—Dr Cooper's retrospective, observational study is consistent with several reports in the literature that former users of psychotropic drugs with sedative or autonomic effects have lower rates of falls and fractures than do current users.1 We concur with Drs Bernabei and Carbonin that, because the study unit of randomization was the facility, imbalance between treatment and control facilities with regard to factors that influence risk of falls and injuries was of concern. For this reason, we collected information on falls in the 365 days preceding the study, which provides an integrated measure of how patient characteristics and facility factors that influence risk of falls differed between the study groups. If intervention facilities had more staff, safer environments, or other factors that prevented falls, study residents in these facilities should have had fewer falls in the previous year. As shown in Table 1 of our article, this did not occur.
Ray WA. Reducing Falls Among Patients in Nursing Homes-Reply. JAMA. 1997;278(21):1743. doi:10.1001/jama.1997.03550210041032