***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: Background  Falls in older people  are a major public health issue , but the underlying causes are complex . We sought to evaluate the effectiveness of preventive home visits as a multifactorial , individualized strategy to reduce falls in community-dwelling older people . Methods Data were derived from a prospect i ve r and omized controlled trial with follow-up examination after 18 months . Two hundred and thirty participants ( ≥80 years of age ) with functional impairment were r and omized to intervention and control groups . The intervention group received up to three preventive home visits including risk assessment , home counseling intervention , and a booster session . The control group received no preventive home visits . Structured interviews at baseline and follow-up provided information concerning falls in both study groups . R and om-effects Poisson regression evaluated the effect of preventive home visits on the number of falls controlling for covariates . Results R and om-effects Poisson regression showed a significant increase in the number of falls between baseline and follow-up in the control group ( incidence rate ratio 1.96 ) and a significant decrease in the intervention group ( incidence rate ratio 0.63 ) controlling for age , sex , family status , level of care , and impairment in activities of daily living . Conclusion Our results indicate that a preventive home visiting program can be effective in reducing falls in community-dwelling older people OBJECTIVE To investigate the efficacy of a falls prevention clinic and a community step-down program in reducing the number of falls among community-dwelling elderly at high risk of fall . DESIGN Prospect i ve cohort . SETTING Community . PARTICIPANTS Community-dwelling elderly ( N=200 ) were screened for risk of fall ; 60 were identified as being at high risk and were referred to the intervention program . INTERVENTION Twelve sessions of a once-a-week falls prevention clinic , including fall evaluation , balance training , home hazard management program , and medical referrals , were provided in the first 3 months . The community step-down program , including falls prevention education , a weekly exercise class , and 2 home visitations , was provided in the following 9 months . MAIN OUTCOME MEASURES Fall rate , injurious fall , and its associated medical consultation were recorded during the intervention period and the year before intervention . Balance tests included the Berg Balance Scale ( BBS ) , Sensory Organization Test , and limits of stability test ; fear of falling , as evaluated using the Activities-specific Balance Confidence ( ABC ) scale , was measured at baseline and after the training in the falls prevention clinic . RESULTS Significant reductions in fall rate ( 74 % ) , injurious falls ( 43 % ) , and fall-associated medical consultation ( 47 % ) were noted . Significant improvement in balance scores ( BBS , P<.001 ; endpoint excursion in limits of stability test , P=.004 ) and fear of falling ( ABC scale , P=.001 ) was shown . CONCLUSIONS The programs in the falls prevention clinic were effective in reducing the number of falls and injurious falls . The community step-down programs were crucial in maintaining the intervention effects of the falls prevention clinic Introduction This study investigated the effects of the A Matter of Balance ( MOB ) program on falls and physical risk factors of falling among community-dwelling older adults living in Tampa , Florida , in 2013 . Methods A total of 110 adults ( 52 MOB , 58 comparison ) were enrolled in this prospect i ve cohort study . Data on falls , physical risk of falling , and other known risk factors of falling were collected at baseline and at the end of the program . Multivariate analysis of covariance with repeated measures and logistic regressions were used to investigate the effects of this program . Results Participants in the MOB group were less likely to have had a fall and had significant improvements in their physical risk of falling compared with adults in the comparison group . No significant effects of the MOB program on recurrent falls or the number of falls reported were found . Conclusion This study contributes to our underst and ing of the MOB program and its effectiveness in reducing falls and the physical risk of falling among older adults . The findings support extended use of this program to reduce falls and physical risk of falling among older adults Background Older people are at increased risk of falls after hospital discharge . This study aim ed to describe the circumstances of falls in the six months after hospital discharge and to identify factors associated with the time and location of these falls . Methods Participants in this r and omized controlled study comprised fallers ( n = 138 ) who were part of a prospect i ve observational cohort ( n = 343 ) nested within a r and omized controlled trial ( n = 1206 ) . The study tested patient education on falls prevention in hospital compared with usual care in older patients who were discharged from hospital and followed for six months after hospital discharge . The outcome measures were number of falls , falls-related injuries , and the circumstances of the falls , measured by use of a diary and a monthly telephone call to each participant . Results Participants ( mean age 80.3 ± 8.7 years ) reported 276 falls , of which 150 ( 54.3 % ) were injurious . Of the 255 falls for which there were data available about circumstances , 190 ( 74.5 % ) occurred indoors and 65 ( 25.5 % ) occurred in the external home environment or wider community . The most frequent time reported for falls was the morning ( between 6 am and 10 am ) when 79 ( 28.6 % ) falls , including 49 ( 32.7 % ) injurious falls , occurred . The most frequently reported location for falls ( n = 80 , 29.0 % ) , including injurious falls ( n = 42 , 28.0 % ) , was the bedroom . Factors associated with falling in the bedroom included requiring assistance with activities of daily living ( adjusted odds ratio 2.97 , 95 % confidence interval ( CI ) 1.57–5.60 , P = 0.001 ) and falling in hospital prior to discharge ( adjusted odds ratio 2.32 , 95 % CI 1.21–4.45 , P = 0.01 ) . Fallers requiring assistance with activities of daily living were significantly less likely to fall outside ( adjusted odds ratio 0.28 , 95 % CI 0.12–0.69 , P = 0.005 ) . Conclusion Older patients who have been recently discharged from hospital and receive assistance with activities of daily living are at high risk of injurious falls indoors , most often in the bedroom . These data suggest that targeted interventions may be needed to reduce falls in this population BACKGROUND To compare the effect of two modes of delivering a falls prevention service in reducing the rate of falls and improving quality of life , activity levels , and physical status among older adults with a history of recent falls . METHODS A r and omized controlled trial was conducted with a total of 107 participants with blinded baseline and follow-up assessment s. The participants were older community-dwelling adults referred for a falls prevention service located in Brisbane , Australia . The intervention was a multiple component falls prevention service delivered in either in a domiciliary or center-based mode of delivery . Both programs were similar apart from setting and consisted of three components , a balance and strength component , falls prevention education , and functional tasks . Physical and psychosocial assessment s were administered at baseline , 8-week follow-up and 6-month follow-up . Falls data were collected by monthly telephone contact and by interview at 8 weeks and 6 months . RESULTS The center-based service demonstrated significantly better results in preventing falls over the home-based service . Clients in the center-based arm of the trial experienced fewer total falls and this group also had a greater reduction in the total number of fallers after the intervention . CONCLUSION This research demonstrates that delivering a similar service in different setting s-home based or center based-impacts upon the effectiveness of the service . Community-dwelling older adults with a history of falls should be provided with center-based programs in preference to home-based programs where they are available Objective : To evaluate the effectiveness of an 18-month multifaceted intervention design ed to reduce the incidence of falls in community-living older adults in China . Methods : A population -based community trial evaluated by before- and -after cross-sectional surveys . Four residential communities were r and omised to either a multifaceted intervention or a control condition . Baseline information was collected from a sample of older adults in each community . A 1-year annual fall rate was calculated after an 18-month comprehensive intervention . Results : After intervention , 7.19 % of the intervention community sample reported falls , compared with 17.86 % of the control community sample ( p<0.000 ) . The annual fall rate decreased by 10.52 % in the intervention communities , whereas the difference in control communities was not statistically significant . Conclusions : Multifaceted interventions in community setting s may be useful in preventing falls among older people , and can be applied in similar setting s in China Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2.28 in the control group . We saw a significant reduction of 31 % in the rate of falls for the LiFE programme compared with controls ( incidence rate ratio 0.69 ( 95 % confidence interval 0.48 to 0.99 ) ) ; the corresponding difference between the structured group and controls was non-significant ( 0.81 ( 0.56 to 1.17 ) ) . Static balance on an eight level hierarchy scale , ankle strength , function , and participation were significantly better in the LiFE group than in controls . LiFE and structured groups had a significant and moderate improvement in dynamic balance , compared with controls . Conclusions The LiFE programme provides an alternative to traditional exercise to consider for fall prevention . Functional based exercise should be a focus for interventions to protect older , high risk people from falling and to improve and maintain functional capacity . Trial registration Australia and New Zeal and Clinical Trials Registry 12606000025538 Objective : to determine the clinical effectiveness of a day hospital-delivered multifactorial falls prevention programme , for community-dwelling older people at high risk of future falls identified through a screening process . Design : multicentre r and omised controlled trial . Setting : eight general practice s and three day hospitals based in the East Midl and s , UK . Participants : three hundred and sixty-four participants , mean age 79 years , with a median of three falls risk factors per person at baseline . Interventions : a day hospital-delivered multifactorial falls prevention programme , consisting of strength and balance training , a medical review and a home hazards assessment . Main outcome measure : rate of falls over 12 months of follow-up , recorded using self-completed monthly diaries . Results : one hundred and seventy-two participants in each arm contributed to the primary outcome analysis . The overall falls rate during follow-up was 1.7 falls per person-year in the intervention arm compared with 2.0 falls per person-year in the control arm . The stratum-adjusted incidence rate ratio was 0.86 ( 95 % CI 0.73–1.01 ) , P = 0.08 , and 0.73 ( 95 % CI 0.51–1.03 ) , P = 0.07 when adjusted for baseline characteristics . There were no significant differences between the intervention and control arms in any secondary outcomes . Conclusion : this trial did not conclusively demonstrate the benefit of a day hospital-delivered multifactorial falls prevention programme , in a population of older people identified as being at high risk of a future fall BACKGROUND Falls occur frequently in older people and strongly affect quality of life . Guidelines recommend multifactorial , targeted fall prevention . We evaluated the effectiveness of a multifactorial intervention in older persons with a high risk of recurrent falls . METHODS A r and omized controlled trial was conducted from April 3 , 2005 , to July 21 , 2008 , at the geriatric outpatient clinic of a university hospital and regional general practice s in the Netherl and s. Of 2015 persons identified , 217 persons aged 65 years or older were selected to participate . They had a high risk of recurrent falls and no cognitive impairment and had visited the 
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Mixed evidence was found for single‐component and multifactorial interventions , strong evidence was found for multicomponent interventions , and moderate evidence was found for population ‐based interventions .
NA ; The findings from this systematic review inform the delivery and integration of interventions in various setting s to minimize falls among community‐dwelling older adults