human
***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 As more and more elderly people are being cared for in residential and nursing homes , how best can their psychiatric needs be met ? We report on evaluation of a behavioural intervention by an old-age psychiatry hospital outreach team . METHODS This r and omised controlled trial of a training and education intervention over 6 months was done in south Manchester , UK . 12 matched nursing and residential homes were r and omised to the  control or intervention group and within each , the staff selected 10 residents whose behavioural problems made them difficult to care for . Care staff in the intervention homes attended seminars from the hospital outreach team and received weekly visits from a psychiatric nurse to assist in developing care planning skills . The main outcome measures were cognitive impairment and depression , behavioural disturbance , and functional ability , assessed by the geriatric mental state schedule , Crichton Royal behaviour rating scale , and Barthel index , respectively . FINDINGS Residents in the intervention group had significantly improved scores for depression ( before- and -after change difference -0.5 [ 95 % CI -0.8 to -0.1 ] ) and for cognitive impairment ( -0.7 [ -1.1 to -0.2 ] ) but not for behaviour rating or Barthel index .  INTERPRETATION Elderly residents can benefit from improved quality of care achieved by training from a hospital outreach team BACKGROUND Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational . We aim ed to do a large , r and omised comparison of person-centred care , dementia-care mapping , and usual care . METHODS In a cluster r and omised controlled trial , urban residential sites were r and omly assigned to person-centred care , dementia-care mapping , or usual care . Carers received training and support in either intervention or continued usual care . Treatment allocation was masked to assessors . The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory ( CMAI ) . Secondary outcomes included psychiatric symptoms including hallucinations , neuropsychological status , quality of life , falls , and cost of treatment . Outcome measures were assessed before and directly after 4 months of intervention , and at 4 months of follow-up . Hierarchical linear models were used to test treatment and time effects . Analysis was by intention to treat . This trial is registered with the Australia and New Zeal and Clinical Trials Registry , number ACTRN12608000084381 . FINDINGS 15 care sites with 289 residents were r and omly assigned . Pairwise contrasts revealed that at follow-up , and relative to usual care , CMAI score was lower in sites providing mapping ( mean difference 10.9 , 95 % CI 0.7 - 21.1 ; p=0.04 ) and person-centred care ( 13.6 , 3.3 - 23.9 ; p=0.01 ) . Compared with usual care , fewer falls were recorded in sites that used mapping ( 0.24 , 0.08 - 0.40 ; p=0.02 ) but there were more falls with person-centred care ( 0.15 , 0.02 - 0.28 ; p=0.03 ) . There were no other significant effects . INTERPRETATION Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care 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 The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training This study aim ed to investigate the long-term effects of group music therapy on  agitation manifested by nursing home residents with Alzheimer 's disease . A non-r and omised experimental design was employed with one group receiving weekly music therapy ( n = 26 ) and another group receiving st and ard nursing home care ( n = 19 ) .  Agitation levels were measured five times over one year using the Cohen-Mansfield Agitation Inventory ( Cohen-Mansfield , J. ( 1989 ) . Agitation in the elderly . In N. Billig & P. V. Rabins ( Eds . ) , Issues in geriatric psychiatry ( pp . 101–113 ) . Basel , Switzerl and : Karger ) . Although music therapy participants showed short-term reductions in agitation , there were no significant differences between the groups in the range , frequency , and severity of agitated behaviours manifested over time . Multiple measures of treatment efficacy are necessary to better underst and the long-term effects music therapy programs have on this population Objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy with st and ard care in care home residents who have mobility limitations and are dependent in performing activities of daily living . Design Cluster r and omised controlled trial , with r and om allocation at the level of care home . Setting Care homes within the NHS South Birmingham primary care trust and the NHS Birmingham East and North primary care trust that had more than five beds and provided for people in the care categories “ physical disability ” and “ older people . ” Participants Care home residents with mobility limitations , limitations in activities of daily living ( as screened by the Barthel index ) , and not receiving end of life care were eligible to take part in the study . Intervention A targeted three month occupational therapy and physiotherapy programme . Main outcome measures Scores on the Barthel index and the Rivermead mobility index . Results 24 of 77 nursing and residential homes that catered for residents with mobility limitations and dependency for activities of daily living were selected for study : 12 were r and omly allocated to the intervention arm ( 128 residents , mean age 86 years ) and 12 to the control arm ( 121 residents , mean age 84 years ) . Participants were evaluated by independent assessors blind to study arm allocation before r and omisation ( 0 months ) , three months after r and omisation ( at the end of the treatment period for patients who received the intervention ) , and again at six months after r and omisation . After adjusting for home effect and baseline characteristics , no significant differences were found in mean Barthel index scores at six months post-r and omisation between treatment arms ( mean effect 0.08 , 95 % confidence interval −1.14 to 1.30 ; P=0.90 ) , across assessment s ( −0.01 , −0.63 to 0.60 ; P=0.96 ) , or in the interaction between assessment and intervention ( 0.42 , −0.48 to 1.32 ; P=0.36 ) . Similarly , no significant differences were found in the mean Rivermead mobility index scores between treatment arms ( 0.62 , −0.51 to 1.76 ; P=0.28 ) , across assessment s ( −0.15 , −0.65 to 0.35 ; P=0.55 ) , or interaction ( 0.71 , −0.02 to 1.44 ; P=0.06 ) . Conclusions The three month occupational therapy and physiotherapy programme had no significant effect on mobility and independence . On the other h and , the variation in residents ’ functional ability , the prevalence of cognitive impairment , and the prevalence of depression were considerably higher in this sample than expected on the basis of previous work . Further research to clarify the efficacy of occupational therapy and physiotherapy is required if access to therapy services is to be recommended in this population . Trial registration IS RCT Objectives : To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living ( ADL ) and living in residential care facilities . Method : Cluster-r and omized controlled study . Participants were 191 older people , aged 65–100 , dependent in ADL and with Mini Mental State Examination scores between 10 and 30 . One-hundred ( 52 % ) of the participants had a diagnosed dementia disorder . A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups . Sessions were held five times over each two week period for three months , a total of 29 times . The outcome measures , Geriatric Depression Scale ( GDS-15 ) and Philadelphia Geriatric Center Morale Scale ( PGCMS ) were blindly assessed at baseline , three and six months . Results : At baseline , mean ± SD ( range ) for GDS was 4.4 ± 3.2 ( 0–14 ) , and for PGCMS 11.0 ± 3.5 ( 2–17 ) . There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample . Among people with dementia , there was a between-group difference at three months in PGCMS scores in favour of the exercise group . Conclusion : A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities . An individualized and multifactorial intervention may be needed in this group . However , an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia Objective : Reminiscence therapy is a psychological intervention which is specifically design ed to address issues of particular relevance to older adults , such as depression . The latest approach to the research on therapeutic utility of reminiscence is gaining popularity among research ers and practitioners , and has yielded promising results . Specifying different types of reminiscence is a crucial component of the approach . The aim of this study was to examine the therapeutic effectiveness of integrative and instrumental types of reminiscence for the treatment of depression in institutionalized older adults dwelling in a nursing home . Method : The study employed a three-group pre – post-test design with r and om allocation to instrumental or integrative reminiscence or an active social discussion control condition .  Twenty-nine institutionalized older adults ( 12 men and 17 women ) with depressive symptoms varying from mild to severe constituted the sample . The interventions were implemented in a short-form group format . Findings : Analysis of changes from pre-test to post-test revealed that integrative reminiscence therapy led to statistically significant reduction in symptoms of depression in contrast with the control group . Although instrumental reminiscence therapy also reduced depressive symptoms , this improvement was not statistically significant compared to the control group . Conclusion : This study provides additional support for the effectiveness of integrative reminiscence therapy as an intervention for depressed older adults living in residential care setting s. This study also provides support for the hypothesis that certain types of reminiscence produce their own specific effects Abstract Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics . Design Cluster r and omised controlled trial with blinded assessment of outcome . Setting 12 specialist nursing homes for people with dementia in London , Newcastle , and Oxford . Participants Residents of the 12 nursing homes ; numbers varied during the study period . Intervention Training and support intervention delivered to nursing home staff over 10 months , focusing on alternatives to drugs for the management of agitated behaviour in dementia . Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour ( Cohen-Mans 
    Output:
    
agent
***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 As more and more elderly people are being cared for in residential and nursing homes , how best can their psychiatric needs be met ? We report on evaluation of a behavioural intervention by an old-age psychiatry hospital outreach team . METHODS This r and omised controlled trial of a training and education intervention over 6 months was done in south Manchester , UK . 12 matched nursing and residential homes were r and omised to the  control or intervention group and within each , the staff selected 10 residents whose behavioural problems made them difficult to care for . Care staff in the intervention homes attended seminars from the hospital outreach team and received weekly visits from a psychiatric nurse to assist in developing care planning skills . The main outcome measures were cognitive impairment and depression , behavioural disturbance , and functional ability , assessed by the geriatric mental state schedule , Crichton Royal behaviour rating scale , and Barthel index , respectively . FINDINGS Residents in the intervention group had significantly improved scores for depression ( before- and -after change difference -0.5 [ 95 % CI -0.8 to -0.1 ] ) and for cognitive impairment ( -0.7 [ -1.1 to -0.2 ] ) but not for behaviour rating or Barthel index .  INTERPRETATION Elderly residents can benefit from improved quality of care achieved by training from a hospital outreach team BACKGROUND Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational . We aim ed to do a large , r and omised comparison of person-centred care , dementia-care mapping , and usual care . METHODS In a cluster r and omised controlled trial , urban residential sites were r and omly assigned to person-centred care , dementia-care mapping , or usual care . Carers received training and support in either intervention or continued usual care . Treatment allocation was masked to assessors . The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory ( CMAI ) . Secondary outcomes included psychiatric symptoms including hallucinations , neuropsychological status , quality of life , falls , and cost of treatment . Outcome measures were assessed before and directly after 4 months of intervention , and at 4 months of follow-up . Hierarchical linear models were used to test treatment and time effects . Analysis was by intention to treat . This trial is registered with the Australia and New Zeal and Clinical Trials Registry , number ACTRN12608000084381 . FINDINGS 15 care sites with 289 residents were r and omly assigned . Pairwise contrasts revealed that at follow-up , and relative to usual care , CMAI score was lower in sites providing mapping ( mean difference 10.9 , 95 % CI 0.7 - 21.1 ; p=0.04 ) and person-centred care ( 13.6 , 3.3 - 23.9 ; p=0.01 ) . Compared with usual care , fewer falls were recorded in sites that used mapping ( 0.24 , 0.08 - 0.40 ; p=0.02 ) but there were more falls with person-centred care ( 0.15 , 0.02 - 0.28 ; p=0.03 ) . There were no other significant effects . INTERPRETATION Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care 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 The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training This study aim ed to investigate the long-term effects of group music therapy on  agitation manifested by nursing home residents with Alzheimer 's disease . A non-r and omised experimental design was employed with one group receiving weekly music therapy ( n = 26 ) and another group receiving st and ard nursing home care ( n = 19 ) .  Agitation levels were measured five times over one year using the Cohen-Mansfield Agitation Inventory ( Cohen-Mansfield , J. ( 1989 ) . Agitation in the elderly . In N. Billig & P. V. Rabins ( Eds . ) , Issues in geriatric psychiatry ( pp . 101–113 ) . Basel , Switzerl and : Karger ) . Although music therapy participants showed short-term reductions in agitation , there were no significant differences between the groups in the range , frequency , and severity of agitated behaviours manifested over time . Multiple measures of treatment efficacy are necessary to better underst and the long-term effects music therapy programs have on this population Objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy with st and ard care in care home residents who have mobility limitations and are dependent in performing activities of daily living . Design Cluster r and omised controlled trial , with r and om allocation at the level of care home . Setting Care homes within the NHS South Birmingham primary care trust and the NHS Birmingham East and North primary care trust that had more than five beds and provided for people in the care categories “ physical disability ” and “ older people . ” Participants Care home residents with mobility limitations , limitations in activities of daily living ( as screened by the Barthel index ) , and not receiving end of life care were eligible to take part in the study . Intervention A targeted three month occupational therapy and physiotherapy programme . Main outcome measures Scores on the Barthel index and the Rivermead mobility index . Results 24 of 77 nursing and residential homes that catered for residents with mobility limitations and dependency for activities of daily living were selected for study : 12 were r and omly allocated to the intervention arm ( 128 residents , mean age 86 years ) and 12 to the control arm ( 121 residents , mean age 84 years ) . Participants were evaluated by independent assessors blind to study arm allocation before r and omisation ( 0 months ) , three months after r and omisation ( at the end of the treatment period for patients who received the intervention ) , and again at six months after r and omisation . After adjusting for home effect and baseline characteristics , no significant differences were found in mean Barthel index scores at six months post-r and omisation between treatment arms ( mean effect 0.08 , 95 % confidence interval −1.14 to 1.30 ; P=0.90 ) , across assessment s ( −0.01 , −0.63 to 0.60 ; P=0.96 ) , or in the interaction between assessment and intervention ( 0.42 , −0.48 to 1.32 ; P=0.36 ) . Similarly , no significant differences were found in the mean Rivermead mobility index scores between treatment arms ( 0.62 , −0.51 to 1.76 ; P=0.28 ) , across assessment s ( −0.15 , −0.65 to 0.35 ; P=0.55 ) , or interaction ( 0.71 , −0.02 to 1.44 ; P=0.06 ) . Conclusions The three month occupational therapy and physiotherapy programme had no significant effect on mobility and independence . On the other h and , the variation in residents ’ functional ability , the prevalence of cognitive impairment , and the prevalence of depression were considerably higher in this sample than expected on the basis of previous work . Further research to clarify the efficacy of occupational therapy and physiotherapy is required if access to therapy services is to be recommended in this population . Trial registration IS RCT Objectives : To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living ( ADL ) and living in residential care facilities . Method : Cluster-r and omized controlled study . Participants were 191 older people , aged 65–100 , dependent in ADL and with Mini Mental State Examination scores between 10 and 30 . One-hundred ( 52 % ) of the participants had a diagnosed dementia disorder . A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups . Sessions were held five times over each two week period for three months , a total of 29 times . The outcome measures , Geriatric Depression Scale ( GDS-15 ) and Philadelphia Geriatric Center Morale Scale ( PGCMS ) were blindly assessed at baseline , three and six months . Results : At baseline , mean ± SD ( range ) for GDS was 4.4 ± 3.2 ( 0–14 ) , and for PGCMS 11.0 ± 3.5 ( 2–17 ) . There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample . Among people with dementia , there was a between-group difference at three months in PGCMS scores in favour of the exercise group . Conclusion : A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities . An individualized and multifactorial intervention may be needed in this group . However , an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia Objective : Reminiscence therapy is a psychological intervention which is specifically design ed to address issues of particular relevance to older adults , such as depression . The latest approach to the research on therapeutic utility of reminiscence is gaining popularity among research ers and practitioners , and has yielded promising results . Specifying different types of reminiscence is a crucial component of the approach . The aim of this study was to examine the therapeutic effectiveness of integrative and instrumental types of reminiscence for the treatment of depression in institutionalized older adults dwelling in a nursing home . Method : The study employed a three-group pre – post-test design with r and om allocation to instrumental or integrative reminiscence or an active social discussion control condition .  Twenty-nine institutionalized older adults ( 12 men and 17 women ) with depressive symptoms varying from mild to severe constituted the sample . The interventions were implemented in a short-form group format . Findings : Analysis of changes from pre-test to post-test revealed that integrative reminiscence therapy led to statistically significant reduction in symptoms of depression in contrast with the control group . Although instrumental reminiscence therapy also reduced depressive symptoms , this improvement was not statistically significant compared to the control group . Conclusion : This study provides additional support for the effectiveness of integrative reminiscence therapy as an intervention for depressed older adults living in residential care setting s. This study also provides support for the hypothesis that certain types of reminiscence produce their own specific effects Abstract Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics . Design Cluster r and omised controlled trial with blinded assessment of outcome . Setting 12 specialist nursing homes for people with dementia in London , Newcastle , and Oxford . Participants Residents of the 12 nursing homes ; numbers varied during the study period . Intervention Training and support intervention delivered to nursing home staff over 10 months , focusing on alternatives to drugs for the management of agitated behaviour in dementia . Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour ( Cohen-Mans 
    Output:
    