***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: Abstract Objectives : To examine the cost of providing hospital at home in place of some forms of inpatient hospital care . Design : Cost minimisation study within a r and omised controlled trial . Setting : District general hospital and catchment area of neighbouring community trust . Subjects : Patients recovering from hip replacement ( n=86 ) , knee replacement ( n=86 ) , and hysterectomy ( n=238 ) ; elderly medical patients ( n=96 ) ; and patients with chronic obstructive airways disease ( n=32 ) . Interventions : Hospital at home or inpatient hospital care . Main outcome measures : Cost of  hospital at home scheme to health service , to general practitioners , and to patients and their families compared with hospital care . Results : No difference was detected in total healthcare costs between hospital at home and hospital care for patients recovering from a hip or knee replacement , or elderly medical patients .  Hospital at home significantly increased healthcare costs for patients recovering from a hysterectomy ( ratio of geometrical means 1.15 , 95 % confidence interval 1.04 to 1.29 , P=0.009 ) and for those with chronic obstructive airways disease ( Mann-Whitney U test , P=0.01 ) . Hospital at home significantly increased general practitioners ' costs for elderly medical patients ( Mann-Whitney U test , P<0.01 ) and for those with chronic obstructive airways disease ( P=0.02 ) . Patient and carer expenditure made up a small proportion of total costs . Conclusion : Hospital at home care did not reduce total healthcare costs for the conditions studied in this trial , and costs were significantly increased for patients recovering from a hysterectomy and those with chronic obstructive airways disease . There was some evidence that costs were shifted to primary care for elderly medical patients and those with chronic obstructive airways disease . Key messages Hospital at home schemes are a popular alternative to st and ard hospital care , but there is uncertainty about their cost effectiveness In our r and omised controlled trial we compared the cost of hospital at home care with that of inpatient hospital care for patients recovering from hip replacement , knee replacement , and hysterectomy ; elderly medical patients ; and those with chronic obstructive airways disease There were no major differences in health service costs between the two arms of the trial for patients recovering from hip or knee replacement and elderly medical patients Hospital at home care increased healthcare costs for patients recovering from hysterectomy and for those with chronic obstructive airways disease Hospital at home care result ed in some costs shifting to general practitioners for elderly medical patients and those with chronic obstructive airways This paper reports the results of a r and omized experiment that tested the effects and costs of providing so-called homemaker services to a chronically ill population . The concept of homemaker services , as dis ? tinct from professional home health and ther ? apeutic nursing services , originally was de ? veloped for children by welfare agencies in the early part of the century . Later , the focus of such services changed from children to adults , with special emphasis on the chronically ill elderly . In the view of some long-term care specialists , homemaker or home health aide services for the elderly now should be regard ? ed as an accepted supplement to family health care , deserving a legitimate position in a con ? tinuum of care.1'2 Medicare policy has not shared this view . Regulations currently authorize a home health aide to perform personal care and only certain limited household services , which include changing the bed , light cleaning , food shop ? ping , and help in cooking.3 For a patient to receive home health aide services , he or she simultaneously must be receiving skilled nurs ? ing or another skilled service . State Medicaid programs are not required to follow these restrictive regulations , but by choice most state programs do . Separation of professional and therapeutic services from those provided by homemaker-home health aides has been advocated by some research ers and practitioners.4,5 Regrettably , little has been reported on the outcomes and costs of homemaker services , although there has been abundant literature on the efficacy and costs of home health care.6 - This study is part of a project that aim ed to increase the participation of informal caregivers in the hospital care for elderly patients . The staff who worked in the wards that were studied created activity programmes for caregivers and changed their ward policies to encourage the participation of the caregivers . In addition , quality assurance programmes were developed and primary nursing was introduced to ensure individualized , need-based and family centered care . In order to explore the changes in perceived quality of care , and to test the differences in care quality between the study and the control wards ( i.e. two wards in a university hospital , two wards in a geriatric unit and two wards of a nursing home ) , the interrupted time series with a non-equivalent control group time series design was used . During periods of 2 months in 1991 , 1992 and 1993 the data were collected from elderly patients ( n = 97 ) and their informal caregivers ( n = 369 ) using a structured question naire based on need theories . The results indicated that the quality of care was improved , especially in the study wards of the university hospital and of the nursing home . This care quality measure was found to be a useful tool for getting feedback from patients and their caregivers concerning care given . Aspects of nursing practice that needed to be improved were identified ( i.e. poor communication between the patient , their caregiver and staff , and lack of support to the patient and caregiver by staff ) 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 This study compared the functional ability and perceived health status of stroke patients treated by a domiciliary rehabilitation team or by routine hospital-based services after discharge from hospital . Patients discharged from two acute and three rehabilitation hospitals in Nottingham were r and omly allocated in three strata ( Health Care of the Elderly , General Medical and Stroke Unit ) to receive domiciliary or hospital-based care after discharge . Functional recovery was assessed by the Extended Activities of Daily Living ( ADL ) scale three and six months after discharge and perceived health at six months was measured by the Nottingham Health Profile .  A total of 327 eligible patients of 1119 on a register of acute stroke admissions were recruited over 16 months . Overall there were no differences between the groups in their Extended ADL scores at three or six months , or their Nottingham Health Profile scores at six months . In the Stroke Unit stratum , patients treated by the domiciliary team had higher household ( p = 0.02 ) and leisure activity ( p = 0.04 ) scores at six months than those receiving routine care . In the Health Care of the Elderly stratum , death or a move into long-term institutional care at six months occurred less frequently in patients allocated to the routine service , about half of whom attended a geriatric day hospital . Overall there was no difference in the effectiveness of the domiciliary and hospital-based services , although younger stroke unit patients appeared to do better with home therapy while some frail elderly patients might have benefited from day hospital attendance This paper describes a program ( Community Care Program ) in which some elderly hospital patients who were c and i date s for nursing home placement were placed in foster homes . Caregivers were carefully trained and supervised . A total of 112 elderly in patients were r and omly assigned to placement in a nursing home or a foster care home . Patients and caregivers were interviewed at 3 , 6 , 9 , and 12 months after placement . Community Care Program patients were more likely to maintain or improve ADL ( activities of daily living ) and mental status scores . They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients . Nursing home patients had higher life satisfaction , and participated in more social and recreational activities . The Community Care Program was 17 per cent less costly than nursing home care . The results suggest that foster care may be a viable alternative for a segment of the nursing home population Abstract Objective : To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital . Design : Pragmatic r and omised controlled trial . Setting : Acute hospital wards and community in north of Bristol , with a catchment population of about 224 000 people . Subjects : 241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate . Interventions : Patients ' received hospital at home care or routine hospital care . Main outcome measures : Patients ' quality of life , satisfaction , and physical functioning assessed at 4 weeks and 3 months after r and omisation to treatment ; length of stay in hospital and in hospital at home scheme after r and omisation ; mortality at 3 months . Results : There were no significant differences in patient mortality , quality of life , and physical functioning between the two arms of the trial at 4 weeks or 3 months . Only one of 11 measures of patient satisfaction was significantly different : hospital at home patients perceived higher levels of involvement in decisions . Length of stay for those receiving routine hospital care was 62 % ( 95 % confidence interval 51 % to 75 % ) of length of stay in hospital at home scheme . Conclusions : The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability . Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services . Key messages Pressure on hospital beds , the increasing age of the population , and high costs associated with acute hospital care have fuelled the search for alternatives to inpatient hospital care There were no significant differences between early discharge to hospital at home scheme and routine hospital care in terms of patient quality of life , physical functioning , and most measures of patient satisfaction Length of stay for hospital patients was significantly shorter than that of hospital at home patients , but , owing to qualitative differences between the two interventions , this does not necessarily mean differences in effectiveness Early discharge to hospital at home provides an acceptable alternative to routine hospital care in terms of effectiveness and patient A survey was conducted on 1035 persons constituting a semi-r and om age-structured sample of the population s of three areas in the west of Scotl and . The object was to attempt to estimate the needs of this population for domiciliary services . A method was developed of classifying the subjects into 12 ' care groups ' based on two characteristics , those of ' potential need ' and ' solitude ' . ' Potential need ' was a measure of disability and its severity was grade d according to the intervals that elapsed between necessary periods of help . ' Solitude ' was a measure of the time during each day when potential sources of help were spontaneously available . ' Potential need ' was found to be related linearly to age but to be independent of the other variables studied . ' Solitude ' was commonest in the 75 - 84-year age group and varied in the three areas studied , but no relationship with any other variable was detected . An estimate was made of the domiciliary services which would be required to ensure a satisfactory st and ard of care for the subjects in the sample . Assuming present or slightly better levels of hospital provision and slightly lower provision of residential homes there is still a need for a very great increase in domiciliary services if satisfactory st and ards of community care are to be attained The purpose of this study was to compare health status outcomes in three alternative  long-term care setting s in the Veterans Administration : 1 ) home care ; 2 ) community-based nursing home care ; and 3 ) hospital-based nursing home care . Patients were measured on a behavioral index of health status , at two points in time : when transferred from the acute care hospital to one of the three treatment programs ( pretest and three months later ( posttest ) . Since patients could not be r and omly distributed to programs , two methods were employed to control for potential sample selection bias : the choice of a nonequivalent control group design , and multivariate analytic techniques . First , within each program type , patients were r and omly selected from both a hospital that offered only that program as a long-term care alternative and from a hospital that provided all three treatment setting s. Second , multiple regression analysis was used to control for pretest differences among patients . Patients placed in the home care program displayed the greatest mean improvement in functional health status , holding all other variables constant 
    Output:
    
No significant difference was found between the two groups when comparing functioning ( ADL and IADL ) , mental status , attitudes to perceived health , life satisfaction or mortality .
REVIEW ER 'S CONCLUSIONS There is insufficient evidence to estimate the likely benefits , harms and costs of institutional or at-home care for functionally dependent older people