***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 Weight loss is a common problem in patients with Alzheimer 's Disease ( AD ) . It is a predictive factor of mortality and it decreases patients ' and caregivers ' quality of life . OBJECTIVE To determine if a nutritional education program can prevent weight loss in AD patients . SUBJECTS 151 AD patients and their caregivers were enrolled to follow the intervention and 74 AD patients and their caregivers constituted a control group . METHOD Caregivers in the intervention group followed 9 nutritional sessions of one hour each , over one year . Caregivers in the control group did n't follow any sessions but were offered advice provided in a normal follow-up . Patients weight , nutritional state , cognitive function , autonomy , mood , behaviour disorders at baseline and at 6- and 12-month follow-up . Caregivers burden , nutritional and AD knowledge at the baseline and at the 12-month follow-up . RESULTS During the year follow-up , the mean weight increased in the intervention group ( 0.7+/-3.6 kg ) whereas it decreased in the control group ( -0.7+/-5.4 kg ) ( p<0.05 ) . The nutritional status ( MNA ) was maintained in the intervention group ( 0.3+/-2.6 ) whereas it decreased significantly in the control group ( -1.0+/-3.4 ) ( p<0.005 ) . After adjustment for baseline differences between the two groups ( caregiver age , nutritional state , eating behaviour disorders , depression ) , the weight change between the two groups was not significant ( 0.6+/-0.4 kg vs. -0.6+/-0 . 6 kg respectively in intervention group and control group ) . However , the percentage of patients with significant weight loss is decreased . The MMSE change became significant between the two groups : -2.3+/-0.3 vs. -3.4+/-0.4 respectively in intervention group and control group ( p<0.05 ) . CONCLUSIONS These results suggest that a nutritional educational program intended for caregivers of AD patients could have a positive effect on patients weight and cognitive function The long-term effectiveness of a structured health education program ( HEP ) for spouses and frail older adults was evaluated in a staff model health maintenance organization ( HMO ) . HEP is a multicomponent group program that includes emotion-focused and problem-focused coping strategies , education , and support . For caregivers , HEP was more effective than usual care ( UC ) in reducing depression , increasing knowledge of community services and how to access them , and changing caregivers ' feelings of competence and the way they respond to the caregiving situation . For care recipients , HEP was more effective than UC in preventing increases in somatic symptoms and symptoms of anxiety/insomnia . ( ( c ) 2004 APA , all rights reserved UNLABELLED This study examines the change in health-related quality of life ( HRQoL ) among ( > or = 60 years ) elderly persons as a result of health education intervention . A community-based intervention study was performed in eight r and omly selected villages ( INTERVENTION n = 4 ; CONTROL n = 4 ) in rural Bangladesh . A total of 1135 elderly persons was selected for this study . The analyses include 839 participants ( INTERVENTION n = 425 ; CONTROL n = 414 ) who participated in both baseline and post-intervention surveys . Participants in the intervention area were further stratified into compliant ( n = 315 ) and non-compliant ( n = 110 ) groups based on the reported compliance to the intervention activities . The intervention includes , for example , physical activity , advice on healthy food intake and other aspects of management . To create an enabling environment , social awareness was provided by means of information about the contribution of and challenges faced by elderly persons at home and the community , including information about elderly persons ' health and health care . The intervention activities were provided to the elderly persons , caregivers , household members and community people for 15 months . The HRQoL was assessed using a multi-dimensional generic instrument design ed for elderly persons . Multivariate analyses revealed that in the non-compliant group the probabilities of increased scores were less likely in overall HRQoL ( OR 0.52 , 95 % CI 0.32 - 0.82 ) . Among the CONTROL group , increased scores were less likely in the physical ( OR 73 , 95 % CI 0.54 - 0.99 ) , social ( OR 0.37 , 95 % CI 0.27 - 0.50 ) , spiritual ( OR 0.60 , 95 % CI 0.34 - 0.94 ) , environment ( OR 0.36 , 95 % CI 0.26 - 0.49 ) dimensions and overall HRQoL ( OR 0.44 , 95 % CI 0.32 - 0.59 ) ( adjusted for age , sex , literacy , marital status and economic status ) . This study concludes that provision of community-based health education intervention might be a potential public health initiative to enhance the HRQoL in old age Objective To assess the effectiveness of health and nutrition program ( NutriAlz ) versus usual care on functional level in elderly people with dementia living at home , as well as on clinical practice related to nutrition and on the caregiver ’s burden . Design Cluster r and omized multi-centre study with one-year follow-up . Setting 11 Alzheimer out patients and day care centres ( Barcelona , Spain ) . Participants Nine hundred and forty six home-living Alzheimer patients with identified caregiver were consecutively recruited ( intervention group : 6 centres , 448 patients vs control group : 5 centres , 498 patients ) .InterventionThe intervention was a teaching and training intervention on health and nutrition program , NutriAlz , directed both to physician and main caregiver , as well as persons affected by Alzheimer ’s disease or other dementias , including a st and ardised protocol for feeding and nutrition . Main Outcome Measures The main outcome measure was the reduction in the loss of autonomy ( Activities of daily living ( ADL/IADL ) scales ) assessed at 6 and 12 months . Secondary outcomes measures were Improvement in nutritional status ( Mini Nutritional Assessment ( MNA ) , BMI , and weight changes ) , and caregiver burden ( Zarit scale ) . Results The one-year assessment was completed for 293 patients ( 65.4 % ) in the intervention group and 363 patients ( 72.9 % ) in the control group  ( usual care ) . The annual rate of ADL change was −0.83 vs −0.62 ( p=0.984 ) , and the caregiver ’s subjective burden 0.59 vs 2.36 ( p=0.681 ) in intervention and control group , respectively . MNA , however , showed an improvement ( + 0.46 vs −0.66 , p=0.028 ) , suggesting an effective nutritional behaviour . Conclusion The NutriAlz program had no effect on functional decline in Alzheimer disease patients living at home over one year , but reduced the risk for malnutrition , as recommendations concerning diet and exercise were provided OBJECTIVE To evaluate the impact of nutritional supplementation on nutritional status , muscle strength , perceived health , and functional status in a population of community-living , frail , undernourished elderly people . DESIGN A 16-week intervention study in which subjects were r and omized to an experimental or a control group and visited in their home on a monthly basis . Outcome variables were measured at the start and end of the study at subjects ' homes by a dietitian blinded to treatment assignment . SUBJECTS/ SETTING 83 elderly people ( experimental group : n=42 ; control group : n=41 ; mean age=80+/-7 years ) receiving community home-care services and at high risk for undernutrition . INTERVENTION Provision of a nutrient-dense protein-energy liquid supplement and encouragement to improve intake from other foods . OUTCOME MEASURES Anthropometric indexes , h and grip strength , isometric elbow flexion and leg extension strength , lower extremity function , perceived health , and functional status . STATISTICAL ANALYSES Study groups were compared on an " intention to treat " basis using analysis of variance for repeated measures and unpaired and paired t tests and their nonparametric equivalents where appropriate . RESULTS Total energy intake ( 1,772 vs 1,440 kcal ; P<.001 ) and weight gain ( 1.62 vs 0.04 kg ; P<.001 ) were higher in the supplemented group . No significant changes were observed with respect to other anthropometric indexes , muscle strength , or functional variables ; however , beneficial effects were observed in emotional role functioning ( P<0.01 ) and number of days spent in bed ( P=.04 ) . APPLICATIONS/ CONCLUSIONS Nutrition intervention is feasible in free-living , frail , undernourished elderly people and results in significant improvement of nutritional status with respect to energy and nutrient intake and weight gain . Weight loss can be stopped and in some cases reversed ; however , increased physical activity may also be required to improve health and functional status OBJECTIVES To study the effects of oral nutritional supplements ( OS ) on body weight , body composition , nutritional status , and cognition in elderly patients with Alzheimer 's disease ( AD ) . DESIGN Prospect i ve , r and omized , controlled study . SETTING Geriatric wards and day care centers in the Toulouse area , France . PARTICIPANTS Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment . INTERVENTION After r and omization , 46 patients ( intervention group ) received 3-month OS . The other 45 patients ( control group ) received usual care . MEASUREMENTS Weight , body composition ( evaluated using dual-energy x-ray absorptiometry ) , cognitive function , activities of daily living , eating behavior , and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months . Supplement compliance was recorded each day . RESULTS Between baseline and 3 months , energy and protein intakes significantly improved in the intervention group , result ing in a significant increase in weight and fat-free mass , but no significant changes were found for dependence , cognitive function , or biological markers . The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months . CONCLUSION Three-month daily OS significantly improves body weight . It is practicable and effective , and the patients accepted it well . The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD . Moreover , regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients BACKGROUND & AIMS Undernourished patients have an increased risk of complications and a prolonged hospital stay , compared to those who are not undernourished . The aim of this study was to evaluate the effect of nutritional intervention in a r and om sample of hospitalized patients at nutritional risk . METHODS A r and omized , controlled trial of  nutritional intervention in 212 patients . Intervention consisted of a specialized nutritional team ( nurse and dietician ) who attended patients and staff for motivation , detailed a nutritional plan , assured delivery of prescribed food and gave advice on enteral or parenteral nutrition when appropriate . The control group received the st and ard regime used in the department . The primary endpoint was the part of the length of stay ( LOS ) that was considered to be sensitive to nutritional support , design ated LOSNDI . The nutritional discharge index ( NDI ) consists of three objective criteria : ( 1 ) the patient is able to manage toilet visits without assistance , reflecting mobilization ; ( 2 ) the patient is without fever ( tp < 38 degrees C ) , reflecting absence of infection ; and ( 3 ) the patient has no intravenous access , reflecting absence of complications in general . On the day when all three criteria were fulfilled , hospital stay was no longer considered to be sensitive to nutritional support . Actual LOS is also reported . Incidence and severity of complications were recorded to explain LOSNDI findings . As a secondary endpoint , quality of life was evaluated by the Short Form 36 ( SF-36 ) question naire . RESULTS Intervention led to an intake of > or = 75 % of requirements in 62 % of the intervention patients , as compared to 36 % of the control patients . Rates of complications , mean LOSNDI and LOS were not significantly different between the two study groups . However , among patients with complications a difference in LOSNDI between intervention patients ( 14 + /- 2 days , mean + /- SE ) and control patients ( 20 + /- 2 days ) was statistically significant ( P = 0.015 ) . In the same patients , LOS was 17 + /- 2 days in the intervention group and 22 + /- 2 days in the control group ( P = 0.028 ) . The SF-36 question naire did not show a significant effect of treatment . CONCLUSIONS Protein and energy intake of nutritionally at-risk patients was increased which result ed in shortening of the part of the length of stay that was considered to be sensitive to nutritional support ( LOSNDI ) and shorter length of stay ( LOS ) among patients with complications 
    Output:
    
Conclusion Interventions targeted at identifying , preventing and /or treating malnutrition were able to improve or prevent decline in nutritional and functional status , without increasing informal carer burden .
The findings of this review support the involvement of non- clinical community care workers and informal carers as part of the nutritional care team for community-dwelling older adults