Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + DRIVING RISK Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 ++ 30%–40% of all community-dwelling persons age >65 y fall at least once a year. Falls are the leading cause of fatal and nonfatal injuries among persons age >65 y. 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 Download Section PDF Listen +++ +++ 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 ++ 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. ++ Source ++ – JAMA. 2017;318(22):2224-2233. +++ Comment ++ The results of studies including the WHI and the Heart and Estrogen/Progestin Replacement Study reveal that HRT probably reduces osteoporotic hip and vertebral fractures and may decrease the risk of colon CA; however, HRT may lead to an increased risk of breast CA, stroke, cholecystitis, dementia, and venous thromboembolism. HRT does not decrease the risk of coronary artery disease (CAD).