***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 Falls and fall injuries are common-potentially preventable-causes of morbidity , functional decline , and increased health-care use among elderly persons . The current analyses , performed on data obtained as part of a r and omized controlled trial conducted within a health maintenance organization , describe the costs of a multifactorial , targeted prevention program for falls , present total net health-care costs , estimate the cost per fall prevented , and describe acute fall-related health-care costs . METHODS The 301 participants were at least 70 years of age and possessed at least one of eight targeted risk factors for falling . The 153 participants r and omized to the  targeted intervention ( TI ) group received a combination of medication adjustment , behavioral recommendations , and exercises as determined by their baseline assessment . The 148 participants r and omized to the usual care ( UC ) group received a series of home visits by a social work student . RESULTS The mean intervention cost per TI participant was $ 925 ( range $ 588 to $ 1,346 ) . Total mean health-care costs were approximately $ 2,000 less in the TI than UC group , whereas median costs were approximately $ 1,100 higher in the TI than UC group . The TI strategy was unequivocally cost effective when mean costs were used because the intervention was associated with both lowered total health-care costs and fewer total and medical care falls . In sensitivity analyses , the cost-effectiveness of the TI strategy appeared robust to widely differing assumptions about total health-care costs ( 25th to 75th percentile of the actual distribution ) and intervention costs ( minimum to maximum costs ) . In subgroup analyses , the TI strategy showed its strongest effect among individuals at high risk of falling , defined as possession of at least four of the eight targeted risk factors . CONCLUSIONS Consideration should be given toward incorporating and reimbursing the cost of fall-prevention programs within the usual health care of community-living elderly persons , particularly for those persons at high risk for falling Based on finding a strong association between number of impairments and risk of falling in earlier studies , Yale FICSIT investigators are conducting an intervention trial comparing the effectiveness of usual care plus social visits ( SV ) and a targeted risk abatement intervention ( TI ) strategy in reducing falls among at risk community elderly persons . Subjects include members of a participating HMO who are > or = 70 years of age , cognitively intact , not terminally ill , not too physically active , and possess at least one fall risk factor . The targeted risk factors include postural hypotension ; sedative use ; at least four targeted medications ; upper and lower extremity strength and range of motion impairments ; foot problems ; and balance , gait , and transfer dysfunctions . The interventions include medication adjustments , behavioral change recommendations , education and training , and home-based exercise regimens targeting the identified risk factors . The interventions are carried out by the study nurse practitioner and physical therapist in TI subjects ' homes . The SV subjects receive a comparable number of home visits as the TI subjects during which a structured life review is performed by social work students . The primary outcome is occurrence of falls during the 12-month followup . Secondary outcomes include change in mobility performance and fall-related efficacy Health visitors were employed specifically to care for two years for a r and om sample of patients in general practice who were aged over 70 . Independent assessment s made at the beginning and end of the study showed that the health visitor in an urban practice had some impact on her caseload of patients ; she provided more services for them , their mortality was reduced , and their quality of life improved , though the last measure just failed to be statistically significant . The health visitor working in a rural practice had no such effect Over three years 285 r and omly selected subjects aged 75 years or more and living in a suburb of Copenhagen were visited every three months in their own homes ( the intervention group ) to assess whether scheduled medically and socially preventive intervention would influence the number of admissions to hospitals or nursing homes , the number of contacts with general practice , or mortality .  A r and omly selected group of 287 people of the same age and sex were visited during the final three months of the study ( the control group ) . Two hundred and nineteen admissions to hospitals ( 4884 bed days ) were registered for the intervention group compared with 271 ( 6442 bed days ) for the control group . Especially during the second half of the study , a significant reduction in the number of admissions to hospitals was seen in the intervention group . Twenty people in the intervention group and 29 in the control group moved into nursing homes ( p greater than 0.05 ) . The corresponding numbers of deaths were 56 and 75 ( p less than 0.05 ) . No difference was seen in the number of contacts with general practice . Significantly fewer emergency medical calls , however , were registered for the intervention group . Subjects in the intervention group benefited from the regular visits and the increased distribution of aids and modifications  to their homes to which these led . The regular visits probably also produced an important increase in confidence OBJECTIVES To describe the process of care of a program of in-home comprehensive geriatric assessment ( CGA ) and to determine : ( 1 ) if there are major findings in all domains of CGA ( medical , functional , mental health , and social/ environmental ) , ( 2 ) if there is a continued clinical yield when CGA is repeated annually , and ( 3 ) factors that affect patient adherence with recommendations from CGA . DESIGN Descriptive prospect i ve study of subjects allocated to the intervention group of a 3-year r and omized trial of preventive in-home CGA . SETTING Homes of participants living in an urban setting . PARTICIPANTS Persons aged 75 years or older and living at home who received the intervention ( N = 202 subjects , mean age 80.8 years , 70 % female , 95 % white , 64 % living alone ) . INTERVENTION Annual in-home CGA and quarterly home visits by gerontologic nurse practitioners for 3 years . MEASUREMENTS Detailed data were collected prospect ively on clinical problems detected by CGA , and specific recommendations were made for these problems using an instrument developed explicitly for this project to study the CGA process . Subject adherence with these recommendations was also recorded . RESULTS Major problems were identified in all domains of CGA ; the most common problems were medical . In the first year , 76.7 % of subjects had at least one major problem identified that was either previously unknown or suboptimally treated . One-third of subjects had additional major problems identified during the second and third years . A constant number of therapeutic and preventive recommendations was made each year ( 11.5 per subject annually ) . Subject adherence varied by type of recommendation ( ANOVA , F = 108.4 , P < .001 ) ; adherence was better for referrals to a physician than for referrals to a non-physician professional or community service or for recommendations involving self-care activities ( Scheffe 's test , P < .001 ) . CONCLUSION In these community-dwelling older people , there was a continued yield of problems identified and recommendations made when CGA was repeated annually for 3 years , supporting the practice of repeat CGA in older people in the community . Subject adherence with recommendations from CGA varied by type of recommendation , but further work is needed to determine additional factors that affect this adherence and to determine the association between the yield of CGA ( i.e. , problems identified , recommendations given and adherence with these recommendations ) and important clinical outcomes A r and omized controlled trial was set up in 1985 to test the effect of social intervention over 3 years among elderly people , aged 75 and above , living alone . The sampling frame was the age/sex register of a large group practice of 12 general practitioners serving the town of Melton Mowbray , Leicestershire , Engl and , with a list size of approximately 32,000 patients . A total of 523 elderly people living alone in 1985 were identified , interviewed , and r and omized into experimental and control groups . A lay worker offered the experimental group ( n = 261 ) individual packages of support that aim ed at enhanced social contacts . The outcome measures , approximately 3 years later in 1988 , were mortality ; changes in physical status ; dem and for medical , paramedical , social , and voluntary services ; and changes in a number of subjective variables ( morale , loneliness , and self-perceived health ) . No significant differences were found for any of the variables with the exception of self-perceived health status , where the experimental group showed significantly greater improvements than did the control group . More importantly , half the elderly in this sample declined several offers of help BACKGROUND AND METHODS The prevention of disability in elderly people poses a challenge for health care and social services . We conducted a three-year , r and omized , controlled trial of the effect of annual in-home comprehensive geriatric assessment and follow-up for people living in the community who were 75 years of age or older . The 215 people in the intervention group were seen at home by gerontologic nurse practitioners who , in collaboration with geriatricians , evaluated problems and risk factors for disability , gave specific recommendations , and provided health education .  The 199 people in the control group received their regular medical care . The main outcome measures were the prevention of disability , defined as the need for assistance in performing the basic activities of daily living ( bathing , dressing , feeding , grooming , transferring from bed to chair , and moving around inside the house ) or the instrumental activities of daily living ( e.g. , cooking , h and ling finances and medication , housekeeping , and shopping ) , and the prevention of nursing home admissions . RESULTS At three years , 20 people in the intervention group ( 12 percent of 170 surviving participants ) and 32 in the control group ( 22 percent of 147 surviving participants ) required assistance in performing the basic activities of daily living ( adjusted odds ratio , 0.4 ; 95 percent confidence interval , 0.2 to 0.8 ; P = 0.02 ) . The number of persons who were dependent on assistance in performing the instrumental activities of daily living but not the basic activities did not differ significantly between the two groups . Nine people in the intervention group ( 4 percent ) and 20 in the control group ( 10 percent ) were permanently admitted to nursing homes ( P = 0.02 ) . Acute care hospital admissions and short-term nursing home admissions did not differ significantly between the two groups . In the second and third years of the study , there were significantly more visits to physicians among the participants in the intervention group than among those in the control group ( mean number of visits per month , 1.41 in year 2 and 1.27 in year 3 in the intervention group , as compared with 1.11 and 0.92 visits , respectively , in the control group ; P = 0.007 and P = 0.001 , respectively ) . The cost of the intervention for each year of disability-free life gained was about $ 46,000 . CONCLUSIONS A program of in-home comprehensive geriatric assessment s can delay the development of disability and reduce permanent nursing home stays among elderly people living at home Public health clients aged 65 years and older were r and omly allocated to receive an intervention by a public health nurse during a home visit , promoting either safety behaviours or influenza immunization .  Sixty-eight clients reported making a total of 103 safety changes , with almost equal proportions making changes in the safety and influenza groups ( 21.9 % vs. 18.3 % ) . A higher percentage of males ( 25.0 % ) than females ( 17.3 % ) reported making safety changes following the intervention . Further research should focus on the effectiveness of safety promotion strategies which are exp and ed to include seniors participation , policy development and community planning and design Previous controlled studies have shown that preventive home visits are a promising method for disability prevention  in elderly persons ; however , due to the lack of data on cost effectiveness and optimal intervention methods , there is still debate on their usefulness . Therefore , additional controlled studies must use new methods to resolve these unanswered issues . We present a novel approach used in the project EIGER ( Evaluation of In-Home Geriatric Health Visits in Elderly Residents ) , an ongoing r and omized controlled trial of preventive home visits in community-residing persons aged 75 years and older in Bern , Switzerl and . The intervention consists of inhome visits with structured comprehensive geriatric assessment and follow-up by specially trained nurses who collaborate with geriatricians and an interdisciplinary team . Special methods were used to optimize the sample size , to improve the health care cost analysis , to minimize and explore refusal to participate , to apply stratified r and omization for subgroup analysis , and to evaluate the intervention process with a tracer method . Selected baseline findings ( N=791 , mean age 82 years , 73 % female ) include uncontrolled systolic hypertension ( 54 % ) , balance/gait disorder ( 9 % ) , cognitive impairment ( 7 % ) , 6 or more medications ( 21 % ) , depressive symptoms ( 10 % ) , and impaired basic ADL ( 15 % ) . Baseline findings demonstrate that this study is likely to contribute to some of the unresolved issues of in-home prevention for older persons . ( Aging Clin . Exp . Res . 7 : 218 - 223 , 1995 OBJECTIVE To evaluate the effectiveness of in-home geriatric assessment s as a means of providing preventive health care and improving health and functional status of community-living elderly veterans . DESIGN R and omized controlled trial with 1-year follow-up . SETTING Home visits performed in a suburb of Los Angeles . PARTICIPANTS Community-living veterans 70 years and older not currently receiving health care at the Sepulveda VA Medical Center ( n = 131 intervention ; 123 controls ) . INTERVENTION A home visit by a physician 's assistant or nurse , to screen for medical , functional and psychosocial problems , followed by a letter 
    Output:
    
CONCLUSIONS No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community .