***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: Bathing creates some of the highest levels of discomfort in the lives of individuals diagnosed with dementia . The present study measured the frequency of 14 agitated behaviors during bathing in 15 elderly residents with dementia residing in a continuing care center . Each resident was observed for four sessions of two different bathing methods , the conventional tub bath and a modification of the bed bath , known as the Thermal bath . The summed frequencies of all agitated behaviors was significantly less for the Thermal bath than the tub bath . This overall effect was greater in men than women and in one particular behavior , shivering . The results suggest that for individuals with dementia the Thermal bath offers a viable alternative to the conventional tub method . Further research may clarify other parameters , such as cost effectiveness and long-term effects of the use of non-rinse cleansers for elderly individuals There has been concern for many years that an older person with dementia is likely to experience increased disorientation if moved from one setting to another . A policy of rebuilding Canadian nursing homes and relocating their residents led these research ers to test a strategy for improving residents '  ability to find their way in a new environment . A r and omised controlled trial conducted in four nursing homes compared an intervention consisting of the use of a location map and a behavioural training technique called ' backward chaining ' with a control group who did not receive it . ' Backward chaining ' involved breaking the trip down into smaller sections which were rehearsed individually , with the section of the journey nearest the intended destination ( the dining room ) being learned first . The results indicated that residents in the treatment group demonstrated an increased ability to find their way to the dining room after one week , but that this effect was not maintained after three months Background Agitated behavior is a widespread problem that adversely affects the health of nursing home residents and increases the cost of their care . Objective To examine whether modifying environmental stimuli by the use of calming music and h and massage affects agitated behavior in persons with dementia . Method A four group , repeated measures experimental design was used to test the effect of a 10-minute exposure to either calming music , h and massage , or calming music and h and massage simultaneously , or no intervention ( control ) on the frequency and type of agitated behaviors in nursing home residents with dementia ( N = 68 ) . A modified version of the Cohen-Mansfield Agitation Inventory was used to record agitated behaviors . Results Each of the experimental interventions reduced agitation more than no intervention . The benefit was sustained and increased up to one hour following the intervention ( F = 6.47 , p < .01 ) . The increase in benefit over time was similar for each intervention group . When types of agitated behaviors were examined separately , none of the interventions significantly reduced physically aggressive behaviors ( F = 1.93 , p = .09 ) , while physically nonaggressive behaviors decreased during each of the interventions ( F = 3.78 , p < 01 ) . No additive benefit result ed from simultaneous exposure to calming music and h and massage . At one hour following any intervention , verbally agitated behavior decreased more than no intervention . Conclusion Calming music and h and massage alter the immediate environment of agitated nursing home residents to a calm structured surrounding , off setting disturbing stimuli , but no additive benefit was found by combining interventions simultaneously 1 . Short-term exposure to a therapy dog can reduce the number of agitation behaviors in institutionalized persons with Alzheimer 's disease ( AD ) , particularly during the period of agitation known as sundown syndrome . 2 . The presence of a therapy dog can increase socialization behaviors among a group of persons with AD . 3 . A therapy dog can be used as an adjunct to other calming interventions for persons with AD Background Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident , caregiver , and others in the environment . Behavioral interventions might ameliorate them and have a positive effect on residents ’ mood ( affect ) . Objectives This study tested two interventions —an activities of daily living and a psychosocial activity intervention— and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia . Methods The study had three treatment groups ( activities of daily living , psychosocial activity , and a combination ) and two control groups ( placebo and no intervention ) . Nursing assistants hired specifically for this study enacted the interventions under the direction of a master ’s prepared gerontological clinical nurse specialist . Nursing assistants employed at the nursing homes recorded the occurrence of  disruptive behaviors  . Raters analyzed videotapes filmed during the study to determine the interventions ’ influence on affect . Results Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups . Conclusions The treatments did not specifically address the factors that may have been triggering disruptive behaviors . Interventions much more precisely design ed than those employed in this study require development to quell disruptive behaviors . Nontargeted interventions might increase positive affect . Treatments that produce even a brief improvement in affect indicate improved quality of mental health as m and ated by federal law BACKGROUND Behavioral and psychological symptoms in dementia are frequent and are a major management problem , especially for patients with severe cognitive impairment . Preliminary reports have indicated positive effects of aromatherapy using select essential oils , but there are no adequately powered placebo-controlled trials . We conducted a placebo-controlled trial to determine the value of aromatherapy with essential oil of Melissa officinalis ( lemon balm ) for agitation in people with severe dementia . METHOD Seventy-two people residing in National Health Service ( U.K. ) care facilities who had clinical ly significant agitation in the context of severe dementia were r and omly assigned to aromatherapy with Melissa essential oil ( N = 36 ) or placebo ( sunflower oil ) ( N = 36 ) . The active treatment or placebo oil was combined with a base lotion and applied to patients ' faces and arms twice a day by caregiving staff . Changes in clinical ly significant agitation ( Cohen-Mansfield Agitation Inventory [ CMAI ] ) and quality of life indices ( percentage of time spent socially withdrawn and percentage of time engaged in constructive activities , measured with Dementia Care Mapping ) were compared between the 2 groups over a 4-week period of treatment . RESULTS Seventy-one patients completed the trial . No significant side effects were observed . Sixty percent ( 21/35 ) of the active treatment group and 14 % ( 5/36 ) of the placebo-treated group experienced a 30 % reduction of CMAI score , with an overall improvement in agitation ( mean reduction in CMAI score ) of 35 % in patients receiving Melissa balm essential oil and 11 % in those treated with placebo ( Mann-Whitney U test ; Z = 4.1 , p < .0001 ) . Quality of life indices also improved significantly more in people receiving essential balm oil ( Mann-Whitney U test ; percentage of time spent socially withdrawn : Z = 2.6 , p = .005 ; percentage of time engaged in constructive activities : Z = 3.5 , p = .001 ) . CONCLUSION The finding that aromatherapy with essential balm oil is a safe and effective treatment for clinical ly significant agitation in people with severe dementia , with additional benefits for key quality of life parameters , indicates the need for further controlled trials Two equivalent special care nursing home units for elders with dementing illness were r and omly design ated as experimental and control units for an intervention called the " stimulation-retreat " model . This model introduced a set of staffing and program changes whose purpose was to diagnose , prescribe , and apply a package of care according to individual needs for additional stimulation or relief from stimulation ( " retreat " ) . A total of 49 experimental and 48 control unit residents completed 12 months of care and were evaluated at baseline , 6 months , and 12 months . It was hypothesized that the intervention would not affect the basic disability ( cognitive and activities of daily living functions ) , would improve negative behaviors and observed affects , and would have maximum impact in increasing positive behaviors and affects . Over time , most functions worsened , including negative attributes and affects . Lesser decline in positive affect and increases in external engagement , however , led to the conclusion that the intervention showed a marginally significant and selective effect on positive behaviors and affect OBJECTIVE To evaluate the efficacy of Simulated Presence , a personalized approach to enhance well-being among nursing home residents with Alzheimer 's disease and related dementia 's ( ADRD ) . DESIGN Latin-Square , double blinded , 3-factor design with restrictive r and omization of three treatments ( the study intervention , a placebo audio tape of a person reading the newspaper , and usual care ) . The three factors were treatment , time , and facility type . SETTING Nine nursing homes in Eastern Massachusetts and Southern New Hampshire . PARTICIPANTS Fifty-four subjects with documented ADRD who were aged 50 years or older , medically stable , had resided in their current nursing home for at least 3 months , and who had no planned discharge . All subjects had a history of agitated or withdrawn behaviors . INTERVENTION The purpose of Simulated Presence is to provide a personalized intervention for persons with moderate to severe cognitive impairment . Through a unique testing process , some of the best loved memories of the ADRD person 's lifetime are identified and then those memories are introduced to the patient in the format of a telephone conversation using a continuous play audio tape system . The intervention may be used for extended periods of time because each repetition is viewed as a fresh , live telephone call as a result of the short-term memory deficit of the person with ADRD . MEASUREMENTS Direct observations of outcomes included using a newly developed scale , the Scale for the Observation of Agitation in Persons with Dementia , an agitation visual analog scale , the Positive Affect Rating Scale ( mood and " interest " ) , a withdrawal visual analog scale , and facial diagrams of mood . Reported measures included daily staff observation logs of responses to interventions offered , and weekly staff surveys using the short-form Cohen-Mansfield Agitation Inventory and the Multidimensional Observation Scale for Elderly Subjects ( mood and " interest " ) . Severity of dementia was assessed by the Mini-Mental State Exam , the Test for Severe Impairment , the Bedford Alzheimer 's Nursing Scale , and the ADL Self-Performance Scale . RESULTS Chi-square analysis of direct observations , using facial diagrams , revealed that Simulated Presence was equivalent to usual care ( P = .141 ) and superior to placebo for producing a happy facial expression ( P = .001 ) . A positive effect was also documented in nursing staff observation logs using Analysis of Variance techniques ( ANOVA ) for subjects during Simulated Presence phases compared with the placebo phases ( P < .001 ) and usual care phases ( P < .001 ) . According to ANOVA analyses of " interest " from weekly surveys , Simulated Presence was superior to both usual care ( P = .001 ) and placebo ( P = .008 ) . We were unable to find evidence of significant differences ( P < .05 ) among interventions for other direct observations and weekly reports of overall agitation or mood aspects of withdrawal . Subjects accepted the intervention most of the time , except for five subjects who refused it more than 50 % of the time . CONCLUSION This study provided evidence that Simulated Presence can be effective in enhancing well-being and decreasing problem behaviors in the nursing home setting as a substitute for or complement to usual care Background : Treatment of agitation is a crucial problem in the care of patients with AD . Although antipsychotic and antidepressant medications and behavior management techniques ( BMT ) have each been used to treat agitation , clinical trials of these treatments have been characterized by small sample sizes and uncontrolled treatment design s. Objective : To compare haloperidol , trazodone , and BMT with placebo in the treatment of agitation in AD out patients . Methods : A total of 149 patients with AD and their caregivers participated in a r and omized , placebo-controlled , multicenter trial . Blind assessment was conducted at baseline and after 16 weeks of treatment . The three active treatments were haloperidol , trazodone , and BMT . The Alzheimer ’s Disease Cooperative Study Clinical Global Impression of Change was the primary outcome measure . Secondary outcomes included patient agitation , cognition , and function , and caregiver burden . Results : Thirty-four percent of subjects improved relative to baseline . No significant differences on outcome were obtained between haloperidol ( mean dose , 1.8 mg/d ) , trazodone ( mean dose , 200 mg/d ) , BMT , or placebo . Significantly fewer adverse events of bradykinesia and parkinsonian gait were evident in the BMT arm . No other significant difference in adverse events was seen . Symptoms did not respond differentially to the different treatments . Conclusions : Comparable modest reductions in agitation occurred in patients receiving haloperidol , trazodone , BMT , and placebo .  More effective pharmacologic , nonpharmacologic , and combination treatments are needed OBJECTIVE To conduct a controlled investigation to examine the effects of an abilities-focused program of morning care on the interaction behaviors and functioning of residents with dementia and on caregivers ' interaction behaviors and perceptions of caregiving . DESIGN A quasi-experimental , repeated measures design . SETTING The study was conducted on four , nursing-home-level cognitive supports units in a geriatric care center . One of the units was r and omly selected as the experimental unit ; the other three served as controls . PARTICIPANTS The final sample consisted of 40 residents ( 20 each in the experimental and three control groups ) and 44 caregivers ( 16 on the experimental unit and 28 on the three control units ) . INTERVENTION An educational program on delivering abilities-focused morning care , design ed by the authors , was provided to caregivers on the experimental unit . MEASUREMENTS Measures were taken at baseline and at 3 and 6 months postinter 
    Output:
    
Conclusion : This systematic review indicated that among the seven types of nonpharmacological interventions available for agitation in older adults with dementia , only sensory interventions had efficacy in reducing agitation .