***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 better underst and fall risk factors in older adults with cognitive impairment living in residential care . DESIGN A prospect i ve observational cohort study . SETTING Residential care homes in South London , UK . PARTICIPANTS Residents older than 60 , with cognitive impairment who had a life expectancy of at least 6 months and were not bedbound or recently discharged from hospital . MEASUREMENTS Baseline assessment s were undertaken in domains of demographics , medical history , medication use , behavior , affect , gait , balance , sensorimotor performance and neuropsychological function . Participants were followed for 6 months for falls using care home reporting systems . RESULTS A total of 109 participants completed baseline assessment and had adequate falls follow-up . Fallers took more medications , were more likely to be taking antidepressants , had more functional impairment , poorer balance and gait , were more impulsive and anxious , exhibited more dementia-related behaviors , and performed worse on cognitive tests involving attention and orientation , memory , and fluency . Logistic regression analysis identified 4 significant and independent predictors of falls : poor attention and orientation , increased postural sway with eyes closed , anxiety , and antidepressant use . The AUC for this model was 0.84 ( 95 % CI 0.76 - 0.91 ) . CONCLUSIONS This study identified important risk factors for falls potentially amenable to intervention in older people with cognitive impairment living in residential care . This information may be useful in design ing effective approaches to fall prevention in this high-risk population 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 OBJECTIVES To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes . DESIGN Cluster-r and omized controlled trial . SETTING Forty-five nursing homes in Germany . PARTICIPANTS Three hundred thirty-three residents who were being restrained at the start of the intervention . INTERVENTION Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used , the adverse effects , and alternatives to their use . Technical aids , such as hip protectors and sensor mats , were provided . The training was design ed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints . MEASUREMENTS The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention . Secondary outcomes were partial reductions in restraint use , percentage of fallers , number of psychoactive drugs , and occurrence of behavioral symptoms . RESULTS The probability of being unrestrained in the intervention group ( IG ) was more than twice that in the control group ( CG ) at the end of the study ( odds ratio=2.16 , 95 % confidence interval=1.05 - 4.46 ) . A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG . No negative effect was observed regarding medication or behavioral symptoms . The percentage of fallers was higher in the IG . CONCLUSION The intervention reduced restraint use without a significant increase in falling , behavioral symptoms , or medication OBJECTIVES To investigate the effect of use of external hip protectors on occurrence of  hip fracture . DESIGN R and omized controlled trial , with r and omization at the individual level . SETTING residential aged-care facilities in urban areas of New South Wales , Australia . PARTICIPANTS 174 women , aged 75 years and older , who had had two or more falls or one fall requiring hospital admission in the previous 3 months , and who lived in hostels or nursing homes . Eighty-six subjects were in the intervention group and 88 in the control group . INTERVENTION Use of external hip protectors and encouragement by nurses to use the protectors . MEASUREMENTS Follow-up visits at approximately 2 weeks and 2 , 10 and 18 months to determine falls and fall injury ( including hip fracture ) ; we also measured adherence to hip protector use . RESULTS The mean age of participants was 85 ; they lived in 32 different aged-care facilities , two-thirds of which were nursing homes . Intervention and control groups had similar baseline characteristics , with a mean Barthel index of 58 at enrollment and a mean Short Portable Mental Status Question naire score of six errors , indicating severe disability and major cognitive impairment . During follow-up , a mean of 4.6 falls per person occurred . There was no difference in mortality , with 28 deaths in each group . Eight hip fractures occurred in the intervention group and seven in the control group ( hazard ratio 1.46 ; 95 % confidence interval 0.53 - 4.51 ) . No hip fractures occurred when hip protectors were being worn as directed . Adherence was about 57 % over the duration of the study and hip protectors were worn at the time of 54 % of falls in the intervention group . Adherence varied markedly between institutions , but the greatest was about 80 % . CONCLUSION Hip protectors were not effective in reducing the incidence of hip fractures in this study , but because of low statistical power , a reduction in risk of hip fracture of up to 50 % may not have been detected . There was limited adherence with their use , result ing in a large number of falls occurring without hip protectors in place . All hip fractures in the intervention group occurred when hip protectors were not being used 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 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 Objective To assess the effectiveness of an activity programme in improving function , quality of life , and falls in older people in residential care . Design Cluster r and omised controlled trial with one year follow-up . Setting 41 low level dependency residential care homes in New Zeal and . Participants 682 people aged 65 years or over . Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse , reinforced by usual healthcare assistants ; 352 residents received social visits . Main outcome measures Function ( late life function and disability instruments , elderly mobility scale , FICSIT-4 balance test , timed up and go test ) , quality of life ( life satisfaction index , EuroQol ) , and falls ( time to fall over 12 months ) . Secondary outcomes were depressive symptoms and hospital admissions . Results 473 ( 70 % ) participants completed the trial . The programme had no impact overall . However , in contrast to residents with impaired cognition ( no differences between intervention and control group ) , those with normal cognition in the intervention group may have maintained overall function ( late life function and disability instrument total function , P=0.024 ) and lower limb function ( late life function and disability instrument basic lower extremity , P=0.015 ) . In residents with cognitive impairment , the likelihood of depression increased in the intervention group . No other outcomes differed between groups . Conclusion A programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition but was not beneficial for those with poor cognition . Trial registration Australian Clinical Trials Register ACTRN12605000667617 OBJECTIVES To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents . DESIGN Secondary analysis of a cluster-r and omized , controlled trial . SETTING Six nursing homes in Germany . PARTICIPANTS Seven hundred twenty-five long 
    Output:
    
The data gathered from studies that used both interventions showed a significant reduction in fall rate .