***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 
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    Input: BACKGROUND People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery , about 30 - 50 % of all those who sustain a hip fracture have dementia . Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia . METHODS A r and omized controlled trial with subgroup analyses among patients with dementia . Sixty-four patients with femoral neck fracture , aged ≥70 years at Umeå University Hospital , Sweden . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications , especially delirium . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation , including a follow-up at 4 months postoperatively . The control group followed conventional postoperative routines . RESULTS There were fewer postoperative complications in the intervention group such as urinary tract infections , p=0.001 ; nutritional problems , p=0.025 ; postoperative delirium , p=0.002 ; falls , p=0.006 . At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance , p=0.005 . At 12 months a larger proportion in the intervention group had regained the activities of daily living ( ADL ) performance level they had before the fracture , p=0.027 . CONCLUSION This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs The objective of this study was to evaluate the short-term outcome of intranasal calcitonin treatment of elderly hip fracture patients on pain , bone loss , functional recovery , and length of hospital stay . In addition , we wanted to compare the effect of calcitonin with placebo on fusion of hip fractures treated with internal fixation using a screw or a nail . In a r and omized , double-blind , clinical ly controlled trial , 260 independently living patients ( aged 65 years or older ) with acute hip fracture were r and omly assigned to intranasal calcitonin 200 IU daily for 3 months or matching placebo nasal spray . Analyses were completed on an intention-to-treat basis . Three months after the operation , the median intensity of pain in visual analog scale was 0 mm ( IQR 0.20 ) in the calcitonin group and 4 mm ( IQR 0.33 ) in the placebo group ( P = 0.15 ) . The mean change in calcaneal bone mineral density from baseline to 3 months was not statistically significant between the groups ? 0.004 ( 95 % CI ? 0.008 to ? 0.001 ) in the calcitonin group and ? 0.007 ( 95 % CI ? 0.012 to ? 0.003 ) in the placebo group ( P = 0.28 ) . There were no significant differences in mortality , side effects , length of hospital stay , and functional recovery . Among patients with internal fixation using a screw or a nail ( n = 99 ) , fusion of the fracture was observed in an X-ray 3 months after the operation in 84 % in the calcitonin group and in 63 % in the placebo group ( P = 0.029 , difference 20 % [ 95 % CI 2 to 39 ] ) . We conclude that intranasal calcitonin might be useful for hip fracture patients but the clinical significance of this finding needs to be confirmed by studies with more participants , a longer treatment period , a longer follow-up , and perhaps a higher dose of calcitonin Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation Background Falls are a major cause of morbidity and mortality in dementia , but there have been no prospect i ve studies of risk factors for falling specific to this patient population , and no successful falls intervention/prevention trials . This prospect i ve study aim ed to identify modifiable risk factors for falling in older people with mild to moderate dementia . Methods and Findings 179 participants aged over 65 years were recruited from outpatient clinics in the UK ( 38 Alzheimer 's disease ( AD ) , 32 Vascular dementia ( VAD ) , 30 Dementia with Lewy bodies ( DLB ) , 40 Parkinson 's disease with dementia ( PDD ) , 39 healthy controls ) . A multifactorial assessment of baseline risk factors was performed and fall diaries were completed prospect ively for 12 months . Dementia participants experienced nearly 8 times more incident falls ( 9118/1000 person-years ) than controls ( 1023/1000 person-years ; incidence density ratio : 7.58 , 3.11–18.5 ) . In dementia , significant univariate predictors of sustaining at least one fall included diagnosis of Lewy body disorder ( proportional hazard ratio ( HR ) adjusted for age and sex : 3.33 , 2.11–5.26 ) , and history of falls in the preceding 12 months ( HR : 2.52 , 1.52–4.17 ) . In multivariate analyses , significant potentially modifiable predictors were symptomatic orthostatic hypotension ( HR : 2.13 , 1.19–3.80 ) , autonomic symptom score ( HR per point 0–36 : 1.055 , 1.012–1.099 ) , and Cornell depression score ( HR per point 0–40 : 1.053 , 1.01–1.099 ) . Higher levels of physical activity were protective ( HR per point 0–9 : 0.827 , 0.716–0.956 ) . Conclusions The management of symptomatic orthostatic hypotension , autonomic symptoms and depression , and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia . R and omised controlled trials to assess such a strategy are a priority Abstract Objective : To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department . Design : R and omised controlled trial . Participants : 274 cognitively impaired older people ( aged 65 or over ) presenting to the accident and emergency department after a fall : 130 were r and omised to assessment and intervention and 144 were r and omised to assessment followed by conventional care ( control group ) .  Setting : Two accident and emergency departments , Newcastle upon Tyne . Main outcome measures : Primary outcome was number of participants who fell in year after intervention . Secondary outcomes were number of falls ( corrected for diary returns ) , time to first fall , injury rates , fall related attendances at accident and emergency department , fall related hospital admissions , and mortality . Results : Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year 's follow up ( 74 % ( 96/130 ) and 80 % ( 115/144 ) , relative risk ratio 0.92 , 95 % confidence interval 0.81 to 1.05 ) . No significant differences were found between groups for secondary outcome measures . Conclusions : Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall . What is already known on this topic Multifactorial intervention prevents falls in cognitively normal older people living in the community and in those who present to the accident and emergency department after a fall Fall prevention strategies have not been tested by controlled trials in patients with cognitive impairment and dementia who fall What this study adds No benefit was shown from multifactorial assessment and intervention after a fall in patients with cognitive impairment and dementia presenting to the accident and emergency department The intervention was less effective in these patients than in cognitively normal older OBJECTIVES There is lack of data on the frequency and the causes of hospitalization in mild to moderate Alzheimer 's disease ( AD ) patients . The aims of the present study were to evaluate the frequency and the causes of hospitalization in a large prospect i ve cohort of mild to moderate patients with AD . DESIGN Six hundred and eighty-six AD patients from the French Network on AD ( REAL.FR ) were followed up and assessed every 6 months for 2 years . During follow-up , all events occurring between two visits , in particular hospital admissions or nursing home placements were carefully recorded . RESULTS Annual incidences for hospitalizations were 26.2 % ( 95 % CI , 22.5 to 29.7 ) . After two years , 202 subjects were hospitalized for 296 hospitalizations . 139 subjects were hospitalized once , 40 twice , 13 three times , 4 four times and 2 five times during the two-year follow-up . The duration of hospitalization was 14.3 + /- 23.5 days . For repeated hospitalizations , the time interval between the first and the second hospitalization was 176.4 days ( SD 150.2 ) and the cause of multiple hospitalizations was most different . Fractures and falls not causing fracture were the main reasons for hospital admission ( 20.9 % ) , followed by cardiovascular disorders ( 14.5 % ) and by behavioural disorders ( 11.0 % ) . Admission due to associated diseases or life events was the main reason for hospitalization ( 75.7 % ) . CONCLUSIONS Hospitalization is a frequent event for AD patients even at mild to moderate stage of the disease . In this cohort , the major causes for hospital admission were due to associated diseases or life events and not due to the direct consequences of the disease itself Background Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia . The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline . Methods This was a single-center , prospect i ve , r and omized controlled trial in which patients with hip fracture were r and omized to treatment in an acute geriatric ward or st and ard orthopedic ward . Inclusion and r and omization took place in the Emergency Department at Oslo University hospital . The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings . Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale ( CDR ) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer ’s Disease battery ( CERAD ) . Secondary outcomes were pre- and postoperative delirium , delirium severity and duration , mortality and mobility ( measured by the Short Physical Performance Battery ( SPPB ) ) . Patients were assessed four and twelve months after surgery by evaluators blind to allocation . Results A total of 329 patients were included . There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards ( mean 54.7 versus 52.9 , 95 % confidence interval for the difference -5.9 to 9.5 ; P = 0.65 ) . There was also no significant difference in delirium rates ( 49 % versus 53 % , P = 0.51 ) or four month mortality ( 17 % versus 15 % , P = 0.50 ) between the intervention and the control group . In a pre-planned sub-group analysis , participants living in their own home at baseline who were r and omized to orthogeriatric care had better mobility four months after surgery compared with patients r and omized to the orthopedic ward , measured with SPPB ( median 6 versus 4 , 95 % confidence interval for the median difference 0 to 2 ; P = 0.04 ) . Conclusions Pre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or 
    Output:
    
Multidisciplinary care and early mobilisation showed short-term improvements for some outcomes .
Only an annual administration of zoledronic acid showed long-term reduction in recurrent falls .
Most post-fall interventions were not aim ed at patients with dementia and have shown little efficacy regardless of cognitive status .
Minor improvements to some quality of life indicators were shown , but these were generally not statistically significant .
Conclusions were also limited due to most studies addressing hip fracture ; the interventions provided for this type of injury may not be suitable for other types of fractures or soft tissue injuries , or for use in primary care .