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: PURPOSE Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy . SUBJECTS AND METHODS A prospect i ve , controlled , rater-blinded , clinical trial with two follow-ups was conducted as part of a larger cluster-r and omized trial in 18 nursing homes in Berlin . n=117 dementia patients with apathy , defined as a score of 40 or more on the apathy evaluation scale ( AES ) or presence of apathy on the Neuropsychiatric Inventory ( NPI )  , were r and omly assigned to intervention or control group . The intervention included 10 months of brief activities , provided once a week . The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months . RESULTS We found significant group differences with respect to apathy during the 10 month intervention period ( F2,82=7.79 , P<0.01 ) , which reflected an increase in apathy in the control group , but not in the intervention group . Within one year after the intervention was ceased , the treatment group worsened and no longer differed significantly from the control group ( P=0.55 ) . CONCLUSIONS Our intervention was effective for the therapy of apathy in dementia , when applied , but not one year after cessation of therapy OBJECTIVES To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia . DESIGN Cluster r and omized controlled trial . SETTING Twenty-four nursing homes in North Carolina . PARTICIPANTS Residents with advanced dementia and feeding problems and their surrogates . INTERVENTION Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia . Controls received usual care . MEASUREMENTS Primary outcome was the Decisional Conflict Scale ( range : 1 - 5 ) measured at 3 months ; other main outcomes were surrogate knowledge , frequency of communication with providers , and feeding treatment use . RESULTS Two hundred fifty-six residents and surrogate decision-makers were recruited . Residents ' average age was 85 ; 67 % were Caucasian , and 79 % were women . Surrogates ' average age was 59 ; 67 % were Caucasian , and 70 % were residents ' children . The intervention improved knowledge scores ( 16.8 vs 15.1 , P < .001 ) . After 3 months , intervention surrogates had lower Decisional Conflict Scale scores than controls ( 1.65 vs 1.90 , P < .001 ) and more often discussed feeding options with a healthcare provider ( 46 % vs 33 % , P = .04 ) . Residents in the intervention group were more likely to receive a dysphagia diet ( 89 % vs 76 % , P = .04 ) and showed a trend toward greater staff eating assistance ( 20 % vs 10 % , P = .08 ) . Tube feeding was rare in both groups even after 9 months ( 1 intervention vs 3 control , P = .34 ) . CONCLUSION A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers OBJECTIVES This article describes results of a r and omized controlled trial comparing a time-limited  early-stage memory loss ( ESML )  support group program conducted by a local Alzheimer 's Association chapter to a wait-list ( WL ) control condition . METHODS One hundred and forty-two dyads were r and omized in blocks to ESML ( n = 96 ) or WL ( n = 46 ) . Mean age of participants was 74.9 years , and mean Mini-Mental State Examination was 23.4 . The primary outcome was participant 's quality of life ; secondary outcomes included mood , family communication , and perceived stress . RESULTS On the intent-to-treat ( ITT ) pre-post analysis , significant differences were seen in participant quality of life ( p < .001 ) , depression ( p < .01 ) , and family communication ( p < .05 ) . Within the care partner groups , there was no significant difference between ESML and WL in the ITT analysis . A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems ( p < .05 ) , improved family communication ( p < .05 ) , self-efficacy ( p < .01 ) , Medical Outcomes Study short form ( SF-36 ) role-emotional ( p < .05 ) , SF-36 social functioning ( p < .05 ) , and SF-36 mental health components ( p < .01 ) in improvers . DISCUSSION These results support the efficacy of ESML support groups for individuals with dementia BACKGROUND There is good evidence of the positive effects of person-centered care ( PCC ) on agitation in dementia . We hypothesized that a person-centered environment ( PCE ) would achieve similar outcomes by focusing on positive environmental stimuli , and that there would be enhanced outcomes by combining PCC and PCE . METHODS 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified , then r and omized to one of four intervention groups : ( 1 ) PCC ; ( 2 ) PCE ; ( 3 ) PCC + PCE ; ( 4 ) no intervention .  People with dementia , over 60 years of age and consented were eligible . Co- outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation , emotional responses in care , quality of life and depression , and care interaction quality . RESULTS From 38 homes r and omized , 601 people with dementia were recruited . At follow-up the mean change for quality of life and agitation was significantly different for PCE ( p = 0.02 , p = 0.05 , respectively ) and PCC ( p = 0.0003 , p = 0.002 respectively ) , compared with the non-intervention group ( p = 0.48 , p = 0.93 respectively ) . Quality of life improved non-significantly for PCC+PCE ( p = 0.08 ) , but not for agitation ( p = 0.37 ) . Improvements in care interaction quality ( p = 0.006 ) and in emotional responses to care ( p = 0.01 ) in PCC+PCE were not observed in the other groups . Depression scores did not change in any of the groups . Intervention compliance for PCC was 59 % , for PCE 54 % and for PCC+PCE 66 % . CONCLUSION The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported , even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group . The Australian New Zeal and Clinical Trials Registry Number is ACTRN 12608000095369 OBJECTIVES To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders . DESIGN 18-month r and omized controlled trial of 303 community-living elders . SETTING 28 postal code areas of Baltimore , MD . PARTICIPANTS Age 70 + years , with a cognitive disorder , community-living , English-speaking , and having a study partner available . INTERVENTION 18-month care coordination intervention to systematic ally identify and address dementia-related care needs through individualized care planning ; referral and linkage to services ; provision of dementia education and skill-building strategies ; and care monitoring by an interdisciplinary team . MEASUREMENTS Primary outcomes were time to transfer from home and total percent of unmet care needs at 18 months . RESULTS Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37 % ( Hazard ratio : 0.63 , 95 % Confidence Interval : 0.42 - 0.94 ) compared with control participants . Although there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months , the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls . Intervention participants had a significant improvement in self-reported quality of life ( QOL ) relative to control participants . No group differences were found in proxy-rated QOL , neuropsychiatric symptoms , or depression . CONCLUSIONS A home-based dementia care coordination intervention delivered by non- clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home , reduced unmet needs , and improved self-reported QOL Objectives : The Enriched Opportunities Programme ( EOP ) is a multi-level intervention focussing on improved quality of life for people with dementia . This study compared the experience of people living with dementia and other mental health problems in extra care housing schemes that utilised EOP with schemes that employed an active control intervention . Method : Ten extra care housing schemes were cluster r and omised to receive either the EOP intervention or an active control intervention for an 18-month period . Residents with dementia or other significant mental health problems ( 20–30 per scheme ) were assessed on a number of outcome measures at baseline , six months , one year and 18 months . The primary outcome measure was quality of life . Self-reported depression was an important secondary outcome . Results : The EOP-participating residents rated their quality of life more positively over time ( 4.0 ( SE 0.6 ) units ; 14 % p < 0.001 ) than the active control ( 1.3 ( SE 0.6 ) units ; 4 % p = 0.003 ) . There was also a significant group – time interaction for depressive symptoms ( p = 0.003 ) . The EOP-participating residents reported a reduction of 25 % at both six and 12 months and a 37 % reduction at 18 months ( all p 's < 0.001 ) . EOP residents were less likely than residents in the active control sites to move to a care home or to be admitted to a hospital inpatient bed . They were more likely to be seen by a range of community health professionals . Conclusion : The EOP had a positive impact on the quality of life of people with dementia in well-staffed extra care housing schemes OBJECTIVES This r and omized controlled study tested the effectiveness of individualized activities , led by certified nursing assistants ( CNAs ) , to increase positive and reduce negative affect and behavior among nursing home residents with dementia . METHOD Nursing home residents with mild to advanced dementia ( N = 180 ) were r and omly assigned to usual care ( UC , n = 93 ) or 1 of 2 experimental conditions . Residents in the attention control group ( AC , N = 43 ) participated in st and ardized one-to-one activities with their CNAs . Individualized Positive Psychosocial Intervention ( IPPI ) participants ( n = 44 ) received a CNA-led activity matched to their interests and ability . Outcomes were residents ' positive and negative affect and verbal and nonverbal behavior . RESULTS The IPPI and AC groups experienced similar benefits -more pleasure , alertness , engagement , positive touch , and positive verbal behavior-compared with UC . The AC group displayed more anger , uncooperativeness , and very negative verbal behavior than UC or IPPI . DISCUSSION This study demonstrates the value of individualized activities for nursing home residents with dementia . In a stringent test , residents were happier and less angry during a customized intervention compared with a st and ardized intervention . Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia OBJECTIVE To compare a complex nondrug intervention including actively approaching counseling and caregiver support groups with differing intensity against usual care with respect to time to institutionalization in patients with dementia . METHODS Within this three-armed cluster-r and omized controlled trial , 390 community-dwelling patients aged 65 years or older with physician-diagnosed mild to moderate dementia and their caregivers were enrolled via 129 general practitioners in Middle Franconia , Germany . The intervention included general practitioners ' training in dementia care and their recommendation of support groups and actively approaching caregiver counseling . Primary study end point was time to institutionalization over 2 years . In addition , long-term intervention effects were assessed over a time horizon of 4 years . Secondary end points included cognitive functioning , ( instrumental ) activities of daily living , burden of caregiving , and health-related quality of life after 2 years . Frailty models with strict intention-to-treat approach and mixed linear models were applied to account for cluster r and omization . Health care costs were assessed from the societal perspective . RESULTS After 2 ( 4 ) years , 12 % ( 24 % ) of the patients were institutionalized and another 21 % ( 35 % ) died before institutionalization . No significant differences between study groups were observed with respect to time to institutionalization after 2 and 4 years ( P 0.25 and 0.71 , respectively ) . Secondary end points deteriorated , but differences were not significant between study groups . Almost 80 % of the health care costs were due to informal care . Total annual costs amounted to more than € 47,000 per patient and did not differ between study arms . CONCLUSION The intervention showed no effects on time to institutionalization and secondary outcomes OBJECTIVES To determine the efficacy of multimodal , nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia . DESIGN R and omized , controlled , longitudinal trial . Data were analyzed using multiple linear regression . SETTING Five German nursing homes . PARTICIPANTS One hundred thirty-nine nursing home 
    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: PURPOSE Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy . SUBJECTS AND METHODS A prospect i ve , controlled , rater-blinded , clinical trial with two follow-ups was conducted as part of a larger cluster-r and omized trial in 18 nursing homes in Berlin . n=117 dementia patients with apathy , defined as a score of 40 or more on the apathy evaluation scale ( AES ) or presence of apathy on the Neuropsychiatric Inventory ( NPI )  , were r and omly assigned to intervention or control group . The intervention included 10 months of brief activities , provided once a week . The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months . RESULTS We found significant group differences with respect to apathy during the 10 month intervention period ( F2,82=7.79 , P<0.01 ) , which reflected an increase in apathy in the control group , but not in the intervention group . Within one year after the intervention was ceased , the treatment group worsened and no longer differed significantly from the control group ( P=0.55 ) . CONCLUSIONS Our intervention was effective for the therapy of apathy in dementia , when applied , but not one year after cessation of therapy OBJECTIVES To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia . DESIGN Cluster r and omized controlled trial . SETTING Twenty-four nursing homes in North Carolina . PARTICIPANTS Residents with advanced dementia and feeding problems and their surrogates . INTERVENTION Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia . Controls received usual care . MEASUREMENTS Primary outcome was the Decisional Conflict Scale ( range : 1 - 5 ) measured at 3 months ; other main outcomes were surrogate knowledge , frequency of communication with providers , and feeding treatment use . RESULTS Two hundred fifty-six residents and surrogate decision-makers were recruited . Residents ' average age was 85 ; 67 % were Caucasian , and 79 % were women . Surrogates ' average age was 59 ; 67 % were Caucasian , and 70 % were residents ' children . The intervention improved knowledge scores ( 16.8 vs 15.1 , P < .001 ) . After 3 months , intervention surrogates had lower Decisional Conflict Scale scores than controls ( 1.65 vs 1.90 , P < .001 ) and more often discussed feeding options with a healthcare provider ( 46 % vs 33 % , P = .04 ) . Residents in the intervention group were more likely to receive a dysphagia diet ( 89 % vs 76 % , P = .04 ) and showed a trend toward greater staff eating assistance ( 20 % vs 10 % , P = .08 ) . Tube feeding was rare in both groups even after 9 months ( 1 intervention vs 3 control , P = .34 ) . CONCLUSION A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers OBJECTIVES This article describes results of a r and omized controlled trial comparing a time-limited  early-stage memory loss ( ESML )  support group program conducted by a local Alzheimer 's Association chapter to a wait-list ( WL ) control condition . METHODS One hundred and forty-two dyads were r and omized in blocks to ESML ( n = 96 ) or WL ( n = 46 ) . Mean age of participants was 74.9 years , and mean Mini-Mental State Examination was 23.4 . The primary outcome was participant 's quality of life ; secondary outcomes included mood , family communication , and perceived stress . RESULTS On the intent-to-treat ( ITT ) pre-post analysis , significant differences were seen in participant quality of life ( p < .001 ) , depression ( p < .01 ) , and family communication ( p < .05 ) . Within the care partner groups , there was no significant difference between ESML and WL in the ITT analysis . A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems ( p < .05 ) , improved family communication ( p < .05 ) , self-efficacy ( p < .01 ) , Medical Outcomes Study short form ( SF-36 ) role-emotional ( p < .05 ) , SF-36 social functioning ( p < .05 ) , and SF-36 mental health components ( p < .01 ) in improvers . DISCUSSION These results support the efficacy of ESML support groups for individuals with dementia BACKGROUND There is good evidence of the positive effects of person-centered care ( PCC ) on agitation in dementia . We hypothesized that a person-centered environment ( PCE ) would achieve similar outcomes by focusing on positive environmental stimuli , and that there would be enhanced outcomes by combining PCC and PCE . METHODS 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified , then r and omized to one of four intervention groups : ( 1 ) PCC ; ( 2 ) PCE ; ( 3 ) PCC + PCE ; ( 4 ) no intervention .  People with dementia , over 60 years of age and consented were eligible . Co- outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation , emotional responses in care , quality of life and depression , and care interaction quality . RESULTS From 38 homes r and omized , 601 people with dementia were recruited . At follow-up the mean change for quality of life and agitation was significantly different for PCE ( p = 0.02 , p = 0.05 , respectively ) and PCC ( p = 0.0003 , p = 0.002 respectively ) , compared with the non-intervention group ( p = 0.48 , p = 0.93 respectively ) . Quality of life improved non-significantly for PCC+PCE ( p = 0.08 ) , but not for agitation ( p = 0.37 ) . Improvements in care interaction quality ( p = 0.006 ) and in emotional responses to care ( p = 0.01 ) in PCC+PCE were not observed in the other groups . Depression scores did not change in any of the groups . Intervention compliance for PCC was 59 % , for PCE 54 % and for PCC+PCE 66 % . CONCLUSION The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported , even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group . The Australian New Zeal and Clinical Trials Registry Number is ACTRN 12608000095369 OBJECTIVES To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders . DESIGN 18-month r and omized controlled trial of 303 community-living elders . SETTING 28 postal code areas of Baltimore , MD . PARTICIPANTS Age 70 + years , with a cognitive disorder , community-living , English-speaking , and having a study partner available . INTERVENTION 18-month care coordination intervention to systematic ally identify and address dementia-related care needs through individualized care planning ; referral and linkage to services ; provision of dementia education and skill-building strategies ; and care monitoring by an interdisciplinary team . MEASUREMENTS Primary outcomes were time to transfer from home and total percent of unmet care needs at 18 months . RESULTS Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37 % ( Hazard ratio : 0.63 , 95 % Confidence Interval : 0.42 - 0.94 ) compared with control participants . Although there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months , the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls . Intervention participants had a significant improvement in self-reported quality of life ( QOL ) relative to control participants . No group differences were found in proxy-rated QOL , neuropsychiatric symptoms , or depression . CONCLUSIONS A home-based dementia care coordination intervention delivered by non- clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home , reduced unmet needs , and improved self-reported QOL Objectives : The Enriched Opportunities Programme ( EOP ) is a multi-level intervention focussing on improved quality of life for people with dementia . This study compared the experience of people living with dementia and other mental health problems in extra care housing schemes that utilised EOP with schemes that employed an active control intervention . Method : Ten extra care housing schemes were cluster r and omised to receive either the EOP intervention or an active control intervention for an 18-month period . Residents with dementia or other significant mental health problems ( 20–30 per scheme ) were assessed on a number of outcome measures at baseline , six months , one year and 18 months . The primary outcome measure was quality of life . Self-reported depression was an important secondary outcome . Results : The EOP-participating residents rated their quality of life more positively over time ( 4.0 ( SE 0.6 ) units ; 14 % p < 0.001 ) than the active control ( 1.3 ( SE 0.6 ) units ; 4 % p = 0.003 ) . There was also a significant group – time interaction for depressive symptoms ( p = 0.003 ) . The EOP-participating residents reported a reduction of 25 % at both six and 12 months and a 37 % reduction at 18 months ( all p 's < 0.001 ) . EOP residents were less likely than residents in the active control sites to move to a care home or to be admitted to a hospital inpatient bed . They were more likely to be seen by a range of community health professionals . Conclusion : The EOP had a positive impact on the quality of life of people with dementia in well-staffed extra care housing schemes OBJECTIVES This r and omized controlled study tested the effectiveness of individualized activities , led by certified nursing assistants ( CNAs ) , to increase positive and reduce negative affect and behavior among nursing home residents with dementia . METHOD Nursing home residents with mild to advanced dementia ( N = 180 ) were r and omly assigned to usual care ( UC , n = 93 ) or 1 of 2 experimental conditions . Residents in the attention control group ( AC , N = 43 ) participated in st and ardized one-to-one activities with their CNAs . Individualized Positive Psychosocial Intervention ( IPPI ) participants ( n = 44 ) received a CNA-led activity matched to their interests and ability . Outcomes were residents ' positive and negative affect and verbal and nonverbal behavior . RESULTS The IPPI and AC groups experienced similar benefits -more pleasure , alertness , engagement , positive touch , and positive verbal behavior-compared with UC . The AC group displayed more anger , uncooperativeness , and very negative verbal behavior than UC or IPPI . DISCUSSION This study demonstrates the value of individualized activities for nursing home residents with dementia . In a stringent test , residents were happier and less angry during a customized intervention compared with a st and ardized intervention . Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia OBJECTIVE To compare a complex nondrug intervention including actively approaching counseling and caregiver support groups with differing intensity against usual care with respect to time to institutionalization in patients with dementia . METHODS Within this three-armed cluster-r and omized controlled trial , 390 community-dwelling patients aged 65 years or older with physician-diagnosed mild to moderate dementia and their caregivers were enrolled via 129 general practitioners in Middle Franconia , Germany . The intervention included general practitioners ' training in dementia care and their recommendation of support groups and actively approaching caregiver counseling . Primary study end point was time to institutionalization over 2 years . In addition , long-term intervention effects were assessed over a time horizon of 4 years . Secondary end points included cognitive functioning , ( instrumental ) activities of daily living , burden of caregiving , and health-related quality of life after 2 years . Frailty models with strict intention-to-treat approach and mixed linear models were applied to account for cluster r and omization . Health care costs were assessed from the societal perspective . RESULTS After 2 ( 4 ) years , 12 % ( 24 % ) of the patients were institutionalized and another 21 % ( 35 % ) died before institutionalization . No significant differences between study groups were observed with respect to time to institutionalization after 2 and 4 years ( P 0.25 and 0.71 , respectively ) . Secondary end points deteriorated , but differences were not significant between study groups . Almost 80 % of the health care costs were due to informal care . Total annual costs amounted to more than € 47,000 per patient and did not differ between study arms . CONCLUSION The intervention showed no effects on time to institutionalization and secondary outcomes OBJECTIVES To determine the efficacy of multimodal , nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia . DESIGN R and omized , controlled , longitudinal trial . Data were analyzed using multiple linear regression . SETTING Five German nursing homes . PARTICIPANTS One hundred thirty-nine nursing home 
    Output:
    