***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: A r and omized trial of family caregiver support for the home management of older people suffering from moderate to severe progressive irreversible dementia was conducted in an urban center in southern Ontario . Thirty caregivers were allocated to receive the experimental intervention consisting of : caregiver-focused health care , education about dementia and caregiving , assistance with problem solving , regularly scheduled in-home respite , and a self-help family caregiver support group .  Thirty control subjects received conventional community nursing care . Before completion of the intervention , 18 ( 30 % ) were withdrawn , almost equally from each group . The most frequent reason was long-term institutionalization of the demented relative ( n = 10 ) . At baseline , caregivers in both groups were suffering from above-average levels of depression and anxiety . After the six-month intervention period , we found neither experimental nor control group improved in these areas . However , the experimental group showed a clinical ly important improvement in quality of life , experienced a slightly longer mean time to long-term institutionalization , found the caregiver role less problematic , and had greater satisfaction with nursing care than the control group This investigation evaluates effects of care consultation delivered within a partnership between a managed health care system and Alzheimer 's Association chapter .  Care consultation is a multi-component telephone intervention in which Association staff work with patients and caregivers to identify personal strengths and re sources within the family , health plan , and community . The primary hypothesis is that care consultation will decrease utilization of managed care services and improve psychosocial outcomes . A secondary modifying-effects hypothesis posits benefits will be greater for patients with more severe memory impairment . The sample is composed of managed care patients whose medical records indicate a diagnosis of dementia or memory loss . Patients were r and omly assigned to an intervention group , which was offered care consultation in addition to usual managed care services , or to a control group , which was offered only usual managed care services . Data come from two in-person interviews with patients , and medical and administrative records . Results supporting the primary hypothesis show intervention group patients feel less embarrassed and isolated because of their memory problems and report less difficulty coping . Findings consistent with the modifying-effects hypothesis show intervention group patients with more severe impairment have fewer physician visits , are less likely to have an emergency department visit or hospital admission , are more satisfied with managed care services , and have decreased depression and strain OBJECTIVE To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers . DESIGN Single blind r and omised controlled trial . Assessors were blinded for treatment allocation . SETTING Memory clinic and day clinic of a geriatrics department and participants ' homes . PARTICIPANTS 135 patients aged > or = 65 with mild to moderate dementia living in the community and their primary care givers . INTERVENTIONS 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . MAIN OUTCOME MEASURES Patients ' daily functioning assessed with the assessment of motor and process skills ( AMPS ) and the performance scale of the interview of deterioration in daily activities in dementia ( IDDD ) . Care giver burden assessed with the sense of competence question naire ( SCQ ) . Participants were evaluated at baseline , six weeks , and three months . RESULTS Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls ( differences were 1.5 ( 95 % confidence interval 1.3 to 1.7 ) for the process scale ; -11.7 ( -13.6 to -9.7 ) for the performance scale ; and ( 11.0 ; 9.2 to 12.8 ) for the competence scale ) . This improvement was still significant at three months . The number needed to treat to reach a clinical ly relevant improvement in motor and process skills score was 1.3 ( 1.2 to 1.4 ) at six weeks . Effect sizes were 2.5 , 2.3 , and 1.2 , respectively , at six weeks and 2.7 , 2.4 , and 0.8 , respectively , at 12 weeks . CONCLUSIONS Occupational therapy improved patients '  daily functioning and reduced the burden on the care giver , despite the patients ' limited learning ability . Effects were still present at 12 weeks , which justifies implementation of this intervention . TRIAL REGISTRATION Clinical Trials NCT00295152 [ Clinical Trials.gov ] The purpose oF this study was to examine the eFFects oF 3 behavioral interventions on aFFect and mood in nursing home residents with Alzheimer 's disease . In a pre — post design , 90 residents with Alzheimer 's disease were r and omized to 3 groups : supervised walking , comprehensive exercise ( walking plus strength training , balance , and Flexibility exercises ) , and social conversation ( casual rather than therapeutic themes ) . Interventions were provided 5 days a week and progressed up to 30 minutes per session over 16 weeks . Interventions were conducted primarily indoors . Outcome measures included the Lawton Observed AFFect Scale , Alzheimer Mood Scale , and Dementia Mood Assessment . At posttest , participants receiving comprehensive exercise exhibited higher positive and lower negative aFFect and mood . The social conversation group exhibited the least positive and most negative mood and aFFect . Results suggest that exercise programs be emphasized in long-term care , particularly whole-body involvement rather than walking alone OBJECTIVE To determine the long-term effectiveness of comprehensive support and counseling for spouse-caregivers and families  in postponing or preventing nursing home placement of patients with Alzheimer disease ( AD ) . DESIGN R and omized controlled intervention study . SETTING Outpatient research clinic in the New York City metropolitan area . PARTICIPANTS Referred , volunteer sample of 206 spouse-caregivers of AD patients who enrolled in the study during a 3 1/2-year period . All patients were living at home at baseline and had at least 1 relative living in the area . INTERVENTION Caregivers in the treatment group were provided with 6 sessions of individual and family counseling within 4 months of enrollment in the study and were required to join support groups . In addition , counselors were available for further counseling at any time . MAIN OUTCOME MEASURE Time from enrollment of caregivers in the study to placement of the AD patients in a nursing home . RESULTS Using Kaplan-Meier survival analysis , we estimated that the median time ( weighted average of estimates for male and female caregivers ) from baseline to nursing home placement of AD patients was 329 days longer in the treatment group than in the control group ( z=2.29 ; P=.02 ) . The relative risk ( RR ) from a Cox proportional hazard model of nursing home placement ( intent-to-treat estimate ) after adjusting for caregiver sex , patient age , and patient income was 0.65 ( 95 % confidence interval [ CI ] , 0.45 to 0.94 ; P=.02 ) , indicating that caregivers were approximately two thirds as likely to place their spouses in nursing homes at any point in time if they were in the treatment group than if they were in the control group . Treatment had the greatest effect on risk of placement for patients who were mildly demented ( RR , 0.18 ; 95 % CI , 0.04 to 0.77 ) or moderately demented ( RR , 0.38 ; 95 % CI , 0.17 to 0.82 ) . CONCLUSIONS A program of counseling and support can substantially increase the time  spouse-caregivers are able to care for AD patients at home , particularly during the early to middle stages of dementia when nursing home placement is generally least appropriate Caregivers of persons with Alzheimer 's disease ( AD ) are confronted with novel decision-making tasks that leave them at risk for social isolation . Computer Link is a computer network providing information , communication , and decision-support functions for caregivers of persons with AD . One hundred two AD caregivers participated in a r and omized field experiment to evaluate the effects of ComputerLink on confidence in decision making , decision-making skill , and social isolation . During the 1-year study period , AD caregivers averaged two encounters per week with Computer Link for sessions lasting an average of 13 minutes . Access to Computer Link enhanced caregivers'decision-making confidence . Decision-making skill was unaffected . ComputerLink access did not lead to changes in social isolation as measured by st and ard instruments . The decision-support function was used least often . Postings to ComputerLink 's public bulletin board included both information-seeking and supportive messages . These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint . Design Cost effectiveness study alongside a single blind r and omised controlled trial . Setting Memory clinic , day clinic of a geriatrics department , and participants ’ homes . Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers . Intervention 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment ( that is , a combined patient and care giver outcome measure of clinical ly relevant improvement on process , performance , and competence scales ) at three months after r and omisation . Bootstrap methods used to determine confidence intervals for these measures . Results The intervention cost € 1183 ( £ 848 , $ 1738 ) ( 95 % confidence interval € 1128 ( £ 808 , $ 1657 ) to € 1239 ( £ 888 , $ 1820 ) ) per patient and primary care giver unit at three months . Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were € 1748 ( £ 1279 , $ 2621 ) lower in the intervention group , with the main cost savings in informal care . There was a significant difference in proportions of successful treatments of 36 % at three months . The number needed to treat for successful treatment at three months was 2.8 ( 2.7 to 2.9 ) . Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective , especially in terms of informal care giving Spouse-caregivers of Alzheimer 's disease patients were r and omly assigned to either a treatment group ( individual and family counseling , support group participation , and ad hoc consultation ) or a control group ( only routine support ) . In the first year after intake , the treatment group had less than half as many nursing home placements as the control group . This suggests that a comprehensive counseling program can reduce the socioeconomic impact of Alzheimer 's disease . Nursing home placement also was affected by the patient 's need for assistance with activities of daily living , patient income , and the age of the patients and caregivers OBJECTIVES To test the efficacy of an individualized social activity intervention ( ISAI ) on decreasing daytime sleep , improving nighttime sleep , and lowering the day/night sleep ratio and to determine its cost . DESIGN Pretest/posttest r and omized with an experimental and control group . SETTING Seven nursing homes . PARTICIPANTS One hundred forty-seven residents with dementia . INTERVENTION One to 2 hours of individualized social activities for 21 consecutive days . MEASUREMENTS Twenty-four-hour sleep/wake patterns using an Actigraph . RESULTS The ISAI group had significantly less daytime sleep ( P=.001 ) and a lower day/night sleep ratio ( P=.03 ) than the control group , after adjusting for baseline values . Because 40 % of the sample slept 7 or more hours at night , a secondary analysis was conducted . When only those residents with a sleep efficiency of less than 50 % ( n=50 ) were included , the ISAI group ( n=20 ) had less daytime sleep ( P=.005 ) , a lower day/night sleep ratio ( P=.02 ) , fell asleep faster ( P=.03 ) , and were awake less at night ( P=.04 ) than the control group ( n=30 ) , after adjusting for baseline values . The weekly cost of the ISAI was roughly $ 70 per participant . Initial training and supply costs were $ 1,944 . CONCLUSION The ISAI provides an alternative to medications , without side effects BACKGROUND Individualized problem-solving counseling for caregivers of cognitively impaired relatives is thought to help caregivers cope with the stress and burden of caregiving . Few studies have shown the effectiveness of counseling for these caregivers . OBJECTIVES To determine the effectiveness of individualized problem-solving counseling by nurses for caregivers and the expenditures of health care utilization . METHOD Caregivers ( n = 77 ) of the cognitively impaired living at home were r and omized to receive nurse counseling or not .  Psychosocial adjustment to their relative 's illness , psychological distress , burden , coping skills , and expenditures were measured after 6 months and 1 year . RESULTS Although on average , all caregivers receiving nurse counseling indicated no improvement in psychosocial adjustment to their relative 's illness , psychological distress , or caregiver burden , they found counseling very helpful and it was effective for a subgroup of caregivers . Those with poor logical analysis coping skills at baseline had decreased psychological distress ( F(1,53 ) = 9.7 , p = .003 ) and improved psychosocial adjustment ( F(1,53 ) = 4.7 , p = .035 
    Output:
    
Results : Grade A treatment recommendation was achieved for institutionalization delay ( multicomponent interventions for the caregiver , CG ) .
Grade B recommendation was reached for the person with dementia ( PWD ) for : improvement in cognition ( cognitive training , cognitive stimulation , multicomponent interventions for the PWD ) ; activities of daily living ( ADL ) ( ADL training , multicomponent interventions for the PWD ) ; behavior ( cognitive stimulation , multicomponent interventions for the PWD , behavioral interventions , professional CG training ) ; mood ( multicomponent interventions for the PWD ) ; QoL ( multicomponent interventions for PWD and CG ) and restraint prevention ( professional CG training ) ; for the CG , grade B was also reached for : CG mood ( CG education , CG support , multicomponent interventions for the CG ) ; CG psychological well-being ( cognitive stimulation , multicomponent interventions for the CG ) ; CG QoL ( multicomponent interventions for PWD and CG ) .
Conclusion : NPTs emerge as a useful , versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG