***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: OBJECTIVE To use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities . DESIGN R and omized , controlled trial . SETTING The study took place at two long-term care facilities with services ranging from independent living to skilled nursing . PARTICIPANTS One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions . INTERVENTION Participants were r and omized to one of two exercise groups ( resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming ) or to a control group ( basic enhanced programming only ) . Exercise classes were held three times per week throughout the study . MEASUREMENTS Participants were evaluated for cognitive and physical functioning at baseline and 6 , 12 , and 24 months . Falls were determined from incident reports filed by the nursing staffs at the facilities . RESULTS Time to first fall , time to death , number of days hospitalized , and incidence of falls did not differ among the treatment and control groups ( P>.05 ) . Among all participants , those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program . CONCLUSION There were no significant differences in falls among the two exercise groups and the control group . Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs The eight FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) sites test different intervention strategies in selected target groups of older adults . To compare the relative potential of these interventions to reduce frailty and fall-related injuries , all sites share certain descriptive ( risk-adjustment ) measures and outcome measures . This article describes the shared measures , which are referred to as the FICSIT Common Data Base ( CDB ) . The description is divided into four sections according to the four FICSIT committees responsible for the CDB : ( 1 ) psychosocial health and demographic measures ; ( 2 ) physical health measures ; ( 3 ) fall-related measures ; and ( 4 ) cost and cost-effectiveness measures . Because the structure of the FICSIT trial is unusual , the CDB should expedite secondary analyses of various research questions dealing with frailty and falls BACKGROUND Falls in elderly people are a common presenting complaint to accident and emergency departments . Current practice commonly focuses on the injury , with little systematic assessment of the underlying cause , functional consequences , and possibilities for future prevention . We undertook a r and omised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms of further falls . METHODS Eligible patients were aged 65 years and older , lived in the community , and presented to an accident and emergency department with a fall . Patients assigned to the intervention group ( n=184 ) underwent a detailed medical and occupational-therapy assessment with referral to relevant services if indicated ; those assigned to the control group ( n=213 ) received usual care only . The analyses were by intention to treat . Follow-up data were collected every 4 months for 1 year . FINDINGS At 12-month follow-up , 77 % of both groups remained in the study . The total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group ( p=0.0002 ) . The risk of falling was significantly reduced in the intervention group ( odds ratio 0.39 [ 95 % CI 0.23 - 0.66 ] ) as was the risk of recurrent falls ( 0.33 [ 0.16 - 0.68 ] ) . In addition , the odds of admission to hospital were lower in the intervention group ( 0.61 [ 0.35 - 1.05 ] ) whereas the decline in Barthel score with time was greater in the control group ( p<0.00001 ) . INTERPRETATION The study shows that an interdisciplinary approach to this high-risk population can significantly decrease the risk of further falls and limit functional impairment OBJECTIVE To investigate the effect of a second task on balance and gait maneuvers used in everyday life . Our hypothesis was that those who were more distracted by a familiar manual task performed concurrently with functional maneuvers were more frail and more prone to falls . DESIGN A cross-sectional design with prospect i ve follow-up for falls . SETTING Sheltered accommodation in Umeå , Sweden . PARTICIPANTS Forty-two residents ( 30 women , 12 men ; mean age + /- SD = 79.7 + /- 6.1 years ) , ambulant with or without a walking aid , able to follow simple instructions and able to carry a tumbler . MEASUREMENTS  Timed Up & Go ( TUG ) , i.e. , the time taken to rise from an armchair , walk 3 meters , turn round , and sit down again . TUG was repeated with an added manual task ( TUGmanual ) , which was to carry a glass of water while walking . The Montgomery-Asberg Depression Rating Scale , Barthel Index , Functional Reach , Mini-Mental State Examination , and Line Bisection test were used to assess for frailty . The subjects were followed-up prospect ively regarding falls indoors for a period of 6-months . RESULTS Subjects with a time difference ( diffTUG ) between TUGmanual and TUG of > or = 4.5 seconds were considered to be distracted by the second task . Ten subjects had a difference in time of > or = 4.5 seconds . These subjects were more frail , and seven of them fell indoors during the follow-up period ( odds ratio 4.7 , 95%Confidence Interval ( CI ) 1.5 - 14.2 ) . CONCLUSION The time difference between the TUGmanual and the TUG appears to be a valid marker of frailty and a useful tool for identifying older persons prone to falling BACKGROUND AND PURPOSE The aim of this study was to develop and evaluate a screening tool for the identification of older people living in residential care facilities who are prone to falling . METHOD Two tests focusing on attentional  dem  and s while walking  were performed :  ' Stops walking when talking ' and the  ' diffTUG ' . Medical assessment , rating for cognition , depression and activities of daily living were also carried out . Falls indoors were followed up prospect ively over a period of six months . A flowchart , the Mobility Interaction Fall ( MIF ) chart , for the identification of older people who are prone to falling was developed . The MIF chart includes an observation of mobility level and ' Stops walking when talking ' , the diffTUG , a test of vision and a rating of concentration .  Study subjects were 78 residents , aged over 65 years , in one residential care facility ( 22 M ; 56 F ; median age 82 years , range 66 - 99 years ) in Umeå , Sweden . RESULTS Thirty-three ( 42 % ) subjects suffered at least one fall indoors during the follow-up period . The rate of falls differed significantly between those subjects classified as being at risk of falls and those not so classified ( log rank test 39.1 ; p < 0.001 ; hazard ratio 12.1 ; 95 % CI 4.6 - 31.8 ) . The positive predictive value for the classification was 78 % ( 95 % CI 67 - 87 % ) and the negative predictive value was 88 % ( 95 % CI 79 - 95 % ) . CONCLUSION The initial findings for the MIF chart indicate a promising way of classifying older people at residential care facilities as being at high or low risk of falling . The classification is quick and easy and requires no expensive equipment OBJECTIVE To describe the incidence and associated factors of injury-causing falls by place of residence . DESIGN A prospect i ve population -based study . SETTING Five municipalities in northern Finl and . PARTICIPANTS All persons in the five communities aged 70 years or older living at home ( n = 1016 ) and in long-term institutionalized care ( n = 143 ) . MEASUREMENTS We recorded all fall incidents  during a 2-year period by occurrence and severity of injury , using diary reporting and regular calls and by examining the medical and nursing records of all participants . The times , places , circumstances , and medical treatment needed were recorded as well . RESULTS Men living at home experienced 71 minor injuries/1000 person years ( PY ) , 42 major soft tissue injuries/1000PY , and 12 fractures/1000PY ; women at home experienced 175 minor injuries/1000PY , 65 major soft tissue injuries/1000PY , and 33 fractures/1000PY . Institutionalized older men had 272 minor injuries/1000PY , 122 major soft tissue injuries/1000PY , and 41 fractures/1000PY ; institutionalized women had 292 minor injuries/1000PY , 131 major soft tissue injuries/1000PY , and 58 fractures/1000PY . Falls causing injury to older adults in long-term institutionalized care were more evenly distributed by time of day than those that occurred at home . The majority of the injuries sustained in long-term institutionalized care were injuries to the head . The incidence rate of fall injuries requiring medical attention in women , 113/1000PY , was twice that in men , 57/1000PY . CONCLUSIONS Injury-causing falls are more frequent in older people living in long-term institutionalized care , and the time-distribution and some circumstances differ from those of injury-causing falls in home-dwelling older people BACKGROUND Past studies suggest multidisciplinary interventions that include physical therapy ( PT ) can improve function of nursing home residents . This trial specifically evaluates effects of PT for frail long-stay nursing home residents . DESIGN R and omized , controlled trial . SETTING One academic nursing home and eight community nursing homes . PATIENTS A total of 194 elderly nursing home residents dependent in at least two activities of daily living residing in the nursing home for at least 3 months . INTERVENTIONS Patients were r and omized to individually tailored one-on-one PT sessions or friendly visits ( FVs ) three times a week for 4 months . Physical therapy included range-of-motion , strength , balance , transfer , and mobility exercises . MAIN OUTCOME MEASURES Performance-based physical function assessed by the Physical Disability Index ; self-perceived health status assessed with the Sickness Impact Profile ; observer-reported activities of daily living ; and falls . RESULTS Eighty-nine percent and 92 % of PT and FV sessions , respectively , were attended ; 5 % and 9 % of subjects dropped out in the PT group and FV group , respectively . Compared with the FV group , the PT group experienced no significant improvements in overall Physical Disability Index , Sickness Impact Profile , or activities of daily living scores . A 15.5 % improvement in the mobility subscale of the Physical Disability Index was seen ( 95 % confidence interval [ CI ] , 6.4 % to 24.7 % ) ; no benefits in range-of-motion , strength , or balance subscales were found . Compared with the FV group , the PT group used assistive devices for bed mobility tasks less often ( P = .06 ) and were less likely to use assistive devices and wheelchairs for locomotion ( P < .005 ) . There were 79 falls in the PT group vs 60 falls in the FV group ( P = .11 ) . Charge for the 4-month PT program was $ 1220 per subject ( 95 % CI , $ 412 to $ 1832 ) . CONCLUSION This st and ardized physical therapy program provided modest mobility benefits for very frail long-stay nursing home residents with physical disability due to multiple comorbid conditions Abstract Objective : To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing  falls and injuries in elderly women . Design : R and omised controlled trial of an individually tailored programme of physical therapy in the home ( exercise group , n=116 ) compared with the usual care and an equal number of social visits ( control group , n=117 ) . Setting : 17 general practice s in Dunedin , New Zeal and . Subjects : Women aged 80 years and older living in the community and registered with a general practice in Dunedin . Main outcome measures : Number of falls and injuries related to falls and time between falls during one year of follow up ; changes in muscle strength and balance measures after six months . Results : After one year there were 152 falls in the control group and 88 falls in the exercise group . The mean ( SD ) rate of falls was lower in the exercise than the control group ( 0.87 ( 1.29 ) v 1.34 ( 1.93 ) falls per year respectively ; difference 0.47 ; 95 % confidence interval 0.04 to 0.90 ) . The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 ( 0.52 to 0.90 ) . The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 ( 0.39 to 0.97 ) . After six months , balance had improved in the exercise group ( difference between groups in change in balance score 0.43 ( 0.21 to 0.65 ) . Conclusions : An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing  falls and injuries in women 80 years and older . Key messages Modifiable risk factors for falls in elderly people have been well defined ; they include loss of muscle strength and impaired balance A programme to improve strength and balance in women aged 80 years and older can be set up 
    Output:
    
Contribution This r and omized trial shows that a multidisciplinary fall prevention program reduces falls and femoral fractures in older people living in residential care facilities .
The program included general as well as resident-specific , tailored strategies .
Other trials have not shown reductions in falls or injuries ( 10 - 13 ) but have shown fewer hospital admissions ( 11 ) and improvements in mobility ( 12 ) , visual acuity , and hypotension ( 13 ) .
The use of hip protectors has consistently proved effective in preventing hip fractures in selected high-risk population s ( 14 ) .
Increasing the staff 's knowledge about fall prevention was believed to be the starting point of a process that would produce long-term results .