***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: BACKGROUND Family carers of people with dementia frequently report acting abusively toward them and carer psychological morbidity predicts this . We investigated whether START ( STrAtegies for RelaTives ) , a psychological intervention which reduces depression and anxiety in family carers also reduces abusive behavior in carers of people living in their own homes . We also explored the longitudinal course of carer abusive behavior over two year . METHODS We included self-identified family carers who gave support at least weekly to people with dementia referred in the previous year to three UK mental health services and a neurological dementia service . We r and omly assigned these carers to START , an eight-session , manual-based coping intervention , or treatment as usual ( TAU ) .  Carer abusive behavior ( Modified Conflict Tactic Scale ( MCTS ) score ≥2 representing significant abuse ) was assessed at baseline , 4 , 8 , 12 , and 24 months . RESULTS We recruited 260 carers , 173 to START and 87 to TAU . There was no evidence that abusive behavior levels differed between r and omization groups or changed over time . A quarter of carers still reported significant abuse after two years , but those not acting abusively at baseline did not become abusive . CONCLUSION There was no evidence that START , which reduced carer anxiety and depression , reduced carer abusive behavior . For ethical reasons , we frequently intervened to manage concerning abuse reported in both groups , which may have disguised an intervention effect . Future dementia research should include elder abuse as an outcome , and consider carefully how to manage detected abuse Background Current evidence on mental health disorders ( MHDs ) in the U.S. elderly home care population is highly varied and limited to the local level . Aim The objective of this study was to examine the prevalence and characteristics of U.S. elders with MHDs on the national level . Methods This is a primary analysis of secondary use data from a 5 % r and om sample of the 2010 National Outcome and Assessment Information Set ( OASIS ) data spanning a 60-day home care session . MHDs included depression , anxiety , substance abuse , psychotic disorders , aggression , and socially inappropriate behaviors and were identified by diagnosis , symptoms , or mental health service order in the plan of care . Logistic regression was used to identify correlates of MHD . Results The final analysis was conducted on records from 28,475 elderly patients with an average age of 79 ( range 65–110 ) . Patients were primarily female , White , Medicare beneficiaries , referred from short-stay acute hospitals , and living with others at home .  Prevalence of MHDs was approximately 40 % ; depression ( 28.0 % ) and anxiety ( 18.9 % ) were common . Factors associated with MHDs were younger age , female , smokers , frail , living alone , referred from psychiatric hospitals , cognitively or sensory impaired , poorer health status , recent history of falls or multiple hospitalizations , and insufficient social support . Only about one third of patients identified with MHD received mental health services during the 60-day home care episode , including psychiatric nursing services and depression interventions . Discussion MHDs are a national health concern in the older U.S. home care population and are common but largely undermanaged . Future research in the home care sector should be aim ed at developing targeted MHD screening and interventional protocol s and training the current workforce , as well as exp and ing the future workforce to improve psychiatric care for the homebound elderly Paid caregivers possess an essential role in home care services . However , recruitment and retention issues are extensive within this workforce , largely in relation to poor working conditions . This article primarily focuses on the qualitative data extracted from a large r and omised controlled trial in New Zeal and and is supported by some quantitative findings . The aim was to explore paid caregiver perceptions of a restorative home care intervention in comparison with usual home care . The purpose of the qualitative exploration was to gather rich descriptive data that highlight differences between the two services with an emphasis on the workforce viewpoint . Four focus groups were undertaken with paid caregivers , two at baseline ( 4 and 5 participants in the control and intervention groups , respectively ) and two at 14 months ( eight participants in each focus group ) . Focus group data were collected in December 2005 and February 2007 . A general inductive approach was used to analyse focus group transcripts . Two themes emerged from both the control and intervention focus groups : relationship with older people and issues with home care service delivery . A further two themes were pertinent to the intervention group : job satisfaction and preintervention . Findings revealed the intervention had a substantial positive impact on  paid caregiver job satisfaction in comparison with usual care . This appeared to be due to improved training , increased support and supervision , and more flexibility . The intervention result ed in positive changes from the paid caregiver perspective and substantially reduced turnover in comparison with usual home care . However , both groups identified the need for further improvements to their working conditions . In addition , the need to regulate this vulnerable workforce is discussed In our r and omized controlled study , home health aides ( HHAs ) were given in-service training on arthritis in the hope that they would teach their homebound patients with arthritis ways to better manage their activities of daily living . We were unable to demonstrate significant differences in knowledge scores between the experimental and control groups . HHAs ' self-report showed more numerous and frequent arthritis care activities after the in-service training . However , HHAs encountered problems with lack of professional supervision and lack of patient receptivity , which greatly limited HHAs ' ability to add patient teaching to their existing roles Background Support with managing medicines at home is a common reason for older people to receive community nursing services . With population ageing and projected nurse shortages , reliance on nurses may not be sustainable . We developed and tested a new workforce model : ‘ Workforce Innovation for Safe and Effective ( WISE ) Medicines Care ’ , which enabled nurses to delegate medicines support home visits for low-risk clients to support workers ( known as community care aides [ CCAs ] ) . Primary study aims were to assess whether the model increased the number of medicines support home visits conducted by CCAs , explore nurses ’ , CCAs ’ and consumers ’ experiences with the CCAs ’ exp and ed role , and identify enablers and barriers to delegation of medicines support . Methods A prospect i ve before-after mixed- methods study was conducted within a community nursing service that employed a small number of CCAs . The CCAs ’ main role prior to the WISE Medicines Care model was personal care , with a very limited role in medicines support . CCAs received training in medicines support , and nurses received training in assessment , delegation and supervision . Home visit data over two three-month periods were compared . Focus groups and interviews were conducted with purposive sample s of nurses ( n = 27 ) , CCAs ( n = 7 ) and consumers ( n = 28 ) . Results Medicines support visits by CCAs increased from 43/16,863 ( 0.25 % ) to 714/21,552 ( 3.3 % ) ( p < 0.001 ) . Nurses reported mostly positive experiences , and high levels of trust and confidence in CCAs . They reported that delegating to CCAs sometimes eliminated the need for duplicate nurse and CCA visits ( for people requiring personal care plus medicines support ) and enabled them to visit people with more complex needs . CCAs enjoyed their exp and ed role and were accepted by clients and /or carers . Nurses and CCAs reported effective communication when medicine-related problems occurred . No medication incidents involving CCAs were reported . Barriers to implementation included the limited number of CCAs employed in the organisation and reluctance from some nurses to delegate medicines support to CCAs . Enablers included training and support , existing relationships between CCAs and nurses , and positive staff attitudes . Conclusions Appropriately trained and supervised support workers can be used to support community nurses with providing medicines management for older people in the home care setting , particularly for those who are at low risk of adverse medication events or errors . The model was acceptable to nurses , clients and carers , and may offer a sustainable and safe and effective future workforce solution to provision of medicines support for older people in the home care setting Due to the ageing population , there is an increased dem and for home care services . Restorative care is one approach to improving home care services , although there is little evidence to support its use in the community setting . The objective of this trial was to evaluate the impact of a restorative home care service for community-dwelling older people . The study was a cluster r and omised controlled trial undertaken at a home care agency in New Zeal and . The study period was from December 2005 to May 2007 . Older people were interviewed face-to-face at baseline , four and 7 months . A total of 186 older people who received assistance from a home care agency participated in the study , 93 received restorative home care and 93 older people received usual home care .  The primary outcome measure was change in health-related quality of life ( measured by the Short Form 36 [ SF36 ] Health Survey ) . Secondary outcomes were the physical , mental , and social well-being of older people ( Nottingham Extended Activities of Daily Living , Timed Up and Go , Mastery scale , Duke Social Support Index ) . Findings revealed that compared with usual care , the intervention demonstrated a statistically significant benefit in health-related quality of life ( SF36 ) at 7 months for older people ( mean difference 3.8 , 95 % CI -0.0 to 7.7 , P = 0.05 ) . There were no changes in other scale measurements for older people in either group over time . There was a statistically significant difference in the number of older people in the intervention group identified for reduced hours or discharge ( 29 % ) compared with the control group ( 0 % ) ( P < 0.001 ) . In conclusion , a restorative home care service may be of benefit to older people , and improves home care service efficacy BACKGROUND AND OBJECTIVE Frail elderly patients have complex problems that require a multidimensional assessment and a range of treatment goals . Goal Attainment Scaling ( GAS ) measures multiple , individualized goals , but its responsiveness in comparative clinical trials has not been established . METHODS We assessed the responsiveness of GAS in a r and omized , controlled trial of an interdisciplinary Mobile Geriatric Assessment Team ( MGAT ) in 265 rural frail older adults . Sensitivity to change was compared with st and ard measures ; clinical meaningfulness was assessed in relation to a patient and a blinded physician global measure . RESULTS At 3 months follow-up , GAS was the most responsive measure ( st and ardized response mean 1.22 , Norman 's responsiveness statistic 0.58 ) compared with the Barthel Index ( 1.13 , 0.46 ) , Physical Self-Maintenance Scale ( 0.10 , 0.16 , 0.02 ) , Instrumental Activities of Daily Living ( 0.23 , 0.00 ) , and modified Spitzer Quality of Life Index ( -0.04 , 0.00 ) . CONCLUSIONS Only GAS detected clinical ly important change associated with the MGAT intervention in these frail elderly patients . Clinometric measures can offer a responsive means of evaluating complex interventions 
    Output:
    
In the only quantitative study ( a cluster R and omized Controlled Trial ) , rated higher quality , setting meaningful goals , carer training , and supervision improved client health-related quality of life .
In our qualitative synthesis of four studies , intervention elements carers valued were greater flexibility to work to a needs-based rather than a task-based model , learning more about clients , and improved communication with management and other workers .
There is a dearth of evidence regarding effective strategies to improve how home care is delivered to older clients , particularly those with dementia .