***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 no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information Applicants for a newly opened special unit for dementia sufferers were r and omly allocated to full-time care in the unit or placed on a waiting list and offered periodic respite care in the meantime .  All applicants were living in the community at the time of r and om assignment . Both groups were followed up for three months to assess the effects on the dementia sufferers and on their family care-givers . Care-givers initially had a high level of psychological symptoms , which was greatly reduced after admission of the dementia sufferer to full-time care . By contrast , the care-givers of the community care group of sufferers continued to have a high level of symptoms . Dementia sufferers continued to deteriorate with both forms of care , with little difference between the two groups . Admission of dementia sufferers to full-time care in a special unit appears to be of great benefit to the psychological health of their care-givers and has no adverse effects on the dementia sufferers themselves A program for elderly persons with cognitive impairment and their caregivers was evaluated for its effectiveness and efficiency with regard to caregiver burden , sense of coherence , satisfaction , and cost to the health-care system . The program consisted of a weekly 2-hour visit and walk by volunteers . During a 9-month period in 1997 , all eligible referrals were r and omly assigned to receive the service immediately ( experimental group ) or be placed on a waiting list to receive it 6 weeks later ( control group ) . Eleven caregivers/recipients formed the experimental group ; 10 caregivers/recipients formed the control group . All completed question naires at r and omization and at 6-week follow-up . Perceived burden decreased by 8 % only for the caregivers in the experimental group ( F = 6.8 , p = .02 ) . They indicated that they appreciated the respite and support and that the care recipient enjoyed the visit/walk . Although this study was short in duration and small in sample size , improvements were noted in perceived caregiver burden and caregivers expressed satisfaction with the program . The program did not result in additional health and social-service expenditures Family units ( N = 541 ) of impaired elderly persons and caregivers were r and omly assigned to a control group or one of five treatment groups eligible for a variety of respite or educational services . After 12 months of service eligibility , caregivers of elderly persons remaining in the community reported lower levels of subjective burden . Services appeared to delay nursing home placement among families with adult child caregivers , but encouraged placement by spouse caregivers This article summarizes the study results and presents an evaluative summary of the implementation of study methods design ed to provide guidance in the degree of confidence with which the results may be accepted and generalized to other situations . Patients who were offered VA-ADHC services in the first phase of this study had significantly higher VA health care costs on average than patients assigned to customary care , with no apparent incremental health benefit to themselves or their care givers . One can have a high level of confidence in these results . The ADHC clinical services were implemented as planned , the r and omized controlled trial was implemented successfully , and such threats to validity as insufficient numbers of patients and differential attrition were not present . Certain subgroups of patients assigned to VA-ADHC had VA costs of care that were not significantly higher than those assigned to customary care , although these results must be interpreted with caution . The findings of the second phase of the study evaluating contract ADHC provide no support for choosing to provide either contract ADHC or VA-ADHC over the other . The nonr and omized design and smaller sample size suggest that inferences from the contract ADHC evaluation should be drawn with more caution than those from the VA-ADHC evaluation OBJECTIVES This study reports the findings of an evaluation of the psychological benefits of use of adult day care by family caregivers assisting a relative with dementia . METHODS The study used a quasi-experimental design in which caregivers in the treatment group used substantial amounts of services , whereas  caregivers in a control group did not use day care at any point during the evaluation and only small amounts of other respite services . The evaluation was guided by the stress process model of caregiving which distinguishes between appraisal s of primary stressors and well-being . RESULTS Results after 3 months of day care use showed that the treatment group had significantly lower scores than the control group on two of the three measures of primary appraisal s ( overload and strain ) and two of the three measures of well-being ( depression and anger ) . Findings at one year showed that the treatment group had significantly lower scores on overload and depression than the control group . DISCUSSION These results demonstrate that use of adult day care by caregivers of dementia patients results in lower levels of caregiving-related stress and better psychological well-being when compared to that of controls Collaborative working in care for older people is often seen as a desirable goal . However , there can be problems with this approach . This paper reports on a single blind r and omized controlled trial which was carried out to compare outcomes of  rehabilitation  in two setting s : a day hospital and social services day centres augmented by visiting therapists .  The subjects were 105 older patients . Principal outcome measures were the Barthel Index , Philadelphia Geriatric Centre Morale Scale and the Caregiver Strain Index . Two aspects of the trial are examined here . Firstly , we investigated whether trial patients were more disabled than regular day centre attendees . Levels of health and well being amongst trial patients were compared with those of a r and om sample of 20 regular attendees from both of the participating day centres and an additional voluntary sector day centre . Secondly , key staff from the different setting s were interviewed to assess how well the day centre model had worked in practice . Trial patients were significantly more disabled than regular day centre attendees according to the Barthel Index ( P < 0.001 ) , but this difference was no longer significant after three months of treatment . The day centre model had several problems , principally discharge policy , acceptability , facilities and attitudes of staff and regular attendees . Positive aspects of the day centre model , as well as successful rehabilitation , included shared skills , knowledge and re sources . This paper suggests that collaborative working in day centres requires multi purpose facilities . If health staff maintain a permanent presence , benefits can include improved joint working , easier access to health care and the use of rehabilitative therapy as a preventative strategy . Day care setting s can be analyzed as representing different types of communities . Allowing older users a greater degree of choice in facilities may increase the acceptability of care Objectives : To assess outcomes and satisfaction among frail elderly day care clients and their informal caregivers and the impact of adult day care on the cost of health services . Methods : One-hundred eight elderly participants were r and omly assigned to the experimental group ( immediate admission to an adult day care center ) and 104 participants to the control group ( 3 months on a waiting list ) . Results : Participants ’ and caregivers ’ subjective perceptions of the day center ’s effects were positive . However , using st and ard research instruments , there was no evidence of an effect of day center attendance on the client ’s anxiety , depression , or functional status ; on caregiver burden ; or on the cost of health services . Discussion : It is difficult to demonstrate objective ly the benefits of programs and interventions that are perceived by clients , caregivers , and staff to have positive effects . In future studies , maintenance of high levels of participation should be incorporated as an explicit program goal After a baseline interview of 642 caregivers of aged Alzheimer 's disease victims , half were offered formal respite care . Over 12 months , families with respite care  maintained their impaired relative significantly longer in the community ( 22 days ) . Although respite was ineffective for caregiver burden and mental health , satisfaction was very high . Although not a strong intervention , respite care can increase caregivers ' quality of life 
    Output:
    
For all types of respite , the effects upon caregivers were generally small , with better-controlled studies finding modest benefits only for certain subgroups , although many studies reported high levels of caregiver satisfaction .
No reliable evidence was found that respite care delays entry to residential care or adversely affects frail older people .
The economic evaluations all assessed day care , which tended to be associated with similar or higher costs than usual care .