***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: Objective . To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent disability in an elderly population . Design . R and omized , controlled trial with intention-to-treat and subgroup analyses . Subjects and setting . All home-dwelling persons aged 85 years or older in the City of Oulu ( n = 555 , 67 % ) , including 486 persons with a history of recurrent falls or at least one risk factor for disability in the activities of daily living ( ADL ) or mobility . Interventions . Programme consisting of home exercise , walking exercise , group exercise , and self-care exercise . Main outcome measures . Change in ADL and mobility during the intervention . Results . Change in ADL performance did not differ ( p = 0.462 ) but a positive change was found in mobility performance ( p = 0.013 ) in the intervention subjects ( n = 243 ) compared with the controls ( n = 243 ) . At the end of the intervention period , severe mobility restrictions existed similarly in intervention and control subjects : 48 ( 34 % ) and 46 ( 31 % ) ( p = 0.650 ) respectively . Frequency of admissions into long-term institutional care were similar in intervention and control groups : 15 ( 7 % ) and 13 ( 6 % ) ( p = 0.669 ) . Impaired balance existed in fewer intervention subjects ( 64 , 45 % ) than controls ( 89 , 59 % ) ( p = 0.015 ) . Frequency and times of home exercise activity reduced in control subjects ( p < 0.001 ) but did not change in subjects assigned to home exercise intervention ( p > 0.05 ) . Conclusion . A pragmatic intervention slowed down the reduction of movement performance but positive effects could not be found in subjects with severe movement and any ADL dysfunction . Positive effects were also found in balance performance Objective To evaluate the effects of the population -based , person-centred and integrated care service ‘ Embrace ’ at twelve months on three domains comprising health , wellbeing and self-management among community-living older people . Methods Embrace supports older adults to age in place . A multidisciplinary team provides care and support , with intensity depending on the older adults ’ risk profile . A r and omised controlled trial was conducted in fifteen general practice s in the Netherl and s. Older adults ( ≥75 years ) were included and stratified into three risk profiles : Robust , Frail and Complex care needs , and r and omised to Embrace or care as usual ( CAU ) . Outcomes were recorded in three domains . The EuroQol-5D-3L and visual analogue scale , INTERMED for the Elderly Self- Assessment , Groningen Frailty Indicator and Katz-15 were used for the domain ‘ Health . ’ The Groningen Well-being Indicator and two quality of life questions measured ‘ Wellbeing . ’ The Self-Management Ability Scale and Partners in Health scale for older adults ( PIH-OA ) were used for ‘ Self-management . ’ Primary and secondary outcome measurements differed per risk profile . Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses , for the whole sample and per risk profile . Results 1456 eligible older adults participated ( 49 % ) and were r and omized to Embrace ( n(T0 ) = 747 , n(T1 ) = 570 , mean age 80.6 years ( SD 4.5 ) , 54.2 % female ) and CAU ( n(T0 ) = 709 , n(T1 ) = 561 , mean age 80.8 years ( SD 4.7 ) , 55.6 % female ) . Embrace participants showed a greater – but clinical ly irrelevant – improvement in self-management ( PIH-OA Knowledge subscale effect size [ ES ] = 0.14 ) , and a greater – but clinical ly relevant – deterioration in health ( ADL ES = 0.10 ; physical ADL ES = 0.13 ) compared to CAU . No differences in change in wellbeing were observed . This picture was also found in the risk profiles . Complete case analyses showed comparable results . Conclusions This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health , wellbeing and self-management in community-living older adults Purpose To identify correlates of  self-rated and caregiver-rated quality of life ( QOL )  in community-residing persons with dementia ( PWD ) for intervention development . Methods Cross-sectional data of 254 PWD and their caregivers participating in a clinical trial were derived from in-home assessment s.  Self-rated QOL  was measured with the  Quality of Life-Alzheimer Disease ( QOL-AD ) scale  , and  caregiver-rated QOL  was measured using the  QOL-AD  and  Alzheimer Disease-Related Quality of Life ( ADRQL ) scales . Multivariate modeling identified correlates of the PWD ’ QOL . Results Self-rated QOL was related significantly to participant race , unmet needs , depression , and total medications . Caregiver-rated QOL-AD scores were significantly associated with participant function , unmet needs , depression , and health problems and with caregiver burden and self-rated health . Significant correlates of ADRQL scores included neuropsychiatric symptom severity , functional and cognitive impairment , and caregiver burden and depression . Conclusions Correlates of QOL in community-residing PWD depend on who rates the PWD ’s QOL and which measure is used . Addressing health problems , medication use , and dementia-related unmet needs , reducing functional dependency , and treating neuropsychiatric symptoms in PWD , while reducing caregiver burden and depression , may maximize QOL in those with dementia Background Case management has been applied in community aged care to meet frail older people ’s holistic needs and promote cost-effectiveness . This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes . Methods We search ed Web of Science , Scopus , Medline , CINAHL ( EBSCO ) and PsycINFO ( CSA ) from inception to 2011 July . Inclusion criteria were : no restriction on date , English language , community-dwelling older people and /or carers , case management in community aged care , published in refereed journals , r and omized control trials ( RCTs ) or comparative observational studies , examining client or carer outcomes . Quality of studies was assessed by using such indicators as quality control , r and omization , comparability , follow-up rate , dropout , blinding assessors , and intention-to-treat analysis . Two review ers independently screened potentially relevant studies , extracted information and assessed study quality . A narrative summary of findings were presented . Results Ten RCTs and five comparative observational studies were identified . One RCT was rated high quality . Client outcomes included mortality ( 7 studies ) , physical or cognitive functioning ( 6 studies ) , medical conditions ( 2 studies ) , behavioral problems ( 2 studies ) , unmet service needs ( 3 studies ) , psychological health or well-being ( 7 studies ) , and satisfaction with care ( 4 studies ) , while carer outcomes included stress or burden ( 6 studies ) , satisfaction with care ( 2 studies ) , psychological health or well-being ( 5 studies ) , and social consequences ( such as social support and relationships with clients ) ( 2 studies ) . Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group , while all the three studies consistently reported fewer unmet service needs among the intervention participants . In contrast , available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden . There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above . Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs . Future studies should investigate what specific components of case management are crucial in improving clients and their carers ’ outcomes OBJECTIVE To verify the efficacy of a multidimensional preventive programme on functional decline of older people .  DESIGN R and omized controlled trial . SETTING Community of Sherbrooke City , Quebec , Canada . SUBJECTS A representative sample of individuals aged over 75 living at home and identified to be at risk of functional decline by postal question naire ( n = 503 ) . INTERVENTION Subjects r and omized to the study group ( n = 250 ) were assessed at home by a nurse on 12 dimensions ( including medication , depressive mood , risk of falls , hearing ) . A report of the assessment was sent to the general practitioner with recommendations for interventions . A monthly telephone contact was carried out by the nurse for surveillance and to verify if the recommendations had been applied . METHODS The primary outcome --functional decline -- was defined as either death , admission to an institution or increase of > or = 5 points on the disability score of the Functional Autonomy Measurement System ( SMAF ) scale during the reference year . Secondary outcomes were functional autonomy ( on the SMAF ) , well-being ( General Well-being Schedule ) , perceived social support ( Social Provisions Scale ) and use of health care services . RESULTS Of the 494 subjects who completed the study , 48 ( 19.6 % ) of 245 in the study group and 49 ( 19.7 % ) of 249 in the control group had functional decline ( relative risk 1.00 ; 95 % confidence interval 0.82 - 1.23 ) . There were no differences between the groups in all secondary outcomes . CONCLUSIONS This study confirms the inefficacy of multidimensional programmes for preventing functional decline in the older population . More effort should be devoted to improving the efficacy of specific interventions for conditions causing functional decline OBJECTIVES To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services . DESIGN R and omized controlled trial . SETTING Community-dwelling couples with one spouse caring for the other spouse with dementia . PARTICIPANTS Couples with dementia ( N=125 ) were allocated at r and om to the intervention ( n=63 ) or control group ( n=62 ) . INTERVENTION Intervention couples were provided with a multicomponent intervention program with a family care coordinator , a geriatrician , support groups for caregivers , and individualized services . MEASUREMENTS Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples . RESULTS At 1.6 years , a larger proportion in the control group than in the intervention group was in long-term institutional care ( 25.8 % vs 11.1 % , P=.03 ) . At 2 years , the difference was no longer statistically significant . The 2-year adjusted hazard ratio for the intervention group was 0.53 ( 95 % confidence interval (CI)=0.23 - 1.19 , P=.12 ) . Intervention led to reduction in use of community services and expenditures . The difference for the benefit of intervention group was -7,985 Euro ( 95 % CI=-16,081 to -1,499 , P=.03 ) . When the intervention costs were included , the differences between the groups were not significant . CONCLUSION Although the intervention did not result in a significant difference in the need for institutional care after 2 years , individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services Objectives The aim was to evaluate the effects of integrated home care and discharge practice on the functional ability ( FA ) and health-related quality of life ( HRQoL ) of home care patients . Methods A cluster r and omised trial ( CRT ) with Finnish municipalities ( n=22 ) as the units of r and omisation . At baseline the sample included 669 patients aged 65 years or over . Data consisted of interviews ( at discharge , and at 3-week and 6-month follow-up ) , medical records and care registers . The intervention was a generic prototype of care/case management- practice ( IHCaD- practice ) that was tailored to municipalities needs . The aim of the intervention was to st and ardize practice s and make written agreements between hospitals and home care administrations , and also within home care and to name a care/case manager pair for each home care patient . The main outcomes were HRQoL — as measured by a combination of the Nottingham Health Profile ( NHP ) and the EQ-5D instrument for measuring health status— and also Activities of Daily Living ( ADL ) . All analyses were based on intention-to-treat . Results At baseline over half of the patient population perceived their FA and HRQoL as poor . At the 6-month follow-up there were no improvements in FA or in EQ-5D scores , and no differences between groups . In energy , sleep , and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups . In the 3-week follow-up , physical mobility was higher in the trial group . Conclusions Although the effects of the new practice did not improve the patients ' FA and HRQoL , except for physical mobility at the 3-week follow-up , the workers thought that the intervention worked in practice . The intervention st and ardised practice s and helped to integrate services . The intervention was focused on staff activities and through the changed activities also had an effect on patients . It takes many years to achieve permanent changes in every worker 's individual practice and it is also likely that changes in working practice s would be visible before effects on patients . The use of other outcome measures , such as the use of services , may be clearer in showing a positive impact of the intervention rather than FA or OBJECTIVES To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders . DESIGN 18-month 
    Output:
    
Complex interventions did not have a significantly different effect on mortality .
Conclusions Where the goal is to avoid residential aged care admission for people with or without dementia , there is evidence for multifactorial , individualised community programs .
The evidence suggests these interventions do not result in greater mortality and hence are safe .