***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 evaluate the effectiveness of a multifactorial , tailored program of physical therapy to reduce the occurrence of falls among a heterogeneous group of high-risk elderly Singaporeans recently discharged from the emergency department ( ED ) . DESIGN R and omized controlled trial . SETTING Communities . PARTICIPANTS Adults ( N=354 ) aged ≥65 years who were seen in the ED for a fall or fall-related injuries and discharged home . INTERVENTIONS The intervention primarily consisted of a tailored program of physical therapy focused on progressive training in strength , balance , and gait for a period of 3 months . Participants in the intervention group also received screening and follow-up for vision , polypharmacy , and environmental hazards . Participants in the control group received usual care prescribed by a physician and educational material s on falls prevention . MAIN OUTCOME MEASURES The primary outcome measure was experiencing at least 1 fall during the 9-month study period ( a 3-mo active intervention phase and a 6-mo maintenance phase ) . Secondary outcome measures were the occurrence of at least 1 injurious fall during the study period and a change in the Short Physical Performance Battery ( SPPB ) score . Participants were assessed both after 3 and 9 months . RESULTS During the 9-month study period , 37.8 % of the control group and 30.5 % of the intervention group fell at least once , which was not statistically significantly different ( odds ratio [OR]=.72 ; 95 % confidence interval [ CI ] , .46 - 1.12 ; P=.146 ) . The intervention group had statistically significantly fewer individuals with injurious falls ( OR=.56 ; 95 % CI , .32-.98 ; P=.041 ) and less deterioration in physical performance , reflected by a mean difference of 0.6 in SPPB scores ( P=.029 ) . Multivariate analyses indicated a strong interaction effect between the intervention and the presence of 2 or more major comorbidities ; after accounting for this effect , the intervention program reduced the number of people experiencing at least 1 fall ( OR=.34 ; 95 % CI , .17-.67 ; P=.002 ) . CONCLUSIONS We observed that in this heterogeneous population , the proportion of participants experiencing at least 1 fall during the study period was not statistically significantly lower in the intervention group compared with the control group . Secondary analyses strongly suggest that individuals with 2 or more major comorbidities do not benefit from a tailored physical therapy program ; however , individuals with less comorbidity may substantially benefit OBJECTIVE To determine whether a new model of primary care , Chronic Care Clinics , can improve outcomes of common geriatric syndromes ( urinary incontinence , falls , depressive symptoms ,  high risk medications  ,  functional impairment ) in frail older adults . DESIGN R and omized controlled trial with 24 months of follow-up . Physician practice s were r and omized either to the Chronic Care Clinics intervention or to usual care . SETTING Nine primary care physician practice s that comprise an ambulatory clinic in a large staff-model HMO in western Washington State . PARTICIPANTS Those patients aged 65 and older in each practice with the highest risk for being hospitalized or experiencing functional decline . INTERVENTION Intervention practice s ( 5 physicians , 96 patients ) held half-day Chronic Care Clinics every 3 to 4 months . These clinics included an extended visit with the physician and nurse dedicated to planning chronic disease management ; a pharmacist visit that emphasized reduction of polypharmacy and high-risk medications ; and a patient self-management/support group . Control practice s ( 4 physicians , 73 patients ) received usual care . MEASUREMENTS Changes in self-reported urinary incontinence , frequency of falls , depressive symptoms , physical function , and satisfaction were analyzed using an intention-to-treat analysis adjusted for baseline differences , covariates , and practice -level variation . Prescriptions for high-risk medications and cost/utilization data obtained from administrative data were similarly analyzed . RESULTS After 24 months , no significant improvements in frequency of incontinence , proportion with falls , depression scores , physical function scores , or prescriptions for high risk medications were demonstrated . Costs of medical care including frequency of hospitalization , hospital days , emergency and ambulatory visits , and total costs of care were not significantly different between intervention and control groups . A higher proportion of intervention patients rated the overall quality of their medical care as excellent compared with control patients ( 40.0 % vs 25.3 % , P = .10 ) . CONCLUSIONS Although intervention patients expressed high levels of satisfaction with Chronic Care Clinics , improved outcomes for selected geriatric syndromes were not demonstrated . These findings suggest the need for developing greater system-wide support for managing geriatric syndromes in primary care and illustrate the challenges of conducting practice improvement research in a rapidly changing delivery system Objectives To evaluate the effects of an advanced practice nurse ( APN ) in-home health consultation program ( HCP ) on quality of life , health indicators ( falls , acute events ) , and healthcare utilization . Design R and omized clinical trial . Setting One urban area in the German-speaking part of Switzerl and . Participants Four hundred sixty-one community-dwelling individuals aged 80 and older ( mean age 85 , 72.7 % female , all Caucasian ) participated in the intervention ( n = 231 ) and control ( n = 230 ) groups . Intervention After a comprehensive geriatric assessment , participants were r and omly assigned to the 9-month HCP with four in-home visits and three phone calls from APNs or to a control group with st and ard care with no intervention . Measurements The primary outcome was quality of life at 3 , 6 , and 9 months . Secondary outcomes were incidence of falls , acute events due to health problems , and healthcare utilization measured for 3-month periods at 3 , 6 , and 9 months . Results The intervention and control groups did not differ significantly on any dimension of the World Health Organization Quality of Life question naire but differed significantly over 9 months in self-reported acute events ( 116 vs 168 , relative risk ( RR ) = 0.70 , P = .001 ) , falls ( 74 vs 101 , RR = 0.71 , P = .003 ) , consequences of falls ( 63.1 % vs 78.7 % , chi-square = 7.39 , P = .007 ) , and hospitalizations ( 47 vs 68 , RR = .70 , P = .03 ) . Conclusion The in-home HCP provided by APNs and guided by the principles of health promotion , empowerment , partnership , and family-centeredness , can be effective in reducing adverse health outcomes such as falls , acute events , and hospitalizations Background The purpose of this study was to assess the effectiveness of a multifactorial intervention to reduce falls among the oldest-old people , including individuals with cognitive impairment or comorbidities . Methods A r and omized , single-blind , parallel-group clinical trial was conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat ( Barcelona ) . Of 696 referred people who were born in 1924 , 328 were r and omized to an  intervention group or a  control group . The intervention model used an algorithm and was multifaceted for both patients and their primary care providers . Primary outcomes were risk of falling and time until falls . Data analyses were by intention-to-treat . Results Sixty-five ( 39.6 % ) subjects in the intervention group and 48 ( 29.3 % ) in the control group fell during follow-up . The difference in the risk of falls was not significant ( relative risk 1.28 , 95 % confidence interval [ CI ] 0.94–1.75 ) . Cox regression models with time from r and omization to the first fall were not significant . Cox models for recurrent falls showed that intervention had a negative effect ( hazard ratio [ HR ] 1.46 , 95 % CI 1.03–2.09 ) and that functional impairment ( HR 1.42 , 95 % CI 0.97–2.12 ) , previous falls ( HR 1.09 , 95 % CI 0.74–1.60 ) , and cognitive impairment ( HR 1.08 , 95 % CI 0.72–1.60 ) had no effect on the assessment . Conclusion This multifactorial intervention among octogenarians , including individuals with cognitive impairment or comorbidities , did not result in a reduction in falls . A history of previous falls , disability , and cognitive impairment had no effect on the program among the community-dwelling subjects in this study BACKGROUND frail older people have a high risk of  falling . OBJECTIVE assess the effect of a frailty intervention on risk factors for falls and fall rates  in frail older people . DESIGN r and omised controlled trial . PARTICIPANTS 241 community-dwelling people aged 70 + without severe cognitive impairment who met the Cardiovascular Health Study frailty definition . INTERVENTION multifactorial , interdisciplinary intervention targeting frailty characteristics with an individualised home exercise programme prescribed in 10 home visits from a physiotherapist and interdisciplinary management of medical , psychological and social problems . MEASUREMENTS risk factors for falls were measured using the Physiological Profile Assessment ( PPA ) and mobility measures at 12 months by a blinded assessor . Falls were monitored with calendars . RESULTS participants had a mean ( SD ) age of 83.3 ( 5.9 ) years , 68 % were women and 216 ( 90 % ) completed the study . After 12 months the intervention group had significantly better performance than the control group , after controlling for baseline values , in the PPA components of quadriceps strength ( between-group difference 1.84 kg , 95 % CI 0.17 - 3.51 , P = 0.03 ) and body sway ( -90.63 mm , 95 % CI -168.6 to -12.6 , P = 0.02 ) , short physical performance battery ( 1.58 , 95 % CI 1.02 - 2.14 , P ≤ 0.001 ) and 4 m walk ( 0.06 m/s 95 % CI 0.01 - 0.10 , P = 0.02 ) with a trend toward a better total PPA score ( -0.40 , 95 % CI -0.83 - 0.04 , P = 0.07 ) but no difference in fall rates ( incidence rate ratio 1.12 , 95 % CI 0.78 - 1.63 , P = 0.53 ) . CONCLUSION the intervention improved performance on risk factors for falls but did not reduce the rate of falls . TRIAL REGISTRATION ACTRN12608000250336 Objective To evaluate whether an interdisciplinary primary care approach for community dwelling frail older people is more effective than usual care in reducing disability and preventing ( further ) functional decline . Design Cluster r and omised controlled trial . Setting 12 general practice s in the south of the Netherl and s Participants 346 frail older people ( score ≥5 on Groningen Frailty Indicator ) were included ; 270 ( 78 % ) completed the study . Interventions General practice s were r and omised to the intervention or control group . Practice s in the control group delivered care as usual . Practice s in the intervention group implemented the “ Prevention of Care ” ( PoC ) approach , in which frail older people received a multidimensional assessment and interdisciplinary care based on a tailor made treatment plan and regular evaluation and follow-up . Main outcome measures The primary outcome was disability , assessed at 24 months by means of the Groningen Activity Restriction Scale . Secondary outcomes were depressive symptomatology , social support interactions , fear of falling , and social participation . Outcomes were measured at baseline and at 6 , 12 , and 24 months ’ follow-up . Results 193 older people in the intervention group ( six practice s ) received the PoC approach ; 153 older people in the control group ( six practice s ) received care as usual  . Follow-up rates for patients were 91 % ( n=316 ) at six months , 86 % ( n=298 ) at 12 months , and 78 % ( n=270 ) at 24 months . Mixed model multilevel analyses showed no significant differences between the two groups with regard to disability 
    Output:
    
Active multifactorial interventions had positive effects on fall rates and the number of people experiencing falls .
Thus , healthcare workers , including nurses , should be involved in planning fall prevention programs so that older adults can be provided with optimal care ; multifactorial interventions that include exercise and environmental modification are particularly effective in reducing falls