***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 describe the epidemiology of hospital inpatient falls , including characteristics of  patients who fall  , circumstances of falls  , and  fall-related injuries . DESIGN : Prospect i ve descriptive study of inpatient falls . Data on patient characteristics , fall circumstances , and injury were collected through interviews with patients and /or nurses and review of adverse event reports and medical records . Fall rates and nurse staffing levels were compared by service . SETTING : A 1,300-bed urban academic hospital over 13 weeks . PATIENTS : All inpatient falls reported for medicine , cardiology , neurology , orthopedics , surgery , oncology , and women and infants services during the study period were included . Falls in the psychiatry service and falls during physical therapy sessions were excluded . MEASUREMENTS AND MAIN RESULTS : A total of 183 patients fell during the study period . The average age of patients who fell was 63.4 years ( range 17 to 96 ) . Many falls were unassisted ( 79 % ) and occurred in the patient ’s room ( 85 % ) , during the evening/overnight ( 59 % ) , and during ambulation ( 19 % ) . Half of the falls ( 50 % ) were elimination related , which was more common in patients over 65 years old ( 83 % vs 48 % ; P<.001 ) . Elimination-related falls increased the risk of fall-related injury ( adjusted odds ratio , 2.4 ; 95 % confidence interval 1.1 to 5.3 ) . The medicine and neurology services had the highest fall rates ( both were 6.12 falls per 1,000 patient-days ) , and the highest patient to nurse ratios ( 6.5 and 5.3 , respectively ) . CONCLUSIONS : Falls in the hospital affect young as well as older patients , are often unassisted , and involve elimination-related activities . Further studies are necessary to prevent hospital falls and reduce fall injury rates BACKGROUND The number of hip fractures occurring worldwide in 1990 was estimated at 1.7 million and is predicted to rise to 6.3 million by 2050 . The vast majority occur as a result of simple falls and the impact of the femoral trochanter with the floor . Previous studies have addressed the problem from the patient 's side of the impact . Little research has been carried out on the other surface involved in the impact , the floor . STUDY LOCATION : 34 residential care homes . METHODS ( 1 ) The mechanical properties of the floor were measured with force transducers . ( 2 ) The number and location of falls and fractures on the various floors were recorded prospect ively for 2 years . The threshold for reporting falls in different care homes was assessed using a st and ardised set of scenarios . RESULTS A total of 6,641 falls  and 222  fractures  were recorded . Wooden carpeted floors were associated with the lowest number of fractures per 100 falls . The risk of fracture result ing from a fall was significantly lower compared to all other floor types ( odds ratio 1.78 , 95 % CI 1.33 - 2.35 ) . The mean impact force was significantly lower on wooden carpeted floors : 11.9 kN compared to the other floor types . DISCUSSION The possible implication s of our findings are considerable . Residents of homes are typically frail and many have a propensity to falls . In design ing safer environments for older people , the type of floor should be chosen to minimise the risk of fracture . This may result in a major reduction in fractures in the elderly Abstract Objective To assess the effectiveness of a targeted , multiple intervention falls prevention programme in reducing falls and injuries related to falls in a subacute hospital . Design R and omised controlled trial of a targeted multiple intervention programme implemented in addition to usual care compared with usual care alone . Setting Three subacute wards in a metropolitan hospital specialising in rehabilitation and care of elderly patients . Participants 626 men and women aged 38 to 99 years ( average 80 years ) were recruited from consecutive admissions to subacute hospital wards . Intervention Falls risk alert card with information brochure , exercise programme , education programme , and hip protectors . Main outcome measures Incidence rate of falls , injuries related to falls , and proportion of participants who experienced one or more falls during their stay in hospital . Results Participants in the intervention group ( n = 310 ) experienced 30 % fewer falls than participants in the control group ( n = 316 ) . This difference was significant ( Peto log rank test P = 0.045 ) and was most obvious after 45 days of observation . In the intervention group there was a trend for a reduction in the proportion of participants who experienced falls ( relative risk 0.78 , 95 % confidence interval 0.56 to 1.06 ) and 28 % fewer falls result ed in injury ( log rank test P = 0.20 ) . Conclusions A targeted multiple intervention falls prevention programme reduces the incidence of falls in the subacute hospital setting Objective To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay . Design Cluster r and omised trial . Setting 24 elderly care wards in 12 hospitals in Sydney , Australia . Participants 3999 patients , mean age 79 years , with a median hospital stay of seven days . Interventions A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards . They provided a targeted multifactorial intervention that included a risk assessment of falls , staff and patient education , drug review , modification of bedside and ward environments , an exercise programme , and alarms for selected patients . Main outcome measure Falls during hospital stay . Results Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics . Overall , 381 falls  occurred during the study . No difference was found in fall rates during follow-up between intervention and control wards : respectively , 9.26 falls per 1000 bed days and 9.20 falls per 1000 bed days ( P=0.96 ) . The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 ( 95 % confidence interval 0.72 to 1.28 ) . Conclusion A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay . Trial registration Australian New Zeal and Clinical Trials Registry ACTRNO 12605000467639 The prevalence of visual impairment among elderly patients admitted to hospital is unknown . This group of patients may be particularly at risk from poor vision which could jeopardise their independence . A prospect i ve study of visual imapairment and its aetiology in acute geriatric admissions assessed after the acute illness had settled was performed . Subjects were all patients aged 65 years or over , excluding those chronically confused , admitted to the Department of Geriatric Medicine at the Royal Liverpool University Hospital with an acute medical illness . After the acute illness had settled visual impairment , as defined by the American criteria ( best acuity 6/18 ) , was assessed on the ward with a Snellen chart read at 6 m using binocular vision and current glasses . Those patients identified with impaired vision on initial screening were formally assessed in the ophthalmology department to identify the cause . 200 patients were examined . 101 patients ( 50.5 % ) had impaired vision .  In these patients , correctable refractive errors were present in 40 % , cataract in 37 % and senile macular degeneration in 14 % . Of the 101 patients with impaired vision 79 % had a reversible cause . Comparing these results with a recent study in the community showed a much higher incidence for patients admitted to hospital . There was a particularly high prevalence in those elderly patients who were admitted with falls ( 76 % , p = 0.0003 ) . In conclusion , elderly patients , especially those presenting with falls , admitted to hospital have a high prevalence of visual impairment . Visual impairment may be compounding or causing falls . ( ABSTRACT TRUNCATED AT 250 WORDS The effects of a fall-focused pharmaceutical intervention program ( FFPIP ) on the clinical and economic outcomes of elderly patients who fall while residing in a rehabilitation center are described . The objectives of this retrospective observational study were to identify the differences in the number of patient falls among elderly patients before and after pharmaceutical interventions , identify the cost savings related to decreasing the number of falls , and determine whether a relationship exists between falls among the elderly and specific medication classes . A data collection tool was developed by the investigators to record demographics and medication use . Two hundred patients were r and omly selected from the preintervention ( October 1 , 1999-September 30 , 2000 ) and postintervention ( October 1 , 2000-September 30 , 2001 ) periods . Two data collectors collected data from patient medical records to test the data collection tool and ensure accuracy . The number of patient falls was reduced in the postintervention group by 47 % , result ing in a future savings of $ 7.74 per patient per day . The use of several classes of medication also decreased in the postintervention period : cardiovascular agents , 10.7 % ; analgesics , 6.3 % ; psychoactive drugs , 18.2 % ; and sedatives and hypnotics , 13.9 % . Patients most likely to fall were male , greater than 76 years of age , had a cardiovascular- or orthopedic-related diagnosis , and were taking analgesics , cardiovascular agents , and central nervous system agents , yet the intervention had a more significant effect on female patients . Implementation of an FFPIP decreased falls by 47 % and decreased the use of cardiovascular drugs , analgesics , psychoactive medications , and sedatives and hypnotics Background Falls can have a considerable impact on a patients ' well being , they can result in serious physical and emotional injury , poor quality of life and increased length of hospital stay . Most of the current literature recommends a comprehensive approach to fall prevention that addresses a wide variety of risk factors and involves the use of risk assessment . Objective The objective of this review was to present the best available evidence for the effectiveness of interventions design ed to reduce the incidence of falls in older adult patients in acute care hospitals . Inclusion Criteria Types of Studies Only r and omised controlled trials ( RCTs ) assessing the effectiveness of risk assessment or other interventions that aim ed to minimise the number of falls were included . Types of Participants Participants were older adult in patients ( defined as aged 65 years or over ) in acute care hospitals . Types of Interventions This review focused on interventions design ed to assess the risk of falling or those used to minimise the risk of falling in older adult hospital patients . These interventions were compared to either st and ard practice , which included any method or technique already in place at the facility , or no intervention . Types of Outcome measures The primary outcome was the number of patient falls during hospitalisation . Search Strategy A search for published and unpublished literature from 1998 to 2008 published in the English language was conducted using all major electronic data bases . A three‐step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured . Assessment of Quality The method ological quality of included studies was assessed by two review ers , who appraised each study independently , using st and ardised Joanna Briggs Institute ( JBI ) critical appraisal tools Data Collection and Analysis Data was extracted from the studies that were identified as meeting the criteria for method ological quality using the st and ard JBI data extraction tools . Due to the heterogeneity of population s and interventions , meta‐analyses were not possible and results are presented in narrative form . Results and Conclusions Seven studies were included in the review . The evidence on interventions for reducing the number of falls in older adults during their stay in an acute health care facility is sparse . There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit . Further high quality research is needed in order to ascertain effective fall prevention strategies in acute care facilities . Implication s for Practice There are some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult in patients : ˙ a multidisciplinary multifactorial intervention program consisting of a falls risk alert card , an exercise program , an education program and the use of hip protectors after approximately 45 days ˙ a one‐on‐one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ˙ a targeted falls risk factor reduction intervention that includes a falls risk factor screen , recommended interventions encompassing local advice and a summary of the evidence There is some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors , as well as active management of postoperative complications can reduce the amount of falls in patients with femoral neck fracture following surgery . Implication s for Research Better design ed RCTs that distinguish subgroups of population s ( for example people with or without cognitive impairment ) and that targets interventions at specific groups is required . Further research that focuses on individual intervention components that are part of larger multifactorial interventions are also warranted Objective : Comparison of two flooring types – carpet and vinyl – in the bed areas , and two modes of physiotherapy – conventional therapy and additional leg strengthening exercises – in avoiding falls . Design : R and omized 2 × 2 controlled trial . Setting : Elderly care rehabilitation ward in a community hospital . Subjects : Fifty-four consecutive patients referred for rehabilitation . Outcome measures : The incidence of falls , and the change in strength . Results : There were 10 falls on carpet , and only a single fall on vinyl floor covering ( relative risk 8.3 , 95 % confidence interval 0.95–73 , p = 0.05 ) . There were four 
    Output:
    
There is also some evidence that delirium avoidance programs , reducing sedative and hypnotic medication , in-depth patient education , and sustained exercise programs may reduce falls as single interventions .
There is no convincing evidence that hip protectors , movement alarms , or low-low beds reduce falls or injury in the hospital setting .