***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 The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients . METHOD This multisite r and omized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics . Primary care patients 65 years old or older ( N=24,930 ) were screened . The final study group consisted of 2,022 patients ( mean age=73.5 years ; 26 % female ; 48 % ethnic minority ) with depression ( N=1,390 ) , anxiety ( N=70 ) , at-risk alcohol use ( N=414 ) , or dual diagnosis ( N=148 ) who were r and omly assigned to integrated care ( mental health and substance abuse providers co-located in primary care ; N=999 ) or enhanced referral to specialty mental health/substance abuse clinics  ( i.e. , facilitated scheduling , transportation , payment ; N=1,023 ) . RESULTS Seventy-one percent of patients engaged in treatment in the integrated model compared with 49 % in the enhanced referral model . Integrated care was associated with more mental health and substance abuse visits per patient ( mean=3.04 ) relative to enhanced referral ( mean=1.91 ) . Overall , greater engagement was predicted by integrated care and higher mental distress . For depression , greater engagement was predicted by integrated care and more severe depression . For at-risk alcohol users , greater engagement was predicted by integrated care and more severe problem drinking . For all conditions , greater engagement was associated with closer proximity of mental health/substance abuse services to primary care . CONCLUSIONS Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics . These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services The purpose of this study was to examine the impact of the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment ( UPBEAT ) Program , an interdisciplinary mental health care management program , on the behavioral health symptoms of elderly veterans . Participants , 60 years and older , included 2637 veterans recruited from medical/surgical units who screened positively for significant depressive or anxiety symptoms and /or at-risk alcohol drinking . Participants were r and omized to UPBEAT or to usual care . Primary outcomes were measured at baseline and at 6 , 12 , and 24 months . Participant nonadherence to the protocol was common and is a major limitation . There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point . Exploratory analyses suggested that among participants with more physical health problems , there were greater improvements in depressive symptoms in those assigned to UPBEAT care . Despite a theoretical and practically sound intervention , participation was low and treatment outcomes , while generally good , appeared unaffected by the addition of the program The purpose of the study was to compare the effectiveness of programmed and intensified intervention on lifestyle changes , including physical activity , cigarette smoking , alcohol consumption and diet , in patients aged ≥ 65 with the usual care of general practitioners ( GP ) . In this multicenter r and omized controlled trial , 738 patients aged ≥ 65 were r and omly assigned to receive intensified intervention ( N = 371 ) or usual care ( N = 367 ) of a GP for lifestyle changes , with 18-month follow-up . The main outcome measures were physical activity , smoking , alcohol consumption and diet . The study was conducted in 59 general practice s in Croatia between May 2008 and May 2010 . The patients ' mean age was 72.3 ± 5.2 years . Significant diet correction was achieved after 18-month follow-up in the intervention group , comparing to controls . More patients followed strictly Mediterranean diet and consumed healthy foods more frequently . There was no significant difference between the groups in physical activity , tobacco smoking and alcohol consumption or diet after the intervention . In conclusion , an 18-month intensified GP 's intervention had limited effect on lifestyle habits . GP intervention managed to change dietary habits in elderly population , which is encouraging since elderly population is very resistant regarding lifestyle habit changes . Clinical trial registration number . IS RCT N31857696 AIMS To examine whether a multi-faceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months . DESIGN R and omized controlled trial . SETTING Three primary care sites in southern California . PARTICIPANTS Six hundred and thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool ( CARET ) were assigned r and omly between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report , booklet on alcohol and aging , drinking diary , advice from the primary care provider and telephone counseling from a health educator at 2 , 4 and 8 weeks . MEASUREMENTS The primary outcome was the proportion of participants meeting at-risk criteria , and secondary outcomes were number of drinks in past 7 days , heavy drinking ( four or more drinks in a day ) in the past 7 days and risk score . FINDINGS At 3 months , relative to controls , fewer intervention group participants were at-risk drinkers [ odds ratio ( OR ) 0.41 ; 95 % confidence interval ( CI ) 0.22 - 0.75 ] ; they reported drinking fewer drinks in the past 7 days [ rate ratio ( RR ) 0.79 ; 95 % CI 0.70 - 0.90 ] , less heavy drinking ( OR 0.46 ; 95 % CI 0.22 - 0.99 ) and had lower risk scores ( RR 0.77 95 % CI 0.63 - 0.94 ) . At 12 months , only the difference in number of drinks remained statistically significant ( RR 0.87 ; 95 % CI 0.76 - 0.99 ) . CONCLUSIONS A multi-faceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers , but does reduce amount of drinking at 12 months BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypertension , diabetes , drug interactions , accidents , and increased rates of emergency department visits and hospitalizations . METHODS A controlled clinical trial ( Project GOAL --Guiding Older Adult Lifestyles ) tested the efficacy of brief physician advice in reducing the alcohol use and use of health care services of older adult problem drinkers . Twenty-four community-based primary care practice s in Wisconsin ( 43 family physicians and internists ) participated in the trial . Of the 6073 patients screened , 105 men and 53 women met inclusion criteria and were r and omized into a control group ( n = 71 ) or an intervention group ( n = 87 ) . Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions that included advice , education , and contracting using a scripted workbook . A total of 146 patients ( 92.4 % ) participated in the 12-month follow-up procedure . RESULTS No significant differences were found between the control and intervention groups at baseline in alcohol use , age , socioeconomic status , depression , onset of alcohol use , smoking status , activity level , or use of mood-altering drugs . The older adults who received the physician intervention demonstrated a significant reduction in 7-day alcohol use , episodes of binge drinking , and frequency of excessive drinking ( P < .005 ) compared with the control group at 3 , 6 , and 12 months after the intervention . There was a 34 % reduction in 7-day alcohol use , 74 % reduction in mean number of binge-drinking episodes , and 62 % reduction in the percentage of older adults drinking more than 21 drinks per week in the intervention group compared with the control group . There were no significant changes in health status . Patterns of health care utilization were not extensively analyzed because of the small number of events . CONCLUSIONS This study provides the first direct evidence that brief physician advice can decrease alcohol use by older adults in community-based primary care practice Objectives The purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and /or at-risk drinking . Material s and Methods Veterans ( N = 97 ) with depression and /or at-risk drinking were identified by systematic screening and assessment . Eligible subjects received either telephone disease management ( TDM ) program or usual care based on r and om assignment of their clinician . The TDM program consisted of regular contacts with each subject by a behavioral health specialist ( BHS ) to assist in assessment , education , support , and treatment planning . Symptomatic outcomes were assessed at 4 months . Results Overall response rates favored those assigned to TDM compared with those assigned to usual care ( 39.1 % responded vs. 17.6 % , p = 0.022 ) . Response rates within the separate diagnostic groups also favored TDM , but this was only significant for depressive disorders . Conclusions Although the sample size was modest and the sample was limited to veterans , findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem . Findings also suggest that a health specialist can focus and manage patients with different diagnoses , thus exp and ing the role beyond just depression care . TDM may be a viable , low-cost , model for primary care clinicians to deliver manual guideline -adherent behavioral health care , especially in a VA clinical setting The authors examined the efficacy of naltrexone as an adjunctive treatment for alcohol dependence in older adults . Forty-four veterans over 50 years of age were enrolled in a 12-week , double-blind , placebo-controlled efficacy study of naltrexone ( the equivalent of 50 mg per day ) . There were no differences in the frequency of any self-reported adverse effects or in liver enzyme values between the placebo- and naltrexone-treated groups . There were no differences between the treatment groups in the number of subjects remaining abstinent or in the number of subjects who relapsed . However , all placebo-treated subjects relapsed after sampling alcohol , whereas only three of six naltrexone-treated subjects met relapse criteria after alcohol exposure ( P = 0.024 ) . The authors conclude that naltrexone was well tolerated and efficacious in preventing relapse in subjects who drank One hundred thirty-seven older alcoholic patients were r and omly assigned to two different inpatient treatment programs at a Veterans Affairs medical center and followed for one year after discharge . The older alcoholic rehabilitation ( OAR ) program was operated by a tolerant staff that specialized in treating elderly alcoholics . Treatment included reminiscence therapy with goals of developing patient self-esteem and peer relationships .  The traditional care program emphasized confrontation to focus on patients ' past failures and present conflicts . Patient care costs were slightly lower ( 2.5 percent lower ) in the OAR program than in the more traditional program , and OAR patients were 2.1 times more likely to report abstinence at one year . Response to the OAR program was best for patients over 60 years of age OBJECTIVE Adherence to treatment has been demonstrated to be an important factor for remission from alcohol dependence . The authors compared therapy and medication adherence for treatment of alcohol dependence in older adults with adherence in younger adults . METHODS All subjects were participants in a r and omized , double-blind , placebo-controlled efficacy trial of naltrexone for the treatment of alcohol dependence . All subjects received a medically-based psychosocial intervention focused on motivating patients to change and on adherence to treatment . The therapy is nonconfrontational and is delivered by a nurse-practitioner . RESULTS Compared with younger adults , older adults had greater attendance at therapy sessions and greater adherence to the medication . Age-group was the only pretreatment factor associated with adherence . The greater adherence in older adults translated to less relapse than in younger adults . CONCLUSION Treatment for alcohol dependence can be effective for older adults . Older adults appear to respond well to a medically-oriented program that is supportive and individualized . In fact , findings from this study suggest that older adults can be treated in mixed-age treatment setting s when psychotherapeutic strategies are used that are age-appropriate and delivered on an individual basis OBJECTIVE The purpose of this study was to examine the effectiveness of a patient-provider educational intervention in reducing at-risk drinking among older adults . METHOD This was a cluster-r and omized controlled trial of 31 primary care providers and their patients ages 60 years and older at a community-based practice with seven clinics . Recruitment occurred from July 2005 to August 2007 . Eligibility was determined by telephone and a baseline mailed survey . A total of 1,186 at-risk drinkers were identified by the Comorbidity Alcohol Risk Evaluation Tool . Follow-up patient surveys were administered at 3 , 6 , and 12 months after baseline . Study physicians and their patients were r and omly assigned to  usual care ( n = 640 patients ) versus the  Project SHARE ( Senior Health and Alcohol Risk Education ) intervention ( n = 546 patients ) , which included personalized reports , educational material s , drinking diaries , physician advice during office visits , and telephone counseling delivered by a health educator . Main outcomes were alcohol consumption , at-risk drinking 
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Our results are counter-intuitive at first instance , but some other authors have found the same results .
In the preparation of this editorial , we found a lack of research in patients who started drinking excessive amounts of alcohol very late in life .
This is in contrast with , for example , a fair amount of research in LOD and at least some research in LOS