***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 assess whether an intervention based on nurse home visits including alert buttons ( NV+AB ) is effective in reducing frailty compared to nurse home visits alone ( NV-only ) and usual care ( control group ) for older adults . Design Unblinded , r and omized , controlled trial . Setting Insured population covered by the Mexican Social Security Institute living in the city of Ensenada , Baja California , Mexico . Participants Patients were aged over 60 years with a frailty index score higher than 0.14 . Intervention After screening and informed consent , participants were allocated r and omly to the control , NV+AB , or NV-only groups . Measurements The primary outcome was the frailty score 9 months later . Quality of life , depression , comorbidities , health status , and health service utilization were also considered . Results The framing sample included 819 patients . Of those , 591 were not located because they did not have a l and line/telephone ( 341 patients ) , they had died ( 107 ) , they were ill ( 50 ) , or they were not currently living in the city ( 28 ) . A screening interview was applied to 228 participants , and 57 had a score ≤0.14 , 171 had ≥0.14 , and 16 refused to complete the baseline question naire . A home visit was scheduled for 155 patients . However , 22 did not complete the baseline question naire . The final 133 subjects were r and omized into the NV+AB ( n = 45 ) , NV-only ( n = 44 ) , and control ( n = 44 ) groups . There were no statistically significant differences in the baseline characteristics of the groups . The mean age overall was 76.3 years ( st and ard deviation 4.7 ) and 45 % were men . At the baseline , 61.65 % were classified as frail . At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3 % versus 58.3 % in the control group . Conclusion : An intervention based on NV+AB seems to have a positive effect on frailty scores Abstract A new version of the EQ‐5D , the EQ‐5D‐5L , is available . The aim of this study is to produce a value set to support use of EQ‐5D‐5L data in decision‐making . The study design followed an international research protocol . R and omly selected members of the English general public completed 10 time trade‐off and 7 discrete choice experiment tasks in face‐to‐face interviews . A 20‐parameter hybrid model was used to combine time trade‐off and discrete choice experiment data to generate values for the 3,125 EQ‐5D‐5L  health states . Valuation data are available for 996 respondents .  Face validity of the data has been demonstrated , with more severe health states generally given lower values . Problems with pain/discomfort and anxiety/depression received the greatest weight . Compared to the existing EQ‐5D‐3L value set , there are considerably fewer “ worse than dead ” states ( 5.1 % , compared with over one third ) , and the minimum value is higher . Values range from −0.285 ( extreme problems on all dimensions ) to 0.950 ( for health states 11211 and 21111 ) . Results have important implication s for users of the EQ‐5D‐5L both in Engl and and internationally . Quality ‐adjusted life year gains from interventions seeking to improve very poor health may be smaller using this value set and may previously have been overestimated OBJECTIVES : To evaluate the effectiveness of a home visiting program on health-related measures in a population of older people with poor health status . DESIGN : R and omized , clinical trial . SETTING : Community-dwelling citizens in the Netherl and s. PARTICIPANTS : Three hundred thirty people aged 70 to 84 r and omly assigned to an intervention group ( n=160 ) or a control group ( n=170 ) . INTERVENTION : Eight home visits , lasting 1 hour or more , with telephone follow-up , over an 18-month period , conducted by experienced home nurses under supervision of a public health nurse ; key elements of the ( systematic ) visits were assessment of health problems and risks , advice , and referral to professional and community services . MEASUREMENTS : Self-rated health , functional status , quality of life , and changes in self-reported problems . RESULTS : No differences were found between the intervention and control group in these and other outcome measures at the end of the intervention 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 In this article we explore older people ’s perspectives on the benefits of preventive home visits ( PHVs ) , after long-term follow-up . PHVs are health services intended to promote older people ’s health and independence , prevent disease , and postpone functional decline . We applied an explorative and descriptive design and analyzed qualitative research interviews of 10 PHV users who had received multiple visits for at least 6 years . We sought manifest and latent content in our analysis . The participants reported benefits falling within four main categories : to feel safe , to manage everyday life , to live well , and to be somebody . Two latent themes emerged : living with an underlying , realistic concern about an uncertain future , and striving to maintain oneself as a person . The perceived benefits of PHVs differed significantly from the outcome measures commonly used in r and omized , controlled trials . PHV interventions should have a longitudinal approach and support each person ’s current needs and valued goals BACKGROUND Multimorbidity is associated with higher mortality , increased disability , a decline in functional status and a lower quality of life . The objective of the study is to explore patterns of multimorbidity in an elderly population . METHODS 328 community inhabitants aged 85 years were included .  Socio-demographic variables and data from the global geriatric assessment were evaluated . Information on the presence of sixteen common chronic conditions was collected : hypertension , diabetes mellitus , dyslipidemia , ischemic cardiomyopathy , heart failure , stroke , chronic obstructive pulmonary disease , ( COPD ) , atrial fibrillation , peripheral arterial disease , Parkinson 's disease , cancer , dementia , anemia , chronic kidney disease ( CKD ) , visual impairment and deafness . Hierarchical cluster analysis was performed . RESULTS The rate of multimorbidity ( > 1 disease ) was 95.1 % . Men had a higher percentage of COPD and malignancy . Four main clusters were identified . The highest value of the bivariate correlation matrix was that between heart failure and visual impairment . These two diseases were included in a cluster with atrial fibrillation , CKD , heart failure , stroke , high blood pressure and diabetes mellitus . CONCLUSIONS The large majority of oldest old subjects had multimorbidity . The results confirm the non-r and om co-occurrence of certain diseases in this age group Background evidence on the effectiveness of interventions to prevent frailty is scarce . Objective to assess the effect of an intervention in preventing frailty progression in pre-frail older people . Study design a r and omised , open label , controlled trial with two parallel arms . Population community-dwelling pre-frail older people ( ≥70 years ) consulting in primary care .  Intervention nutritional assessment ( and derivation to a Nutritional Unit for usual care in the event of nutritional risk ) and a physical activity programme including aerobic exercise and a set of mixed strengthening , balance and coordination exercises .  Control group patients receiving the usual care . Main outcome measure prevalence of frailty ( Fried criteria ) at 12 months . Secondary outcomes measures functional capacity ( Barthel index ) , falls and nutritional status ( Short-Form Mini Nutritional Assessment ) on follow-up at 12 months . Results one hundred and seventy-two participants were recruited and r and omised ( mean age : 78.3 years ; mean number of Fried criteria : 1.45 ) . Thirty-nine participants ( 22.6 % ) were dropped out during the study . At follow-up , 4.9 % of the intervention group and 15.3 % of the control group had evolved to frailty , for a crude odds ratio ( OR ) of 0.29 ( 95 % confidence interval [ CI ] : 0.08 - 1.08 ; P = 0.052 ) and an adjusted ( by age , gender and number of co-morbidities ) OR of 0.19 ( 95 % CI : 0.04 - 0.95 ; P = 0.044 ) . Intervention group showed a higher outdoors walking hour per day ( 0.97 versus 0.73 ; P = 0.019 ) but no difference was observed in muscle strength , gait speed or other functional indicators . Conclusion an intervention focused on physical exercise and maintaining good nutritional status may be effective in preventing frailty in community-dwelling pre-frail older individuals . Clinical Trials.gov identifier NCT02138968 Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information Background An ageing population , a growing prevalence of chronic diseases and limited financial re sources for health care underpin the importance of prevention of disabling health disorders and care dependency in the elderly . A wide variety of measures is generally available for the prevention of falls and fall-related injuries . The spectrum ranges from diagnostic procedures for identifying individuals at risk of falling to complex interventions for the removal or reduction of identified risk factors . However , the clinical and economic effectiveness of the majority of recommended strategies for fall prevention is unclear . Against this background , the literature analyses in this HTA report aim to support decision-making for effective and efficient fall prevention . Research questions The pivotal research question addresses the effectiveness of single interventions and complex programmes for the prevention of falls and fall-related injuries . The target population are the elderly ( > 60 years ) , living in their own housing or in long term care facilities . Further research questions refer to the cost-effectiveness of fall prevention measures , and their ethical , social and legal implication s. Methods Systematic literature search es were performed in 31 data bases covering the publication period from January 2003 to January 2010 . While the effectiveness of interventions is solely assessed on the basis of r and omised controlled trials ( RCT ) , the assessment of the effectiveness of diagnostic procedures also considers prospect i ve accuracy studies . In order to clarify social , ethical and legal aspects all studies deemed relevant with regard to content were taken into consideration , irrespective of their study design . Study selection and critical appraisal were conducted by two independent assessors . Due to clinical heterogeneity of the studies no meta-analyses were performed . Results Out of 12,000 references retrieved by literature search es , 184 meet the inclusion criteria . However , to a variable degree the validity of their results must be rated as compromised due to different biasing factors . In summary , it appears that the performance of tests or the application of parameters to identify individuals at risk of falling yields little or no clinical ly relevant information . Positive effects of exercise interventions  may be expected in relatively young and healthy seniors , while studies indicate opposite effects in the fragile elderly . For this specific vulnerable population the modification of the housing environment shows protective effects 
    Output:
    
NHS and carer support costs were variable but , overall , were lower in the intervention arm than the TAU arm .
Our multicomponent health promotion intervention was acceptable and delivered at modest cost .
Our small study shows promise for improving clinical outcomes , including functioning and independence .