***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: OBJECTIVES To examine the relationships between changes from baseline to post-Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) intervention in caregiver ( CG ) self-reported health , burden , and bother . DESIGN R and omized , multisite clinical trial . SETTING CG and care recipient ( CR ) homes in five U.S. cities . PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads ( 169 Hispanic , 160 white , and 166 African American ) receiving intervention and their controls . INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group . Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months . Control subjects received two brief " check-in " telephone calls during this 6-month period . MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention . Secondary outcomes were CG burden and bother after the intervention . RESULTS After the intervention , CGs reported better self-rated health , sleep quality , physical health , and emotional health , which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention . Changes in depression appeared to mediate these relationships . Several racial and ethnic group differences existed in physical and emotional health , as well as in total frustration with caregiving , emotional burden , and CG-rated bother with CR 's activities of daily living and instrumental activities of daily living at baseline and at follow-up , although differences between baseline and posttest did not vary according to race . CONCLUSION A structured , multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas , improved self-reported health status , and decreased burden and bother in racially and ethnically diverse CGs of people with dementia CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established . OBJECTIVE To test a nonpharmacologic intervention realigning environmental dem and s with patient capabilities . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve 2-group r and omized trial ( Care of Persons with Dementia in their Environments [ COPE ] ) involving patients with dementia and family caregivers ( community-living dyads ) recruited from March 2006 through June 2008 in Pennsylvania . INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits ; obtained blood and urine sample s ; and trained families in home safety , simplifying tasks , and stress reduction . Control group caregivers received 3 telephone calls and educational material s. MAIN OUTCOME MEASURES Functional dependence , quality of life , frequency of agitated behaviors , and engagement for patients and well-being , confidence using activities , and perceived benefits for caregivers at 4 months . RESULTS Of 284 dyads screened , 270 ( 95 % ) were eligible and 237 ( 88 % ) r and omized . Data were collected from 209 dyads ( 88 % ) at 4 months and 173 ( 73 % ) at 9 months . At 4 months , compared with controls , COPE patients had less functional dependence ( adjusted mean difference , 0.24 ; 95 % CI , 0.03 - 0.44 ; P = .02 ; Cohen d = 0.21 ) and less dependence in instrumental activities of daily living ( adjusted mean difference , 0.32 ; 95 % CI , 0.09 - 0.55 ; P = .007 ; Cohen d = 0.43 ) , measured by a 15-item scale modeled after the Functional Independence Measure ; COPE patients also had improved engagement ( adjusted mean difference , 0.12 ; 95 % CI , 0.07 - 0.22 ; P = .03 ; Cohen d = 0.26 ) , measured by a 5-item scale . COPE caregivers improved in their well-being ( adjusted mean difference in Perceived Change Index , 0.22 ; 95 % CI , 0.08 - 0.36 ; P = .002 ; Cohen d = 0.30 ) and confidence using activities ( adjusted mean difference , 0.81 ; 95 % CI , 0.30 - 1.32 ; P = .002 ; Cohen d = 0.54 ) , measured by a 5-item scale . By 4 months , 64 COPE dyads ( 62.7 % ) vs 48 control group dyads ( 44.9 % ) eliminated 1 or more caregiver-identified problems ( chi(2/1 ) = 6.72 , P = . 01 ) . CONCLUSION Among community-living dyads , a nonpharmacologic biobehavioral environmental intervention compared with control result ed in better outcomes for COPE dyads at 4 months . Although no group differences were observed at 9 months for patients , COPE caregivers perceived greater benefits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00259454 PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients . They also determined if treatment effect varied by caregiver gender , race , and relationship to patient . DESIGN AND METHODS Families ( N = 171 ) of dementia patients were r and omized to intervention or usual care control group .  The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications . RESULTS Compared with controls , intervention caregivers reported fewer declines in patients ' instrumental activities of daily living ( p = .030 ) and less decline in self-care and fewer behavior problems in patients at 3 months post-test . Also , intervention spouses reported reduced upset ( p = .049 ) , women reported enhanced self-efficacy in managing behaviors ( p = .038 ) , and women ( p = .049 ) and minorities ( p = .037 ) reported enhanced self-efficacy in managing functional dependency . IMPLICATION S The environmental program appears to have a modest effect on dementia patients ' IADL dependence . Also , among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving PURPOSE This study determined whether the NYU Caregiver Intervention , adapted in Minnesota for adult child caregivers ( NYUCI-AC ) , prevented or delayed residential care placement for persons with dementia . DESIGN AND METHODS A single-blinded r and omized controlled trial design was used . One hundred and seven adult child caregivers of persons with dementia were r and omly assigned to the NYUCI-AC treatment group who received individual and family counseling , support group referral , and ad hoc consultation or a contact control group . Participants were asked to complete structured assessment s quarterly during Year 1 and every 6 months thereafter for a minimum of 2 years . RESULTS Two thirds ( 66 % ) of adult child caregivers in the control condition admitted their parent to a residential care setting compared with 37 % in the treatment condition . Logistic regression and Cox proportional hazards models found that NYUCI-AC participants were significantly less likely ( p < .05 ) to admit their parents to a residential care setting and delayed their parents ' time to admission significantly longer ( 228.36 days longer on average ) than those in the control group . IMPLICATION S The multicomponent NYUCI-AC offered adult children the psychosocial support required to continue providing care to cognitively impaired parents at home OBJECTIVE To test whether the Tailored Activity Program ( TAP ) reduces dementia-related neuropsychiatric behaviors , promotes activity engagement , and enhances caregiver well-being . DESIGN Prospect i ve , two-group ( treatment , wait-list control ) , r and omized , controlled pilot study with 4 months as main trial endpoint . At 4 months , controls received the TAP intervention and were reassessed 4 months later . SETTING Patients ' homes . PARTICIPANTS Sixty dementia patients and family caregivers . INTERVENTION The eight-session occupational therapy intervention involved neuropsychological and functional testing , selection , and customization of activities to match capabilities identified in testing , and instruction to caregivers in use of activities . MEASUREMENTS Behavioral occurrences , activity engagement , and quality of life in dementia patients ; objective and subjective burden and skill enhancement in caregivers . RESULTS At 4 months , compared with controls , intervention caregivers reported reduced frequency of problem behaviors , and specifically for shadowing and repetitive question ing , and greater activity engagement including the ability to keep busy . Fewer intervention caregivers reported agitation or argumentation . Caregiver benefits included fewer hours doing things and being on duty , greater mastery , self-efficacy , and skill enhancement . Wait-list control participants following intervention showed similar benefits for reductions in behavioral frequency and caregiver hours doing things for the patient and mastery .  Caregivers with depressed symptoms derived treatment benefits similar to nondepressed caregivers . CONCLUSIONS Tailoring activities to the capabilities of dementia patients and training families in activity use result ed in clinical ly relevant benefits for patients and caregivers . Treatment minimized trigger behaviors for nursing home placement and reduced objective caregiver burden . Noteworthy is that depressed caregivers effectively engaged in and benefited from the intervention OBJECTIVES This article describes results of a r and omized controlled trial comparing a time-limited  early-stage memory loss ( ESML )  support group program conducted by a local Alzheimer 's Association chapter to a wait-list ( WL ) control condition . METHODS One hundred and forty-two dyads were r and omized in blocks to ESML ( n = 96 ) or WL ( n = 46 ) . Mean age of participants was 74.9 years , and mean Mini-Mental State Examination was 23.4 . The primary outcome was participant 's quality of life ; secondary outcomes included mood , family communication , and perceived stress . RESULTS On the intent-to-treat ( ITT ) pre-post analysis , significant differences were seen in participant quality of life ( p < .001 ) , depression ( p < .01 ) , and family communication ( p < .05 ) . Within the care partner groups , there was no significant difference between ESML and WL in the ITT analysis . A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems ( p < .05 ) , improved family communication ( p < .05 ) , self-efficacy ( p < .01 ) , Medical Outcomes Study short form ( SF-36 ) role-emotional ( p < .05 ) , SF-36 social functioning ( p < .05 ) , and SF-36 mental health components ( p < .01 ) in improvers . DISCUSSION These results support the efficacy of ESML support groups for individuals with dementia OBJECTIVE Does psychosocial intervention for caregivers whose spouses with Alzheimer disease ( AD ) are taking donepezil delay nursing home ( NH ) placement or death of patients ? DESIGN R and omized controlled trial with 2 years of active treatment and up to 8.5 years of follow-up ( mean : 5.4 years , SD : 2.4 ) . SETTING Out patients of research clinics in Australia , the United Kingdom , and the United States . PARTICIPANTS One hundred and fifty-five persons with AD and their spouses . INTERVENTION Five sessions of individual and family counseling ( + prn ad hoc counseling ) or usual care . MEASUREMENTS Time to institutionalization and death using Cox proportional hazards methods . RESULTS Over a mean of 5.4 years ( SD : 2.4 ) , there were no differences in NH placement or mortality by intervention group , but there were by country , with Australian patients admitted to NHs earlier than U.S. than U.K. patients . CONCLUSION Earlier NH admission of Australian compared to U.K. and U.S. subjects may be due to differences in health care , NH systems , availability , and affordability Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society PURPOSE This demonstration evaluates the effects of integrating  Alzheimer 's Association care consultation service with health care 
    Output:
    
Compared with usual care or active controls , caregiver-involved interventions had low to insufficient strength of evidence and did not consistently improve patient outcomes .
Discussion : Evidence is insufficient to endorse use of most caregiver interventions to improve outcomes for patients with dementia or Alzheimer ’s disease