***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 there is inadequate evidence to support currently formulated NHS strategies to achieve health promotion and preventative care in older people through broad-based screening and assessment in primary care . The most extensively evaluated delivery instrument for this purpose is Health Risk Appraisal ( HRA ) . This article describes a trial using HRA to evaluate the effect on health behaviour and preventative-care uptake in older people in NHS primary care . METHODS a r and omised controlled trial was undertaken in three London primary care group practice s. Functionally independent community-dwelling patients older than 65 years ( n = 2,503 ) received a self-administered Health Risk Appraisal for Older Persons ( HRA-O ) question naire leading to computer-generated individualised written feedback to participants and general practitioners ( GPs ) , integrated into practice information-technology ( IT ) systems . All primary care staff received training in preventative health in older people . The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up . RESULTS of 2,503 individuals r and omised , 2,006 respondents ( 80.1 % ) ( intervention , n = 940 , control n = 1,066 ) were available for analysis . Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls . No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up . CONCLUSIONS HRA-O implemented in this way result ed in minimal improvement of health behaviour or uptake of preventative care measures in older people . Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older people The purpose of the study was to compare the effectiveness of programmed and intensified intervention on lifestyle changes , including physical activity , cigarette smoking , alcohol consumption and diet , in patients aged ≥ 65 with the usual care of general practitioners ( GP ) . In this multicenter r and omized controlled trial , 738 patients aged ≥ 65 were r and omly assigned to receive intensified intervention ( N = 371 ) or usual care ( N = 367 ) of a GP for lifestyle changes , with 18-month follow-up . The main outcome measures were physical activity , smoking , alcohol consumption and diet . The study was conducted in 59 general practice s in Croatia between May 2008 and May 2010 . The patients ' mean age was 72.3 ± 5.2 years . Significant diet correction was achieved after 18-month follow-up in the intervention group , comparing to controls . More patients followed strictly Mediterranean diet and consumed healthy foods more frequently . There was no significant difference between the groups in physical activity , tobacco smoking and alcohol consumption or diet after the intervention . In conclusion , an 18-month intensified GP 's intervention had limited effect on lifestyle habits . GP intervention managed to change dietary habits in elderly population , which is encouraging since elderly population is very resistant regarding lifestyle habit changes . Clinical trial registration number . IS RCT N31857696 OBJECTIVE This study was part of the Primary Care Research in Substance Abuse and Mental Health for the Elderly study ( PRISM-E ) and determined the relative effectiveness of two different models of care for reducing at-risk alcohol use among primary care patients aged 65 and older . METHODS This multisite study was a r and omized clinical trial comparing integrated care with enhanced specialty referral for older primary care patients screened and identified to have at-risk drinking . RESULTS Before the study , the 560 participants consumed a mean of 17.9 drinks per week and had a mean of 21.1 binge episodes in the prior three months . At six months , both treatment groups reported lower levels of average weekly drinking ( p<.001 ) and binge drinking ( p<.001 ) , despite low levels of treatment engagement . However , the declines did not differ significantly between treatment groups . CONCLUSIONS These results suggest that older persons with at-risk drinking can substantially modify their drinking over time . Although no evidence suggested that the model of care was important in achieving this result , the magnitude of reduction in alcohol use was comparable with other intervention studies AIMS To examine whether a multi-faceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months . DESIGN R and omized controlled trial . SETTING Three primary care sites in southern California . PARTICIPANTS Six hundred and thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool ( CARET ) were assigned r and omly between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report , booklet on alcohol and aging , drinking diary , advice from the primary care provider and telephone counseling from a health educator at 2 , 4 and 8 weeks . MEASUREMENTS The primary outcome was the proportion of participants meeting at-risk criteria , and secondary outcomes were number of drinks in past 7 days , heavy drinking ( four or more drinks in a day ) in the past 7 days and risk score . FINDINGS At 3 months , relative to controls , fewer intervention group participants were at-risk drinkers [ odds ratio ( OR ) 0.41 ; 95 % confidence interval ( CI ) 0.22 - 0.75 ] ; they reported drinking fewer drinks in the past 7 days [ rate ratio ( RR ) 0.79 ; 95 % CI 0.70 - 0.90 ] , less heavy drinking ( OR 0.46 ; 95 % CI 0.22 - 0.99 ) and had lower risk scores ( RR 0.77 95 % CI 0.63 - 0.94 ) . At 12 months , only the difference in number of drinks remained statistically significant ( RR 0.87 ; 95 % CI 0.76 - 0.99 ) . CONCLUSIONS A multi-faceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers , but does reduce amount of drinking at 12 months BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypertension , diabetes , drug interactions , accidents , and increased rates of emergency department visits and hospitalizations . METHODS A controlled clinical trial ( Project GOAL --Guiding Older Adult Lifestyles ) tested the efficacy of brief physician advice in reducing the alcohol use and use of health care services of older adult problem drinkers . Twenty-four community-based primary care practice s in Wisconsin ( 43 family physicians and internists ) participated in the trial . Of the 6073 patients screened , 105 men and 53 women met inclusion criteria and were r and omized into a control group ( n = 71 ) or an intervention group ( n = 87 ) . Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions that included advice , education , and contracting using a scripted workbook . A total of 146 patients ( 92.4 % ) participated in the 12-month follow-up procedure . RESULTS No significant differences were found between the control and intervention groups at baseline in alcohol use , age , socioeconomic status , depression , onset of alcohol use , smoking status , activity level , or use of mood-altering drugs . The older adults who received the physician intervention demonstrated a significant reduction in 7-day alcohol use , episodes of binge drinking , and frequency of excessive drinking ( P < .005 ) compared with the control group at 3 , 6 , and 12 months after the intervention . There was a 34 % reduction in 7-day alcohol use , 74 % reduction in mean number of binge-drinking episodes , and 62 % reduction in the percentage of older adults drinking more than 21 drinks per week in the intervention group compared with the control group . There were no significant changes in health status . Patterns of health care utilization were not extensively analyzed because of the small number of events . CONCLUSIONS This study provides the first direct evidence that brief physician advice can decrease alcohol use by older adults in community-based primary care practice BACKGROUND There is clear evidence of the detrimental impact of hazardous alcohol consumption on the physical and mental health of the population . Estimates suggest that hazardous alcohol consumption annually accounts for 150,000 hospital admissions and between 15,000 and 22,000 deaths in the UK . In the older population , hazardous alcohol consumption is associated with a wide range of physical , psychological and social problems . There is evidence of an association between increased alcohol consumption and increased risk of coronary heart disease , hypertension and haemorrhagic and ischaemic stroke , increased rates of alcohol-related liver disease and increased risk of a range of cancers . Alcohol is identified as one of the three main risk factors for falls . Excessive alcohol consumption in older age can also contribute to the onset of dementia and other age-related cognitive deficits and is implicated in one-third of all suicides in the older population . OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of a stepped care intervention against a minimal intervention in the treatment of older hazardous alcohol users in primary care . DESIGN A multicentre , pragmatic , two-armed r and omised controlled trial with an economic evaluation . SETTING General practice s in primary care in Engl and and Scotl and between April 2008 and October 2010 . PARTICIPANTS Adults aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test ( 10-item ) ( AUDIT ) were eligible . In total , 529 patients were r and omised in the study . INTERVENTIONS The minimal intervention group received a 5-minute brief advice intervention with the practice or research nurse involving feedback of the screening results and discussion regarding the health consequences of continued hazardous alcohol consumption . Those in the stepped care arm initially received a 20-minute session of behavioural change counselling , with referral to step 2 ( motivational enhancement therapy ) and step 3 ( local specialist alcohol services ) if indicated . Sessions were recorded and rated to ensure treatment fidelity . MAIN OUTCOME MEASURES The primary outcome was average drinks per day ( ADD ) derived from extended AUDIT -- Consumption ( 3-item ) ( AUDIT-C ) at 12 months . Secondary outcomes were AUDIT-C score at 6 and 12 months ; alcohol-related problems assessed using the Drinking Problems Index ( DPI ) at 6 and 12 months ; health-related quality of life assessed using the Short Form Question naire-12 items ( SF-12 ) at 6 and 12 months ; ADD at 6 months ; quality -adjusted life-years ( QALYs ) ( for cost-utility analysis derived from European Quality of Life-5 Dimensions ) ; and health and social care re source use associated with the two groups . RESULTS Both groups reduced alcohol consumption between baseline and 12 months . The difference between groups in log-transformed ADD at 12 months was very small , at 0.025 [ 95 % confidence interval (CI)--0.060 to 0.119 ] , and not statistically significant . At month 6 the stepped care group had a lower ADD , but again the difference was not statistically significant . At months 6 and 12 , the stepped care group had a lower DPI score , but this difference was not statistically significant at the 5 % level . The stepped care group had a lower SF-12 mental component score and lower physical component score at month 6 and month 12 , but these differences were not statistically significant at the 5 % level . The overall average cost per patient , taking into account health and social care re source use , was £ 488 [ st and ard deviation ( SD ) £ 826 ] in the stepped care group and £ 482 ( SD £ 826 ) in the minimal intervention group at month 6 . The mean QALY gains were slightly greater in the stepped care group than in the minimal intervention group , with a mean difference of 0.0058 ( 95 % CI -0.0018 to 0.0133 ) , generating an incremental cost-effectiveness ratio ( ICER ) of £ 1100 per QALY gained . At month 12 , participants in the stepped care group incurred fewer costs , with a mean difference of -£194 ( 95 % CI -£585 to £ 198 ) , and had gained 0.0117 more QALYs ( 95 % CI -0.0084 to 0.0318 ) than the control group . Therefore , from an economic perspective the minimal intervention was dominated by stepped care but , as would be expected given the effectiveness results , the difference was small and not statistically significant . CONCLUSIONS Stepped care does not confer an advantage over minimal intervention in terms of reduction in alcohol consumption at 12 months post intervention when compared with a 5-minute brief ( minimal ) intervention . TRIAL REGISTRATION This trial is registered as IS RCT N52557360 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 17 , No. 25 . See the HTA programme website for further project information AIMS To test if a brief motivational intervention ( BMI ) in a non-treatment seeking population of heavy drinkers results in a reduced alcohol intake . METHODS Screening of 12,364 participants in a Danish health examination survey led to 1026 heavy drinkers of whom 772 were included and r and omized to a BMI group ( n = 391 
    Output:
    
Limited evidence ( three studies ) suggested more intensive interventions with personalised feedback , physician advice , educational material s , follow-up could be most effective .
However , simple interventions including brief interventions , leaflets , alcohol assessment s with advice to reduce drinking could also have a positive effect .