one of the available evaluations. [B] (See the original guideline for the list of tests of gait or balance.)
  2. Older persons who have difficulty or demonstrate unsteadiness during the evaluation require a multifactorial fall risk assessment.
  3. Older persons reporting only a single fall in the past year and reporting or demonstrating no difficulty or unsteadiness during the evaluation do not require a fall risk assessment.

Annotation F: Determine Multifactorial Fall Risk

  1. The multifactorial fall risk assessment should be performed by a clinician (or clinicians) with appropriate skills and training.
  2. The multifactorial fall risk assessment should include the following:
    1. Focused History
      • History of falls: Detailed description of the circumstances of the fall(s), frequency, symptoms at time of fall, injuries, other consequences
      • Medication review: All prescribed and over-the-counter medications with dosages
      • History of relevant risk factors: Acute or chronic medical problems, (e.g., osteoporosis, urinary incontinence, cardiovascular disease)
    2. Physical Examination
      • Detailed assessment of gait, balance, and mobility levels and lower extremity joint function
      • Neurological function: Cognitive evaluation, lower extremity peripheral nerves, proprioception, reflexes, tests of cortical, extrapyramidal and cerebellar function
      • Muscle strength (lower extremities)
      • Cardiovascular status: Heart rate and rhythm, postural pulse and postural blood pressure; and, if appropriate, heart rate and blood pressure responses to carotid sinus stimulation
      • Assessment of visual acuity
      • Examination of the feet and footwear
    3. Functional Assessment
      • Assessment of activities of daily living (ADL) skills including use of adaptive equipment and mobility aids, as appropriate
      • Assessment of the individual's perceived functional ability and fear related to falling
        (Assessment of current activity levels with attention to the extent to which concerns about falling are protective [i.e., appropriate given abilities] or contributing to deconditioning and/or compromised quality of life [i.e., individual is curtailing involvement in activities he or she is safely able to perform due to fear of falling])
    4. Environmental Assessment

Interventions

  1. The multifactorial fall risk assessment should be followed by direct interventions tailored to the identified risk factors, coupled with an appropriate exercise program. [A]

Older Persons Living In the Community

Multifactorial/Multicomponent Interventions to Address Identified Risk(s) and Prevent Falls

  1. A strategy to reduce the risk of falls should include multifactorial assessment of known fall risk factors and management of the risk factors identified. [A]
  2. The components most commonly included in efficacious interventions were:
    1. Adaptation or modification of home environment [A]
    2. Withdrawal or minimization of psychoactive medications [B]
    3. Withdrawal or minimization of other medications [C]
    4. Management of postural hypotension [C]
    5. Management of foot problems and footwear [C]
    6. Exercise, particularly balance, strength, and gait training [A]
  3. All older adults who are at risk of falling should be offered an exercise program incorporating balance, gait, and strength training. Flexibility and endurance training should also be offered, but not as sole components of the program. [A]
  4. Multifactorial/multicomponent intervention should include an education component complementing and addressing issues specific to the intervention being provided, tailored to individual cognitive function and language. [C]
  5. The health professional or team conducting the fall risk assessment should directly implement the interventions or should assure that the interventions are carried out by other qualified healthcare professionals. [A]

Minimize Medications

  1. Psychoactive medications (including sedative hypnotics, anxiolytics, antidepressants) and antipsychotics (including new antidepressants or antipsychotics) should be minimized or withdrawn, with appropriate tapering if indicated. [B]
  2. A reduction in the total number of medications or dose of individual medications should be pursued. All medications should be reviewed, and minimized or withdrawn. [B]

Initiate an Individually-Tailored Exercise Program

  1. Exercise should be included as a component of multifactorial interventions for fall prevention in community-residing older persons. [A]
  2. An exercise program that targets strength, gait and balance, such as tai chi or physical therapy, is recommended as an effective intervention to reduce falls. [A]
  3. Exercise may be performed in groups or as individual (home) exercises, as both are effective in preventing falls. [B]
  4. Exercise programs should take into account the physical capabilities and health profile of the older person, (i.e., be tailored) and be prescribed by qualified health professionals or fitness instructors. [I]
  5. The exercise program should include regular review, progression and adjustment of the exercise prescription as appropriate. [I]

Treat Vision Impairment

  1. In older women in whom cataract surgery is indicated, surgery should be expedited as it reduces the risk of falling. [B]
  2. There is insufficient evidence to recommend for or against the inclusion of vision interventions within multifactorial fall prevention interventions. [I]
  3. There is insufficient evidence to recommend vision assessment and intervention as a single intervention for the purpose of reducing falls. [D]
  4. An older person should be advised not to wear multifocal lenses while walking, particularly on stairs. [C]

Manage Postural Hypotension

  1. Assessment and treatment of postural hypotension should be included as components of multifactorial interventions to prevent falls in older persons. [B]

Manage Heart Rate and Rhythm Abnormalities

  1. Dual chamber cardiac pacing should be considered for older persons with cardioinhibitory carotid sinus hypersensitivity who experience unexplained recurrent falls. [B]

Supplement Vitamin D

  1. Vitamin D supplements of at least 800 IU per day should be provided to older persons with proven vitamin D deficiency. [A]
  2. Vitamin D supplements of at least 800 IU per day should be considered for people with suspected vitamin D deficiency or who are otherwise at increased risk for falls. [B]

Manage Foot and Footwear Problems

  1. Identification of foot problems and appropriate treatment should be included in multifactorial fall risk assessments and interventions for older persons living in the community. [C]
  2. Older people should be advised that walking with shoes of low heel height and high surface contact area may reduce the risk of falls. [C]

Modify the Home Environment

  1. Home environment assessment and intervention carried out by a health care professional should be included in a multifactorial assessment and intervention for older persons who have fallen or who have risk factors for falling. [A]
  2. The intervention should include mitigation of identified hazards in the home, and evaluation and interventions to promote the safe performance of daily activities. [A]

Provide Education and Information

  1. Education and information programs should be considered part of a multifactorial intervention for older persons living in the community. [C]
  2. Education should not be provided as a single intervention to reduce falls in older persons living in the community. [D]

Older Persons in Long-term Care Facilities

Multicomponent Interventions

  1. Multifactorial/multicomponent interventions should be considered in long-term care to reduce falls. [C]

Exercise

  1. Exercise programs should be considered for a variety of benefits to reduce falls in older persons living in long-term care settings (with caution regarding risk of injury); however their effect on fall risk in these settings is yet unproven [C]

Vitamin D

  1. Vitamin D supplements of at least 800 IU per day should be provided to older persons residing in long-term care settings with proven or suspected vitamin D insufficiency. [A]
  2. Vitamin D supplements of at least 800 IU per day should be considered in older persons residing in long-term care settings who have abnormal gait or balance or who are otherwise at increased risk for falls. [B]

Older Persons with Cognitive Impairment

  1. There is insufficient evidence to recommend for or against multifactorial or single interventions to prevent falls in older persons with known dementia living in the community or in long-term care facilities. [I]

Definitions:

Quality of Evidence (QE)

I At least one properly done randomized controlled trial (RCT)
II-1 Well-designed controlled trial without randomization
II-2 Well-designed cohort or case-control analytic study, preferably from more than one source
II-3 Multiple time series evidence with/without intervention, dramatic results of uncontrolled experiment
III Opinion of respected authorities, descriptive studies, case reports, and expert committees

Overall Quality

Good High grade evidence (I or II-1) directly linked to health outcome
Fair High grade evidence (I or II-1) linked to intermediate outcome;
or
Moderate grade evidence (II-2 or II-3) directly linked to health outcome
Poor Level III evidence or no linkage of evidence to health outcome

Net Effect of the Intervention

Substantial More than a small relative impact on a frequent condition with a substantial burden of suffering;
or
A large impact on an infrequent condition with a significant impact on the individual patient level.
Moderate A small relative impact on a frequent condition with a substantial burden of suffering;
or
A moderate impact on an infrequent condition with a significant impact on the individual patient level.
Small A negligible relative impact on a frequent condition with a substantial burden of suffering;
or
A small impact on an infrequent condition with a significant impact on the individual patient level.
Zero or Negative Negative impact on patients;
or
No relative impact on either a frequent condition with a substantial burden of suffering; or an infrequent condition with a significant impact on the individual patient level.

Strength of Recommendation Rating System

A A strong recommendation that the clinicians provide the intervention to eligible patients.
Good evidence was found that the intervention improves important health outcomes; the conclusion is made that benefits substantially outweigh harm.
B A recommendation that clinicians provide this intervention to eligible patients.
At least fair evidence was found that the intervention improves health outcomes; the conclusion is made that benefits outweigh harm.
C No recommendation for or against the routine provision of the intervention is made.
At least fair evidence was found that the intervention can improve health outcomes, but benefits and harms are too closely balanced to justify a general recommendation.
D Recommendation is made against routinely providing the intervention to asymptomatic patients.
At least fair evidence was found that the intervention is ineffective or the conclusion is made that harms outweigh benefits.
I Evidence is insufficient to recommend for or against routinely providing the intervention.
Evidence shows that the effectiveness of the intervention lacking, is of poor quality, or is conflicting; the conclusion is that the balance of benefits and harms cannot be determined.
Clinical Algorithm(s)

An algorithm for the prevention of falls in older persons living in the community is provided in the original guideline document.

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for selected recommendations (see the "Major Recommendations" field).

The recommendations are based primarily on a comprehensive review of published reports. In cases where the data were insufficient to allow evidence-based recommendations to be made, or the existing literature was ambiguous or conflicting, the panel made recommendations based on consensus after intensive discussion.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

The panel anticipates that these guidelines will provide a stimulus for widespread use of effective, evidence-based fall prevention services for older adults. Public awareness of the benefits of such prevention will also increase leading to more demand for fall prevention services by older adults and their advocates. Health care providers across diverse disciplines and settings and at multiple points of access will be able to use the generic criteria provided in these guidelines to appropriately screen individuals for risk of falls. All people identified as being at risk will be offered a multifactorial assessment and tailored interventions, with the understanding that these interventions need to be integrated and balanced with other health care priorities. Preventive services will result in a reduction in the incidence of falls and will maximize functional and quality-of-life outcomes.

Potential Harms

Initiating exercise programs should be done with caution as some studies have shown that exercise may increase the rate of falls in persons with limited mobility who are not used to exercising.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Clinical Algorithm
Patient Resources
Quick Reference Guides/Physician Guides
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
Safety

Identifying Information and Availability

Bibliographic Source(s)
American Geriatrics Society, British Geriatrics Society. AGS/BGS clinical practice guideline: prevention of falls in older persons. New York (NY): American Geriatrics Society; 2010. Various p. [116 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2001 (revised 2010)
Guideline Developer(s)
American Geriatrics Society - Medical Specialty Society
British Geriatrics Society - Medical Specialty Society
Source(s) of Funding

American Geriatrics Society

Guideline Committee

The American Geriatrics Society (AGS) and British Geriatrics Society (BGS) Panel on the Clinical Practice Guideline for the Prevention of Falls in Older Persons

Composition of Group That Authored the Guideline

Panel Members: Rose Anne M. Kenny, MD (Chair), Trinity College and St James Hospital, Dublin, Ireland; Laurence Z. Rubenstein, MD, MPH (Chair), UCLA School of Medicine, Los Angeles, CA; Mary E. Tinetti, MD (Chair), Yale University School of Medicine, New Haven, CT; Kathryn Brewer, PT, MEd, GCS, Mayo Clinic Hospital, Phoenix, AZ; Kathleen A. Cameron, RPh, MPH, American Society of Consultant Pharmacists Research and Education Foundation, Alexandria, VA; Elizabeth A. Capezuti, PhD, RN, New York University College of Nursing, New York, NY; David P. John, MD, Caritas Carney Hospital, Dorchester, MA; Sallie Lamb, DPhil (Oxon), MSc, MCSP, SRP, University of Warwick, Coventry, UK; Finbarr Martin, MD, MSc, FRCP, St Thomas' Hospital, London, England; Paul H. Rockey, MD, MPH, American Medical Association , Chicago, IL; Mary Suther, National Association for Home Care and Hospice, Dallas, TX; Elizabeth Walker Peterson, MPH, OTR/L, University of Illinois, Chicago, IL

Financial Disclosures/Conflicts of Interest

Each expert panel member completed a disclosure form at the beginning of the guideline process that was shared with the entire expert panel at the start of its two expert panel meetings. Conflicts of interest in this guideline have been resolved by having the guideline independently peer reviewed and then edited by the Expert Panel Chair, who had no conflict of interest with the medications being discussed. Expert panel members who disclosed affiliations or financial interests with commercial interests involved with the products or services referred to in the guideline are listed below.

Financial Disclosures

Dr. Tinetti, Dr. Rubenstein, Dr. Kenny, Dr. Lamb, Dr. Rockey, Ms. Brewer, Ms. Peterson, and Mr. Susskind report no financial relationships with relevant commercial entities. Ms. Cameron holds shares in Johnson & Johnson. Ms. Suther holds shares in various pharmaceutical companies. Dr. Capezuti is a board member of Medco Health Solutions, Inc. Dr. John receives grants from the American College of Emergency Physicians. Dr. Martin has received hospitality, but no fees from Pfizer, Orion, and Pharmacia.

Guideline Endorser(s)
American College of Emergency Physicians - Medical Specialty Society
American Medical Association - Medical Specialty Society
American Occupational Therapy Association, Inc. - Professional Association
American Physical Therapy Association - Not stated
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: American Geriatric Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001 May;49(5):664-72.

Guideline Availability

Electronic copies: Available from the American Geriatrics Society Web site External Web Site Policy.

Availability of Companion Documents

The following are available:

  • 2010 AGS/BGS clinical practice guideline: prevention of falls in older persons. Summary of recommendations. New York: American Geriatrics Society; 2010. 4 p. Electronic copies: Available in Portable Document Format (PDF) from the American Geriatrics Society (AGS) Web site External Web Site Policy.
  • Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011 Jan;59(1):148-57. Electronic copies: Available from the AGS Web site External Web Site Policy.

In addition, the prevention of falls guideline is available through a mobile app for iPhone and Android, available from the AGS Web site External Web Site Policy.

Patient Resources

The following are available:

  • Preventing serious falls: tips for older adults and their loved ones. Tools and tips. New York: American Geriatrics Society Foundation for Health in Aging; 2012 Jul. 2 p. Electronic copies: Available in Portable Document Format (PDF) from the Health in Aging Web site External Web Site Policy.
  • Falls prevention. Basic facts & information. New York: American Geriatrics Society Foundation for Health in Aging; 2012 Mar. Electronic copies: Available from the Health in Aging Web site External Web Site Policy.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This summary was completed by ECRI on July 19, 2002. This NGC summary was updated by ECRI Institute on August 23, 2012. The updated information was verified by the guideline developer on October 5, 2012.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. For more information on the American Geriatrics Society (AGS) or AGS guidelines visit their Web site www.americangeriatrics.org External Web Site Policy, or call (212) 308-1414.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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