***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents . DESIGN Cluster , r and omized , controlled trial . SETTING Fourteen r and omly selected residential care homes in Auckl and , New Zeal and . PARTICIPANTS All older residents ( n=628 , 95 % participation rate ) . INTERVENTION Residential care staff , using existing re sources , implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool , high-risk logo , and strategies to address identified risks . MEASUREMENTS Number of residents sustaining a fall , falls , and injurious-falls incidence rates . RESULTS During 12 months of follow-up , 103 ( 43 % ) residents in the control group and 173 ( 56 % ) residents in the intervention group fell ( P<.018 ) . There was a significantly higher incidence rate of falls in intervention homes than in control homes ( incident rate ratio=1.34 , 95 % confidence interval=1.06 - 1.72 ) during the intervention period after adjusting for dependency level ( type of home ) , baseline fall rate , and clustering . There was no difference in the injurious fall incidence rate or incidence of serious injuries . CONCLUSION This fall-prevention intervention did not reduce falls or injury from falls . Low-intensity intervention may be worse than usual care OBJECTIVE to determine the effect of risk factor modification and balance exercise on falls rates in residential care homes . DESIGN cluster r and omised controlled trial . PARTICIPANTS 196 residents ( aged 60 years or over ) in 20 residential care homes were enrolled ( 38 % response rate ) . Homes were r and omly allocated to intervention and control arms . A total of 102 residents were consigned to the intervention arm and 94 to the control arm . INTERVENTION a multifactorial falls prevention programme including 3 months gait and balance training , medication review , podiatry and optometry . MAIN OUTCOME MEASURES number of falls/recurrent falls per person , number of medications per person , and change in Tinetti gait and balance measure . RESULTS in the intervention group there was a mean of 2.2 falls per resident per year compared with 4.0 in the control group ; this failed to reach statistical significance ( P = 0.2 ) once the intra-cluster correlation ( ICC , 0.10 ) had been accounted for . Several risk factors were reduced in the intervention arm . CONCLUSIONS falls risk factor reduction is possible in residents of care homes . A modest reduction in falls rates was demonstrated but this failed to reach statistical significance OBJECTIVES To evaluate the effectiveness of a multifaceted , nonpharmaceutical intervention on incidence of falls and fallers . DESIGN Prospect i ve , cluster-r and omized , controlled 12-month trial . SETTING Six community nursing homes in Germany . PARTICIPANTS Long-stay residents ( n = 981 ) aged 60 and older ; mean age 85 ; 79 % female . INTERVENTIONS Staff and resident education on fall prevention , advice on environmental adaptations , progressive balance and resistance training , and hip protectors . MEASUREMENTS Falls , fallers , and fractures . RESULTS The incidence density rate of falls per 1,000 resident years ( RY ) was 2,558 for the control group ( CG ) and 1,399 for the intervention group ( IG ) ( relative risk ( RR ) = 0.55 , 95 % confidence interval ( CI ) = 0.41 - 0.73 ) . Two hundred forty-seven ( 52.3 % ) fallers were detected in the CG and 188 ( 36.9 % ) in the IG ( RR = 0.75 , 95 % CI = 0.57 - 0.98 ) . The incidence density rate of frequent fallers ( > 2/year ) was 115 ( 24.4 % ) for the CG and 66 ( 13.0 % ) for the IG ( RR = 0.56 , 95 % CI = 0.35 - 0.89 ) . The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG ( RR = 1.11 , 95 % CI = 0.49 - 2.51 ) . Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG ( RR = 0.78 , 95 % CI = 0.57 - 1.07 ) . CONCLUSION The incidence density rate of falls and fallers differed considerably between the control and intervention groups . The study was underpowered to demonstrate a significant difference of hip or nonhip fractures . Because of a low fracture rate in both groups , the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention Abstract Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics . Design Cluster r and omised controlled trial with blinded assessment of outcome . Setting 12 specialist nursing homes for people with dementia in London , Newcastle , and Oxford . Participants Residents of the 12 nursing homes ; numbers varied during the study period . Intervention Training and support intervention delivered to nursing home staff over 10 months , focusing on alternatives to drugs for the management of agitated behaviour in dementia . Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour ( Cohen-Mansfield agitation inventory ) in each home at 12 months . Results At 12 months the proportion of residents taking neuroleptics in the intervention homes ( 23.0 % ) was significantly lower than that in the control homes ( 42.1 % ) : average reduction in neuroleptic use 19.1 % ( 95 % confidence interval 0.5 % to 37.7 % ) . No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes . Conclusions Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics OBJECTIVE --To study the mortality and morbidity associated with proximal femoral fractures with reference to fracture type ( intracapsular and extracapsular )  . DESIGN --Consecutive prospect i ve study with 12 month follow ups . SETTING --Two British trauma receiving centres . PATIENTS --1000 consecutive acute proximal femoral fractures ( fractured necks of femur ) in 972 patients . RESULTS --Significantly higher mortality at one year was seen in patients with extracapsular fractures ( 188/490 ; 38 % ) than in those with intracapsular fractures ( 147/510 ; 29 % ; p < 0.01 ) . Greater morbidity was experienced during the study period by patients with extracapsular fractures , who were less mobile and less independent at the time of their injury . CONCLUSIONS --The rise in average age of presentation with proximal femoral fracture is associated with a persistently high mortality ( 33 % ) and morbidity , greater in patients with an extracapsular fracture . Comparison with other studies , principally from outside Britain , is difficult , but despite advancing st and ards of care the mortality and morbidity of femoral neck fractures remains high , placing an ever increasing burden on the health service CONTEXT Past studies of the efficacy of hip protectors to prevent hip fracture in nursing home residents have had conflicting results , possibly due to potential biases from clustered r and omization design s and modest adherence to intervention . OBJECTIVE To determine whether an energy-absorbing and energy-dispersing hip protector would reduce the risk of hip fracture when worn by nursing home residents . DESIGN , SETTING , AND PARTICIPANTS Multicenter , r and omized controlled clinical trial in which 37 nursing homes were r and omly assigned to having residents wear a 1-sided hip protector on the left or right hip . Participants were 1042 nursing home residents ( mean [ SD ] aged 85 [ 7 ] years ; 79 % women ) who consented and adhered to the hip protector use during a 2-week run-in period and were enrolled . Participating facilities were in greater Boston , Massachusetts , St Louis , Missouri , and Baltimore , Maryl and from October 2002 to October 2004 . Mean duration of participation for nursing home residents was 7.8 months . None were withdrawn because of adverse effects . INTERVENTION(S ) Undergarments with a 1-sided hip protector made of a 0.32-cm outer layer of polyethylene ( 2.7 kg/m3 ) backed by a hard high-density polyethylene shield ( 0.95 cm ) that was backed by 0.9 kg/m3 of 1.27-kg ethylene vinyl acetate foam . Each facility was visited 3 times per week to assess adherence and provide staff support . MAIN OUTCOME MEASURE Adjudicated hip fracture occurrences on padded vs unpadded hips . RESULTS After a 20-month follow-up ( 676 person-years of observation ) , the study was terminated due to a lack of efficacy . The incidence rate of hip fracture on protected vs unprotected hips did not differ ( 3.1 % ; 95 % confidence interval [ CI ] , 1.8%-4.4 % vs 2.5 % ; 95 % CI , 1.3%-3.7 % ; P = .70 ) . For the 334 nursing home residents with greater than 80 % adherence to hip protector use , the incidence rate of hip fracture on protected vs unprotected hips did not differ ( 5.3 % ; 95 % CI , 2.6%-8.8 % vs 3.5 % ; 95 % CI , 1.3%-5.7 % ; P = .42 ) . Overall adherence was 73.8 % . CONCLUSIONS In this clinical trial of an energy-absorbing/shunting hip protector conducted in US nursing homes , we were unable to detect a protective effect on the risk of hip fracture , despite good adherence to protocol . These results add to the increasing body of evidence that hip protectors , as currently design ed , are not effective for preventing hip fracture among nursing home residents . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00058864 OBJECTIVES To determine the effect of four vitamin D supplement doses on falls risk in elderly nursing home residents . DESIGN Secondary data analysis of a previously conducted r and omized clinical trial . SETTING Seven hundred twenty-five-bed long-term care facility . PARTICIPANTS One hundred twenty-four nursing home residents ( average age 89 ) . INTERVENTION Participants were r and omly assigned to receive one of four vitamin D supplement doses ( 200 IU , 400 IU , 600 IU , or 800 IU ) or placebo daily for 5 months . MEASUREMENTS Number of fallers and number of falls assessed using facility incident tracking data base . RESULTS Over the 5-month study period , the proportion of participants with falls was 44 % in the placebo group ( 11/25 ) , 58 % ( 15/26 ) in the 200 IU group , 60 % ( 15/25 ) in the 400 IU group , 60 % ( 15/25 ) in the 600 IU group , and 20 % ( 5/23 ) in the 800 IU group . Participants in the 800 IU group had a 72 % lower adjusted-incidence rate ratio of falls than those taking placebo over the 5 months ( rate ratio=0.28 ; 95 % confidence interval=0.11 - 0.75 ) . No significant differences were observed for the adjusted fall rates compared to placebo in any of the other supplement groups . CONCLUSION Nursing home residents in the highest vitamin D group ( 800 IU ) had a lower number of fallers and a lower incidence rate of falls over 5 months than those taking lower doses . Adequate vitamin D supplementation in elderly nursing home residents could reduce the number of falls experienced by this high falls risk group CONTEXT Several r and omized controlled trials have been performed to examine the effectiveness of external hip protectors in reducing the incidence of hip fractures , but the results are controversial . OBJECTIVE To examine the effectiveness of hip protectors in reducing the incidence of hip fractures in an elderly high-risk population . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of elderly persons aged 70 years or older , who have low bone density , and are at high risk for falls . Participants lived in apartment houses for the elderly , homes for the elderly , and nursing homes in Amsterdam and surrounding areas in the Netherl and s. They were enrolled in the study between March 1999 and March 2001 ; the mean follow-up was 69.6 weeks . Of the 830 persons who were screened , 561 persons were enrolled . INTERVENTION External hip protector . Both groups received written information on bone health and risk factors for falls . MAIN OUTCOME MEASURE Time to first hip fracture . Survival analysis was used to include all participants for the time they participated . RESULTS In the intervention group , 18 hip fractures  occurred vs 20 in the control group . Four hip fractures in the intervention group occurred while an individual was wearing a hip protector . At least 4 hip fractures in the 
    Output:
    
In general , because of the limited number of included trials , the evidence is inconclusive for multifaceted and single interventions in long-term care facilities .
Most of the review ed studies did not find a significant positive effect on fall incidents .
However , our data support the conclusions of Gillespie et al. that multifactorial interventions in long-term care population s seem more likely to be beneficial .
However , single interventions ( eg , targeting vitamin D insufficiency ) can be effective .