Falls in Older Adults: Approach and Prevention.

Falls are a major public health problem, occurring in more than 27% of adults 65 years and older and costing the U.S. health care system tens of billions of dollars each year. The most common risk factors are prior falls, balance disorders, fear of falling, and dementia. Regular physical activity reduces fall risk. Identifying injuries is the first step in evaluating older adults who have fallen. The patient's history may be inaccurate if they have cognitive impairment, and the physical examination can result in false-negative findings. If injury status cannot be determined and suspicion for injury remains high, clinicians can consider whole-body computed tomography (i.e., pan-scan) to evaluate the head, cervical spine, chest, abdomen, and pelvis. After addressing injuries, the next steps are to identify the cause of the fall and implement measures to reduce future fall risk. The Centers for Disease Control and Prevention has developed an easy-to-use tool to screen for and reduce fall risk, known as STEADI (Stopping Elderly Accidents, Deaths, and Injuries). An affirmative answer to any of the three STEADI screening questions indicates further evaluation with a timed up and go test, 30-second chair stand test, and four-stage balance test. If results of these tests are abnormal, multicomponent interventions are indicated to reduce future fall risk. These components include evaluating environmental and home safety factors and optimizing care of chronic medical conditions, such as diabetes mellitus, hypertension, osteoporosis, pain, urinary urgency and incontinence, and depression. Polypharmacy and drugs that increase risk of falls should be avoided, when possible. Optimization of vision and hearing correction, podiatry care, and appropriate use of ambulation devices are also important.

Quality Primary Care and Family Planning Services for LGBT Clients: A Comprehensive Review of Clinical Guidelines.

LGBT clients have unique healthcare needs but experience a wide range of quality in the care that they receive. This study provides a summary of clinical guideline recommendations related to the provision of primary care and family planning services for LGBT clients. In addition, we identify gaps in current guidelines, and inform future recommendations and guidance for clinical practice and research. PubMed, Cochrane, and Agency for Healthcare Research and Quality electronic bibliographic databases, and relevant professional organizations' websites, were searched to identify clinical guidelines related to the provision of primary care and family planning services for LGBT clients. Information obtained from a technical expert panel was used to inform the review. Clinical guidelines meeting the inclusion criteria were assessed to determine their alignment with Institute of Medicine (IOM) standards for the development of clinical practice guidelines and content relevant to the identified themes. The search parameters identified 2,006 clinical practice guidelines. Seventeen clinical guidelines met the inclusion criteria. Two of the guidelines met all eight IOM criteria. However, many recommendations were consistent regarding provision of services to LGBT clients within the following themes: clinic environment, provider cultural sensitivity and awareness, communication, confidentiality, coordination of care, general clinical principles, mental health considerations, and reproductive health. Guidelines for the primary and family planning care of LGBT clients are evolving. The themes identified in this review may guide professional organizations during guideline development, clinicians when providing care, and researchers conducting LGBT-related studies.