Management of Sarcopenia in Primary Care Settings / 가정의학회지

With aging, loss of skeletal muscle mass and muscle function increases, resulting in an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even death. Sarcopenia, which is derived from the Greek words “sarx” or flesh+“penia” or loss, is defined as a condition characterized by low muscle mass and low muscle strength and performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, specifically, presented strategies for case-finding and assessment to help diagnose “possible sarcopenia” in primary care settings. For case finding, the AWGS 2019 guideline proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire (cut-off ≥4). If this case finding is confirmed, handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) should be performed to diagnose “possible sarcopenia.” If an individual is diagnosed as “possible sarcopenia,” AWGS 2019 recommends that the individual should start lifestyle interventions and related health education for primary healthcare users. Because no medication is available to treat sarcopenia, exercise and nutrition is essential for sarcopenia management. Many guidelines, recommend physical activity, with a focus on progressive resistance (strength) training, as a first-line therapy for the management of sarcopenia. It is essential to educate older adults with sarcopenia on the need to increase protein intake. Many guidelines recommended that older people should consume at least 1.2 g of proteins/kg/d. This minimum threshold can be increased in the presence of catabolic or muscle wasting. Previous studies reported that leucine, a branched-chain amino acid, is essential for protein synthesis in muscle, and a stimulator for skeletal muscle synthesis. A guideline conditionally recommends that diet or nutritional supplements should be combined with exercise intervention for older adults with sarcopenia.

Up-to-date knowledge of frailty

Frailty is a state in which the functional reserves of multiple organs in the body are reduced significantly, making an individual vulnerable to a variety of stressors. As a result, frail individuals are more likely to experience falls, disability, and even mortality. Frailty can be reversible and preventable in many cases with specific modalities, such as exercise, protein-calorie supplementation, vitamin D intake, and reducing polypharmacy. The frailty phenotype and frailty index are the most common methods used to diagnose frailty. In the United Kingdom, primary care physicians must use the electronic frailty index to identify frailty in all patients aged ≥65 years.Current Concepts: The Korean frailty and aging cohort study, a multicenter longitudinal cohort study taking place in Korea, has identified some important factors in the management of frailty. In the middle-old age group (70-79 years old), high-level physical activities were associated with lower incidence of frailty after 2 years, but no effect thereof was observed in the oldest-old group (80-84 years old). Physical activities associated with improvement from frailty after 2 years were high-level activities, but those associated with improvement from prefrailty were at least middle-level activities.Discussion and Conclusion: For the prevention and management of frailty, the age of participants and level of physical activity are important factors to determine the success of interventions. Protein intake of 1.5 g/kg/day is needed to improve not only muscle mass but also gait speed in prefrail or frail elderly patients, especially those with a risk of malnutrition, in a short-term period.

Validation of the Korean Frailty Index in community-dwelling older adults in a nationwide Korean Frailty and Aging Cohort study

Background/Aims@#We aimed to assess validity of the Korean Frailty Index (KFI) and the modified KFI (mKFI) in nationwide Korean population as screening measures for frailty status in older adults. @*Methods@#Analysis was performed in the records of baseline assessments of 2,886 participants in the Korean Frailty Aging Cohort study from 2016 to 2017. The KFI included eight items on a history of hospitalization, self-reported health status, polypharmacy, weight loss, mood, incontinence, sensory problems, and timed up and go test. In mKFI, timed up and go test was replaced with a question whether a person can walk around a schoolyard. Cardiovascular Health Study (CHS) frailty scale was used as a gold standard. @*Results@#In study population (mean age, 76; 47.6% men), score of the KFI correlated with the CHS scale. The KFI correlated with common geriatric parameters including Activities of Daily Living, nutritional status, cognitive performance, and mood. As a construct validity, items of KFI correlated with CHS scale. As a criterion validity, sensitivity was 81.6%, specificity was 67.0% to predict frailty by CHS scale with the score of 3 or higher in KFI. The KFI and mKFI correlated with each other (R2 = 0.88), and prediction ability for frailty by CHS scale was not significantly differed between KFI and mKFI. @*Conclusions@#The KFI and mKFI are valid instruments for frailty screening and might be useful as simple frailty screening tools to identify older adults who might benefit from comprehensive geriatric assessment and integrated, multidisciplinary geriatric care services.

Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings / 가정의학회지

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Diagnosis of sarcopenia in primary health care

With aging, there is a loss of skeletal muscle mass and function, which leads to an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even mortality. Sarcopenia has been defined as a condition characterized by low muscle mass together with low muscle strength and/or low muscle performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, in particular, presented strategies for case-finding and assessment, which could aid in the diagnosis of possible sarcopenia in primary care settings. AWGS 2019 proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance in walking, rising from a chair, climbing stairs, falls) questionnaire (cut-off ≥4), followed by handgrip strength measurement (cut-off <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds). Finally, “possible sarcopenia” is defined by either low muscle strength (handgrip strength) or low physical performance (5-time chair stand test). This paper will address the way in which sarcopenic patients can be identified and assessed practically in primary care settings.

The Relationship between Psychological Factors and Weight Gain / 가정의학회지

Background@#This study aimed to investigate stress, depression, sleeping time, physical activity, and dietary patterns as factors causing weight gain and investigate which of these factors have a greater effect on weight gain. @*Methods@#Data were obtained from the seventh Korea National Health and Nutrition Examination Survey, 2016. Among the respondents, 3,163 adults aged 19–64 years were included in the survey, after excluding non-responders and those with diseases that may affect weight change. The t-test and chi-square test were used to analyze the relationship between weight gain and general characteristics. Logistic regression analysis was performed to evaluate weight changes according to stress, depression, sleep time, physical activity, and dietary patterns and evaluate the odds ratios (ORs) for measuring these associations. @*Results@#Participants in the weight gain group were younger and more likely to be obese than those in the control group. Factors that could cause weight gain among women were stress awareness (OR, 1.271; 95% confidence interval [CI], 1.012–1.597), physical inactivity (OR, 1.250; 95% CI, 1.018–1.535), and skipping breakfast (OR, 1.277; 95% CI, 1.028–1.587). Depression was significantly associated with weight gain among women, but not after adjusting for other variables. There were no significant associations with sleeping time. None of these factors in men were significantly associated with weight gain. @*Conclusion@#Stress awareness was significantly associated with weight gain among women, while other psychological factors were not significantly associated with weight gain.

Diagnosis and Management of Frailty in Primary Health Care / 가정의학회지

Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.

What are the illnesses associated with frailty in community-dwelling older adults: the Korean Frailty and Aging Cohort Study

Background/Aims@#Frailty is mainly due to an age-related decrease in the physiological reserves needed to maintain biological homeostasis, but it can also occur as a result of chronic diseases. The purpose of this study was to identify illnesses associated with frailty in Korean community-dwelling older adults. @*Methods@#This was a cross-sectional study that included 2,936 older adults aged between 70 and 84 years who had completed both interviews and physical function assessments for the Korean Frailty and Aging Cohort Study. Current illnesses diagnosed by physicians were included in the analysis. The definition of frailty was derived from the Fried frailty phenotype. @*Results@#The prevalence of hypertension, diabetes mellitus (DM), arthritis, osteoporosis, urinary incontinence, and lung disease (including asthma, chronic obstructive pulmonary disease, and chronic bronchitis) was higher in the frail group (p < 0.05). After adjusting for age, sex, physical activity, alcohol, smoking, education, and presence of a spouse, the odds ratios for DM and urinary incontinence in frailty were 1.51 (95% confidence interval [CI], 1.10 to 2.01; p = 0.01) and 1.88 (95% CI, 1.11 to 3.18; p = 0.02). @*Conclusions@#In Korean community-dwelling older adults, DM and urinary incontinence were associated with frailty after adjusting for various factors. In the future, the list of comorbid diseases that are appropriate for Korean population- specific frailty assessment should be inventoried.

Association of Subclinical Hypothyroidism and Depression with Patient Health Questionnaire-9 in Korean Adults: Results from the Korea National Health and Nutrition Examination Survey, 2014

Background@#Subclinical thyroid disease is characterized by abnormal thyroid stimulating hormone (TSH) levels with normal free thyroxine (T4) levels. This study aimed to verify the association between subclinical hypothyroidism and depression measured using the Patient Health Questionnaire-9 (PHQ-9) score in the Korean population. @*Methods@#This cross-sectional study included 1,786 adults aged ≥19 years with normal free T4 levels and serum TSH levels ≥0.45 mIU/L who had participated in the Korea National Health and Nutrition Examination Survey (KNHANES) 2014. The PHQ-9 was first introduced in the KNHANES to detect depression (PHQ score of ≥10). Serum TSH level of 0.45–4.49 mIU/L was defined as the reference range. The association between subclinical hypothyroidism and depression according to gender and age was evaluated using the binary logistic regression analysis after adjusting for age, education, and body mass index. @*Results@#There was no association between subclinical hypothyroidism and depression according to gender. The odds ratio for depression was 2.498 (95% confidence interval [CI], 0.905–6.895; P=0.077) in men and 0.727 (95% CI, 0.352–1.503; P=0.390) in women. Additionally, there was no association between subclinical hypothyroidism and depression according to age. @*Conclusion@#These results suggest that subclinical hypothyroidism was not associated with depression in Korean adults.

Introduction of Fall Risk Assessment (FRA) System and Cross-Sectional Validation Among Community-Dwelling Older Adults

OBJECTIVE: To predict the risk of falls, Fall Risk Assessment (FRA) system has been newly developed to measure multi-systemic balance control among community-dwelling older adults. The aim of this study was to examine the association between FRA and fall-related physical performance tests. METHODS: A total of 289 community-dwelling adults aged 65 years and older participated in this cross-sectional study. All participants underwent FRA test and physical performance tests such as Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), and Timed Up and Go Test (TUG). RESULTS: Participants who were younger, male, highly educated, living with family members, having high body mass index, having high appendicular lean mass index, and having no irritative lower urinary tract syndrome were more likely to have higher FRA scores. SPPB (β=1.012), BBS (β=0.481), and TUG (β=-0.831) were significantly associated with FRA score after adjusting for the variables (all p < 0.001). CONCLUSION: FRA composite score was closely correlated with SPPB, BBS, and TUG, suggesting that FRA is a promising candidate as a screening tool to predict falls among community-dwelling elderly people.

Urine Cotinine for Assessing the Association between Secondhand Smoke Exposure and Depression in Adult Non-Smokers in Korea: Analysis of the Korea National Health and Nutrition Examination Survey 2016

BACKGROUND: Exposure to secondhand smoke (SHS) has been shown to cause health problems. Recent studies demonstrated an association of SHS with depression and poor mental health. The urinary cotinine concentration (Ucot) is an objective indicator of exposure to SHS. In this study, we evaluated the association between depression and Ucot in adult non-smokers adults in Korea. METHODS: We analyzed the data of 3,417 adults, aged ≥19 years, who participated in the seventh Korea National Health and Nutrition Examination Survey (2016). The eligible subjects were non-smokers. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The subjects were dichotomized into two groups: the high depressive symptom group (PHQ-9 ≥10 [n=185]) and the low depressive symptom group (PHQ-9 <10 [n=3,232]). The demographic, socioeconomic, and clinical characteristics of the subjects were retrieved from the survey data. Ucot was dichotomized into high-Ucot (≥10 ng/mL) and low-Ucot (<10 ng/mL). The Ucot and other characteristics were compared between the two groups. To adjust for confounding variables, we conducted a logistic regression analysis and determined the difference in Ucot between the two groups. RESULTS: After adjusting for confounders, the high depressive symptom group was found to be associated with high-Ucot (odds ratio, 1.824; 95% confidence interval, 1.020–3.262). Sex, education, socioeconomic status, marital status, occupational status, limitation of activity, and the presence of an underlying diseases (diabetes and dyslipidemia) had a significant effect on depression. CONCLUSIONS: This concluded that depression was associated with high urine cotinine level in adult non-smokers.

Urine Cotinine for Assessing the Association between Secondhand Smoke Exposure and Depression in Adult Non-Smokers in Korea: Analysis of the Korea National Health and Nutrition Examination Survey 2016

BACKGROUND@#Exposure to secondhand smoke (SHS) has been shown to cause health problems. Recent studies demonstrated an association of SHS with depression and poor mental health. The urinary cotinine concentration (Ucot) is an objective indicator of exposure to SHS. In this study, we evaluated the association between depression and Ucot in adult non-smokers adults in Korea.@*METHODS@#We analyzed the data of 3,417 adults, aged ≥19 years, who participated in the seventh Korea National Health and Nutrition Examination Survey (2016). The eligible subjects were non-smokers. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The subjects were dichotomized into two groups: the high depressive symptom group (PHQ-9 ≥10 [n=185]) and the low depressive symptom group (PHQ-9 <10 [n=3,232]). The demographic, socioeconomic, and clinical characteristics of the subjects were retrieved from the survey data. Ucot was dichotomized into high-Ucot (≥10 ng/mL) and low-Ucot (<10 ng/mL). The Ucot and other characteristics were compared between the two groups. To adjust for confounding variables, we conducted a logistic regression analysis and determined the difference in Ucot between the two groups.@*RESULTS@#After adjusting for confounders, the high depressive symptom group was found to be associated with high-Ucot (odds ratio, 1.824; 95% confidence interval, 1.020–3.262). Sex, education, socioeconomic status, marital status, occupational status, limitation of activity, and the presence of an underlying diseases (diabetes and dyslipidemia) had a significant effect on depression.@*CONCLUSIONS@#This concluded that depression was associated with high urine cotinine level in adult non-smokers.

Modified Criteria for Diagnosing “Cognitive Frailty”

The concept of cognitive frailty has recently been proposed by an International Consensus Group as the presence of physical frailty and cognitive impairment [defined using the Clinical Dementia Ratings (CDR)=0.5], without concurrent dementia. However, CDR is difficult to implement and not often available in epidemiologic studies or busy clinical settings, and an alternative to CDR is required. We suggest an alternative definition of cognitive frailty as: 1) physical frailty, 2) more than 1.5 standard deviation below the mean for age-, gender-, and education-adjusted norms on any cognitive function test (e.g., the Montreal Cognitive assessment test, the Alzheimer’s disease assessment scale-cognitive subscale, verbal learning test, Digit Span, Boston Naming Test, Trail Making Test, and Frontal Assessment Battery), and 3) no dependency in instrumental activities of daily living. The redefined criteria for cognitive frailty would be more feasible to implement and thus more applicable in epidemiologic studies and busy clinical settings.

Why Geriatric Medicine Is Important for Korea: Lessons Learned in the United States

With the rapid increase in the number of Korean older adults, developing and integrating quality, expert older adult care in the Korean health care system will be essential and a tremendous benefit to these older adult patients, their families, and Korean society. While the awareness of geriatric medicine as a specialty for physicians caring exclusively for older adults has improved greatly in recent decades among Korean health care providers and older adult patients, there is still great opportunity to improve training opportunities for all medical students, primary care physicians, and specialty Geriatrics. Korea must also formally establish uniform geriatric medicine fellowships and certification. However, a number of barriers such as insufficient expertise, low incentives, and competitive geriatric societies exist to implement widespread, quality geriatric medicine in the Korean health care system.

Calf Circumference as a Simple Screening Marker for Diagnosing Sarcopenia in Older Korean Adults: the Korean Frailty and Aging Cohort Study (KFACS)

BACKGROUND: The purpose of this study was to explore the optimal cut-off point of calf circumference (CC) as a simple proxy marker of appendicular skeletal muscle mass (ASM) and sarcopenia in the Korean elderly and to test the criterion-related validity of CC by analyzing its relationships with the physical function. METHODS: The participants were 657 adults aged 70 to 84 years who had completed both dual energy X-ray absorptiometry (DXA) and physical function test in the first baseline year of the Korean Frailty and Aging Cohort Study. RESULTS: ASM and skeletal muscle mass index (SMI) were correlated positively with CC (male, ASM, r = 0.55 and SMI, r = 0.54; female, ASM, r = 0.55 and SMI, r = 0.42; all P < 0.001). Testing the validity of CC as a proxy marker for low muscle mass, an area under the curve (AUC) of 0.81 for males and 0.72 for females were found and their optimal cut-off values of CC were 35 cm for males and 33 cm for females. In addition, CC-based low muscle groups were correlated with physical functions even after adjusting for age and body mass index. Also, the cut-off value of CC for sarcopenia was 32 cm (AUC; male, 0.82 and female, 0.72). CONCLUSION: The optimal cut-off values of CC for low MM are 35 cm for males and 33 cm for females. Lower CC based on these cut-off values is related with poor physical function. CC may be also a good indicator of sarcopenia in Korean elderly.

Evidence-based guidelines for fall prevention in Korea

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.

Evaluation and management of frailty

Physical frailty is a state in which the functional capacity of various organs in the body drops below a certain level, making an individual vulnerable to a variety of stresses; as a result, frail individuals are more likely to experience geriatric diseases, falls, decreased activities of daily living, disability, hospitalization, and mortality. Comprehensive assessments for frail patients are needed, but a simple and rapid screening test such as the FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale can be used in busy outpatient clinics. Physical frailty can be reversible and preventable. Frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reducing polypharmacy.

Health Behavior and Factors Associated with Depression in North Korean Adolescent Defectors in South Korea: The Korea Youth Risk Behavior Web-Based Survey, 2011–2014 / 가정의학회지

BACKGROUND: The number of North Korean adolescent defectors entering South Korea has been increasing. The health behavior, including mental health-related behavior, and factors associated with depression in North Korean adolescent defectors residing in South Korea were investigated. METHODS: Data obtained from the Korea Youth Risk Behavior Web-Based Survey (2011–2014) dataset were utilized. In total, 206 North Korean adolescent defectors were selected, and for the control group, 618 matched South Korean adolescents were selected. Frequency analysis was used to determine the place of birth and nationality of the parents, chi-square tests were used to compare the general characteristics of the North and South Korean subjects, and multivariate logistic regressions were conducted to compare the health behavior of the two sets of subjects. To determine the factors associated with depression in the North Korean subjects, a logistic regression was performed. RESULTS: The North Korean adolescents reported higher current smoking (adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.48 to 4.35), current drinking (aOR, 1.85; 95% CI, 1.15 to 2.99), and drug use rates (aOR, 10.99; 95% CI, 4.04 to 29.88) than did the South Korean adolescents. The factors associated with depression in the North Korean adolescents were current smoking (aOR, 6.99; 95% CI, 1.62 to 30.06), lifetime drinking experience (aOR, 5.32; 95% CI, 1.51 to 18.75), and perceived stress (aOR, 4.74; 95% CI, 1.74 to 12.90). CONCLUSION: There were differences in health behavior between the North and South Korean adolescents. A specialized approach for North Korean adolescent defectors is required to promote proper health behavior and adaptation to South Korean society.

The Association Between Fall History and Physical Performance Tests in the Community-Dwelling Elderly: A Cross-Sectional Analysis

OBJECTIVE: To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population. METHODS: A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests. RESULTS: SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers. CONCLUSION: This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.

Evidence-Based Guideline for Fall Prevention in Korea

Falls and fall-related injuries are common amongst the elderly population and have deleterious effects on the quality of life or independence in daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission, and an increase in medical costs. Given that Korea has shown an extreme demographic shift with its population aging at the fastest pace among developed countries, assessment of fall risks and implementing intervention strategies to the high-risk population are getting more important. The guidelines for the prevention of falls were developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. These guidelines were developed by an adaptation process and the use of an evidence-based method; 4 guidelines were retrieved by systematic review and by the AGREE (appraisal of guidelines for research and evaluation) II process and 7 statements were made based on the grading of evidence, and these recommendations followed the GRADE (grades of recommendation, assessment, development, and evaluation) framework. Given that falls result from a various combination of many factors, the guidelines contain multidimensional assessment measures and multimodal strategies to prevent falls. These guidelines were developed not only for use by primary physicians but also for patients and the general population. Therefore, these guidelines provide detailed recommendations and concrete measures for the assessment of the risk of a fall and to prevent falls amongst the elderly population.