***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: CONTEXT Elderly persons with psychiatric disorders are less likely than younger adults to be diagnosed as having a mental disorder and receive needed mental health treatment . Lack of access to care is 1 possible cause of this disparity . OBJECTIVE To determine whether a nurse-based mobile outreach program to seriously mentally ill elderly persons is more effective than usual care in diminishing levels of depression , psychiatric symptoms , and undesirable moves ( eg , nursing home placement , eviction , board and care placement ) . DESIGN Prospect i ve r and omized trial conducted between March 1993 and April 1996 to assess the effectiveness of the Psychogeriatric Assessment and Treatment in City Housing ( PATCH ) program . SETTING Six urban public housing sites for elderly persons in Baltimore , Md. PARTICIPANTS A total of 945 ( 83 % ) of 1195 residents in the 6 sites underwent screening for psychiatric illness .  Among those screened , 342 screened positive and 603 screened negative . All screen-positive subjects aged 60 years and older ( n=310 ) and a 10 % r and om sample of screen-negative subjects aged 60 years and older ( n=61 ) were selected for a structured psychiatric interview . Eleven subjects moved or died ; 245 ( 82 % ) of those who screened positive and 53 ( 88 % ) of those who screened negative were evaluated to determine who had a psychiatric disorder . Data were weighted to estimate the prevalence of psychiatric disorders at the 6 sites . INTERVENTION Among the 6 sites , residents in 3 buildings were r and omized to receive the PATCH model intervention , which included educating building staff to be case finders , performing assessment in residents ' apartments , and providing care when indicated ; and residents in the remaining 3 buildings were r and omized to receive usual care ( comparison group ) . MAIN OUTCOME MEASURES Number of undesirable moves and scores on the Montgomery-Asberg Depression Rating Scale ( MADRS ) , a measure of depressive symptoms , and the Brief Psychiatric Rating Scale ( BPRS ) , a measure of psychiatric symptoms and behavioral disorder , in intervention vs comparison sites . RESULTS Based on weighted data , at 26 months of follow-up , psychiatric cases at the intervention sites had significantly lower ( F(1)=31.18 ; P<.001 ) MADRS scores ( 9.1 vs 15.2 ) and significantly lower ( F(1)=17.35 ; P<.001 ) BPRS scores ( 27.4 vs 33.9 ) than those at the nontreatment comparison sites . There was no significant difference between the groups in undesirable moves ( relative risk , 0.97 ; 95 % confidence interval , 0 . 44 - 2.17 ) . CONCLUSIONS These results indicate that the PATCH intervention was more effective than usual care in reducing psychiatric symptoms in persons with psychiatric disorders and those with elevated levels of psychiatric symptoms . JAMA . 2000;283:2802 - CONTEXT Older adults with social isolation , medical comorbidity , and physical impairment are more likely to be depressed but may be less able to seek appropriate care for depression compared with older adults without these characteristics . OBJECTIVE To determine the effectiveness of a home-based program of detecting and managing minor depression or dysthymia among older adults . DESIGN AND SETTING R and omized controlled trial with recruitment through community senior service agencies in metropolitan Seattle , Wash , from January 2000 to May 2003 . PATIENTS One hundred thirty-eight patients aged 60 years or older with minor depression ( 51.4 % ) or dysthymia ( 48.6 % ) . Patients had a mean of 4.6 ( SD , 2.1 ) chronic medical conditions ; 42 % of the sample belonged to a racial/ethnic minority , 72 % lived alone , 58 % had an annual income of less than 10 000 dollars , and 69 % received a form of home assistance . INTERVENTIONS Patients were r and omly assigned to the Program to Encourage Active , Rewarding Lives for Seniors ( PEARLS ) intervention ( n = 72 ) or usual care ( n = 66 ) . The PEARLS intervention consisted of problem-solving treatment , social and physical activation , and potential recommendations to patients ' physicians regarding antidepressant medications . MAIN OUTCOME MEASURES Assessment s of depression and quality of life at 12 months compared with baseline . RESULTS At 12 months , compared with the usual care group , patients receiving the PEARLS intervention were more likely to have at least a 50 % reduction in depressive symptoms ( 43 % vs 15 % ; odds ratio [ OR ] , 5.21 ; 95 % confidence interval [ CI ] , 2.01 - 13.49 ) , to achieve complete remission from depression ( 36 % vs 12 % ; OR , 4.96 ; 95 % CI , 1.79 - 13.72 ) , and to have greater health-related quality -of-life improvements in functional well-being ( P = .001 ) and emotional well-being ( P = .048 ) . CONCLUSIONS The PEARLS program , a community-integrated , home-based treatment for depression , significantly reduced depressive symptoms and improved health status in chronically medically ill older adults with minor depression and dysthymia The effects of a multifaceted secondary prevention intervention in residential homes in the Netherl and s were examined , using a quasi-experimental design . In five experimental residential homes , the caregivers received three training sessions on detecting depression and on supporting depressed residents . Furthermore , an information session was organized for all personnel , a further session was organized for residents and their relatives , and several group interventions were offered . 213 residents participated in the study . 211 residents of five other residential homes , matched on basic variables , served as a comparison group . Effects on depressive symptoms ( geriatric depression scale ) and health related quality of life ( MOS-SF-36 ) were measured at pretest and after the intervention , one year later . Because the drop-out rate was high and drop-outs differed significantly from the remaining population , the scores of drop-outs were imputed . Since we used a quasi-experimental design , we controlled for confounding variables . Regression analyses result ed in significant effects of the intervention on the GDS and on role functioning in the total population . When the analyses were limited to those scoring high on the GDS at pretest , significant effects were found on the GDS , and on four domains of health-related quality of life : psychological distress , role functioning , pain and social functioning . The improvement in GDS scores in GDS cases was significantly larger than in other subjects . Our results suggest that general approaches aim ed at a residential home are capable of influencing depressive symptoms in inhabitants . Possibly , it may not be necessary to wait until depressive symptoms have escalated and inhabitants need extensive treatment Abstract Objective : To investigate the efficacy of intervention by a psychogeriatric team in the treatment of depression in elderly disabled people receiving home care from their local authority . Design : R and omised controlled trial with blind follow up six months after recruitment . Setting : Community of south east London . Subjects : 69 people aged 65 or over who received home care and were depressed according to criteria of the st and ardised automatic geriatric examination for computer assisted taxonomy ( AGECAT ) . 33 were r and omly allocated to an intervention group and 36 to a control group . Intervention : Members of the intervention group received an individual package of care that was formulated by the community psychogeriatric team in their catchment area and implemented by a research er working as a member of that team . The control group received normal general practitioner care . Main outcome measures : Recovery from depression ( AGECAT case at recruitment but non-case at follow up ) . Results : Data were analysed on an intention to treat basis . 19 ( 58 % ) of the intervention group recovered compared with only nine ( 25 % ) of the control group , a difference of 33 % ( 95 % confidence interval 10 % to 55 % ) . This powerful treatment effect persisted after controlling for possible confounders in logistic regression analysis , with members of the intervention group more likely than members of the control group to have recovered at follow up ( odds ratio 9.0 ( 2.0 to 41.5 ) ) . This did not seem to be a simple effect of antidepressant prescription : use of antidepressants at follow up did not have a significant effect ( multiply adjusted odds ratio 0.3 ( 0.0 to 1.9 ) ) . Conclusions : Depression is treatable in elderly people receiving home care . Therapeutic nihilism based on an assumed poor response to treatment in these socially isolated , disabled elderly people in the community is not supported . Key messages This r and omised controlled trial evaluated whether intervention by a psychi- atric team would improve depression in elderly people receiving home care Overall , 58 % of those receiving the intervention had recovered from their depression six months later compared with only 25 % of those receiving unsup- plemented general practitioner care These results should be achievable by other community old age psychiatry services The current comparative inaction on the part of health and social services needs to be Abstract Objective : To evaluate the effectiveness of a population based , multifaceted shared care intervention for  late life depression in residential care . Design : R and omised controlled trial , with control and intervention groups studied one after the other and blind follow up after 9.5 months . Setting : Population of residential facility in Sydney living in self care units and hostels . Participants : 220 depressed residents aged ≥65 without severe cognitive impairment . Intervention : The shared care intervention included : ( a ) multidisciplinary consultation and collaboration , ( b ) training of general practitioners and carers in detection and management of depression , and (c)depression related health education and activity programmes for residents . The control group received routine care . Main outcome measure : Geriatric depression scale . Results : Intention to treat analysis was used . There was significantly more movement to “ less depressed ” levels of depression at follow up in the intervention than control group ( Mantel-Haenszel stratification test , P=0.0125 ) . Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders , with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group ( 95 % confidence interval 0.76 to 2.97 , P=0.0011 ) . Conclusions : The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration , by enhancing the clinical skills of general practitioners and care staff , and by providing depression related health education and activity programmes for residents . Key messages Large numbers of depressed elderly people live in residential care but few receive appropriate management A population based , multifaceted shared care intervention  for late life depression was more effective than routine care in improving depression outcome The outcome of late life depression can be improved by enhancing the clinical skills of general practitioners and care staff and by providing depression related health education and activity programmes for residents The intervention needs further refining and evaluation to improve its effectiveness and to determine how best to implement it in other residential care setting OBJECTIVE To examine whether depressive symptoms in older adults contribute to increased cost of general medical services . DESIGN A 4-year prospect i ve cohort study . SETTING Four primary care clinics of a large staff-model health maintenance organization ( HMO ) in Seattle , Wash. PATIENTS A total of 5012 Medicare enrollees older than 65 years were invited to participate in the study ; 2558 subjects ( 51 % ) were successfully enrolled . Non- participants were somewhat older and had a higher level of chronic medical illness . MAIN OUTCOME MEASURES Depressive symptoms as measured by the Center for Epidemiological Studies Depression scale , which was administered as part of a mail survey at baseline , at 2 years , and at 4 years ; and total cost of medical services from the perspective of the HMO . Data were obtained from the cost accounting system of the HMO . RESULTS In this cohort of older adults , depressive symptoms were common , persistent , and associated with a significant increase in the cost of general medical services . This increase was seen for every component of health care costs and was not accounted for by an increase in specialty mental health care . The increase in health care costs remained significant after adjusting for differences in age , sex , and chronic medical illness . CONCLUSIONS Depressive symptoms in older adults are associated with a significant increase in the cost of medical services , even after adjusting for the severity of chronic medical illness Depression in elderly people is a common yet treatable psychiatric problem . The Gospel Oak depression study research ed this much overlooked group and has shown that a community psychiatric nurse ( CPN ) was able significantly to improve the mental state of depressed elderly people . A multifaceted package of care was co-ordinated and delivered by one CPN over a study period of 3 months . A detailed account is given of those interventions implemented , highlighting those which were of most benefit for the patient . Outcome was assessed independently and it was found that those patients allocated to CPN care improved significantly compared to the non-intervention control group . Ways in which nurses can enhance care given to patients in the community are discussed OBJECTIVE To examine treatment for depression among older adults in a large staff model health maintenance organization ( HMO ) . DESIGN A 4-year prospect i ve cohort study ( 1989 - 1993 ) . SETTING Four primary care clinics of a large staff model HMO in Seattle , Washington . PATIENTS A total of 2558 Medicare enrollees aged 65 and older . MAIN OUTCOME MEASURES Treatment of depression  was defined as primary care visits result ing in depression diagnoses , use of antidepressant medications , or specialty mental health services . MAIN RESULTS 
    Output:
    
Twelve studies ( five r and omized controlled trials , one quasi-experimental study , and six uncontrolled cohort studies ) found that home and community-based treatment of psychiatric symptoms were associated with improved or maintained psychiatric status .
CONCLUSIONS Limited data supported the effectiveness of outreach services in identifying isolated older adults with mental illness .
A more substantial evidence base indicated that home-based mental health treatment is effective in improving psychiatric symptoms .