The edition · Geriatrics
A primary-care balance and exercise programme cut falls and likely saved money in rural older adults
The FAMILY trial's economic evaluation finds falls prevention was cheaper and better than usual care; orexin antagonists show no excess falls or fractures; and older adults in behavioural emergencies are sedated more often, mostly with benzodiazepines.
The edition in brief
Four studies for geriatricians and GPs caring for older adults. In the FAMILY cluster randomised trial of 2,610 rural Chinese older adults, a primary-care-integrated balance and functional exercise programme reduced the absolute risk of falls by 8.6%, added 0.024 QALYs per person and was dominant, lowering healthcare costs by more than its ¥20-per-person delivery cost (90% probability of saving money). A meta-analysis of 19 studies (183,595 participants) found dual orexin receptor antagonists for insomnia did not increase falls (OR 0.76, 0.56 to 1.04) or fractures (OR 1.05), with randomised trials suggesting fewer falls, though data in older adults were limited. Among 1.47 million US ambulance encounters for behavioural emergencies, older adults who needed intervention were more often sedated (69.2% vs 61.3%) and more often given benzodiazepines (52.8% vs 45.3%) than younger adults. In a small Vietnamese cluster trial, 24 weeks of exercise improved grip strength and gait speed in sarcopenia. The pearl covers a sedative review at every falls assessment.
Orexin antagonists for insomnia: no excess falls or fractures in pooled data
Where a hypnotic is needed in an older adult, a DORA did not increase falls or fractures in pooled data.
Older adults in behavioural emergencies are sedated more often, mostly with benzodiazepines
Treat acute agitation in older adults as possible delirium, and avoid benzodiazepines where you can.
Exercise improved grip and gait in older adults with sarcopenia; added nutrition did not add much
Structured exercise improved strength and gait in older adults with sarcopenia; make it the first intervention.
Every falls assessment includes a sedative review
Review and reduce sedating drugs at every falls assessment.
Primary-care falls prevention: fewer falls and lower costs in rural older adults
A low-cost, primary-care balance and exercise programme reduced falls in rural older adults and likely saved money.
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