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December 3, 1997

Reducing Falls Among Patients in Nursing Homes

Author Affiliations

Universit Cattolica del Sacro Cuore Rome, Italy

JAMA. 1997;278(21):1742-1743. doi:10.1001/jama.1997.03550210040031

To the Editor.  —In the article by Dr Ray and colleagues1 evaluating an intervention program designed to prevent falls and associated injuries in high-risk nursing home patients, the authors randomized nursing homes that were recruited in pairs and matched according to the number of beds. Other than describing a few eligibility criteria (ie, absence of psychiatric or short-stay skilled nursing care, higher tertiles of psychotropic drug use, and no more than 1 level A violation on the federal survey), the authors do not provide the necessary evidence to show that control nursing homes and intervention nursing homes were comparable.In our opinion, several characteristics of the nursing care facility are critically linked to the prevalence of residents' falls. First, the overall number of nursing staff per resident (eg, mean full-time equivalents per 100 beds) must be considered. It is intuitive that regardless of any specific intervention program, a higher ratio of nurses