***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: Caregivers of persons with Alzheimer 's disease ( AD ) are confronted with novel decision-making tasks that leave them at risk for social isolation . Computer Link is a computer network providing information , communication , and decision-support functions for caregivers of persons with AD . One hundred two AD caregivers participated in a r and omized field experiment to evaluate the effects of ComputerLink on confidence in decision making , decision-making skill , and social isolation . During the 1-year study period , AD caregivers averaged two encounters per week with Computer Link for sessions lasting an average of 13 minutes . Access to Computer Link enhanced caregivers'decision-making confidence . Decision-making skill was unaffected . ComputerLink access did not lead to changes in social isolation as measured by st and ard instruments . The decision-support function was used least often . Postings to ComputerLink 's public bulletin board included both information-seeking and supportive messages . These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems BACKGROUND Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness . METHODS The authors conducted a r and omized , controlled trial comparing telemedicine case management to usual care , with blinding of those obtaining outcome data , in 1,665 Medicare recipients with diabetes , aged 55 years or greater , and living in federally design ated medically underserved areas of New York State . The primary endpoints were HgbA1c , blood pressure , and low-density lipoprotein ( LDL ) cholesterol levels . RESULTS In the intervention group ( n = 844 ) , mean HgbA1c improved over one year from 7.35 % to 6.97 % and from 8.35 % to 7.42 % in the subgroup with baseline HgbA1c > or = 7 % ( n = 353 ) . In the usual care group ( n = 821 ) mean HgbA1c improved over one year from 7.42 % to 7.17 % . Adjusted net reductions ( one-year minus baseline mean values in each group , compared between groups ) favoring the intervention were as follows : HgbA1c , 0.18 % ( p = 0.006 ) , systolic and diastolic blood pressure , 3.4 ( p = 0.001 ) and 1.9 mm Hg ( p < 0.001 ) , and LDL cholesterol , 9.5 mg/dL ( p < 0.001 ) . In the subgroup with baseline HgbA1c > or = 7 % , net adjusted reduction in HgbA1c favoring the intervention group was 0.32 % ( p = 0.002 ) . Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dL. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York . CONCLUSION Telemedicine case management improved glycemic control , blood pressure levels , and total and LDL cholesterol levels at one year of follow-up Family caregivers , the “ second victims ” or hidden patients in dementia care , are at risk for social isolation , stress , depression , and mortality . Telephone-based support ( telesupport groups ) represents a practical , low-burden , low-cost source of emotional support . The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients . Recruited through various community sources , 103 female caregivers were r and omized to the telesupport group treatment or a control condition . Effects on caregiver burden , depression , and personal gains were evaluated at 6 months , the main end point . Older care-givers ( ≥65 ) in telesupport  reported lower depression than control group caregivers did BACKGROUND recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls  in older people . However , research is required to determine whether supervised group exercise programmes , conducted in community setting s with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group . OBJECTIVES to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance , muscle strength , reaction time , physical functioning , health status and prevents falls in at-risk community-dwelling older people . METHODS the sample comprised 163 people aged over 65 years identified as at risk of falling using a st and ardised assessment screen by their general practitioner or hospital-based physiotherapist , residing in South Western Sydney , Australia . Subjects were r and omised into either an exercise intervention group or a control group .  Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial . Falls were measured over a 12-month follow-up period using monthly postal surveys . RESULTS at baseline both groups were well matched in their physical performance , health and activity levels . The intervention subjects attended a median of 23 exercise classes over the year , and most undertook the home exercise sessions at least weekly . At retest , the exercise group performed significantly better than the controls in three of six balance measures ; postural sway on the floor with eyes open and eyes closed and coordinated stability . The groups did not differ at retest in measures of strength , reaction time and walking speed or on Short-Form 36 , Physical Activity Scale for the Elderly or fear of falling scales . Within the 12-month trial period , the rate of falls in the intervention group was 40 % lower than that of the control group ( IRR=0.60 , 95 % CI 0.36 - 0.99 ) . CONCLUSIONS these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people BACKGROUND The authors ' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons . METHODS This r and omized controlled trial involved a sample of 256 physically inactive , community-dwelling adults aged 70 to 92 ( mean age , 77.48 years ; st and ard deviation , 4.95 years ) who were recruited through a patient data base in Portl and , Oregon . Participants were r and omized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months . The primary outcome measure was the number of falls ; the secondary outcome measures included functional balance ( Berg Balance Scale , Dynamic Gait Index , Functional Reach , and single-leg st and ing ) , physical performance ( 50-foot speed walk , Up&Go ) , and fear of falling , assessed at baseline , 3 months , 6 months ( intervention termination ) , and at a 6-month postintervention follow-up . RESULTS At the end of the 6-month intervention , significantly fewer falls ( n=38 vs 73 ; p=.007 ) , lower proportions of fallers ( 28 % vs 46 % ; p=.01 ) , and fewer injurious falls ( 7 % vs 18 % ; p=.03 ) were observed in the Tai Chi group compared with the stretching control group . After adjusting for baseline covariates , the risk for multiple falls in the Tai Chi group was 55 % lower than that of the stretching control group ( risk ratio,.45 ; 95 % confidence interval , 0.30 to 0.70 ) . Compared with the stretching control participants , the Tai Chi participants showed significant improvements ( p<.001 ) in all measures of functional balance , physical performance , and reduced fear of falling . Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group . CONCLUSIONS A three-times-per-week , 6-month Tai Chi program is effective in decreasing the number of falls , the risk for falling , and the fear of falling , and it improves functional balance and physical performance in physically inactive persons aged 70 years or older The present study deals with psychological , sociological and subjective health aspects of social isolation and understimulation in institutional elderly people . In a controlled study over a 6 month period , A programme was devised in collaboration with residents of a senior citizens apartment building and its staff . The aim of the programme was to increase social activation and to encourage among the elderly an enhanced control over their daily lives . It was agreed that the programme implemented should involve no extra costs , overtime work or external re sources . Most psychological and sociological variables were stable over the 6 month period . However , social activity level increased 3-fold in the Experimental group compared with the Control group . The E-group also started to attend activities outside the actual programme , and in general spent more time out of doors . Seasonal variations were found in feelings of depression , visits to the country/summer houses , as well as visits by children and neighbours . There were no changes in psychosomatic or psychological complaints indices . However , feelings of restlessness decreased significantly in the E-group over the 6 month period compared with the C-group . There was also a non significant decrease over time in complaints of heart palpitations in the E-group BACKGROUND Frailty and fitness are important attributes of older persons , but population sample s of their prevalence , attributes , and outcomes are limited . METHODS The authors report data from the community-dwelling sample ( n = 9008 ) of the Canadian Study of Health and Aging , a representative , 5-year prospect i ve cohort study . Fitness and frailty were determined by self-reported exercise and function level and testing of cognition . RESULTS Among the community-dwelling elderly population , 171 per 1000 were very fit and 12 per 1000 were very frail . Frailty increased with age , so that by age 85 years and older , 44 per 1000 were very frail . The risk for adverse health outcomes increased markedly with frailty : Compared with older adults who exercise , those who were moderately or severely frail had a relative risk for institutionalization of 8.6 ( 95 % confidence interval , 4.9 to 15.2 ) and for death of 7.3 ( 95 % confidence interval , 4.7 to 11.4 ) . These risks persist after adjustments for age , sex , comorbid conditions , and poor self-rated health . At all ages , men reported higher levels of exercise and less frailty compared with women . Decreased fitness and increased frailty were also associated with poor self-ratings of health ( 42 % in the most frail vs 7 % in the most fit ) , more comorbid illnesses ( 6 vs 3 ) , and more social isolation ( 34 % vs 29 % ) . CONCLUSIONS Fitness and frailty form a continuum and predict survival .  Exercise influences survival , even in old age . Relative fitness and frailty can be determined quickly in a clinical setting , are potentially useful markers of the risk for adverse health outcomes , and add value to traditional medical assessment s that focus on diagnoses BACKGROUND A r and omized controlled trial was conducted to examine : ( a ) the effect of two physical activity modes on changes in subjective well-being ( SWB ) over the course of a 12-month period in older , formerly sedentary adults ( N = 174 , M age = 65.5 years ) and ( b ) the role played by physical activity participation and social support in changes in SWB over time . METHOD Participants were r and omized into either an aerobic activity group or a stretching and toning group . Structural equation modeling was employed to conduct multiple sample latent growth curve analyses of individual growth in measures of SWB ( happiness , satisfaction with life , and loneliness ) over time . RESULTS A curvilinear growth pattern was revealed with well-being significantly improving over the course of the intervention followed by significant declines at the 6-month follow-up . Subsequent structural analyses were conducted showing that frequency of exercise participation was a significant predictor of improvement in satisfaction with life , whereas social relations were related to increases in satisfaction with life and reductions in loneliness . Improvements in social relations and exercise frequency also helped to buffer the declines in satisfaction with life at follow-up . CONCLUSIONS It appears that social relations integral to the exercise environment are significant determinants of subjective well-being in older adults . Findings are discussed in terms of how physical activity environments might be structured to maximize improvements in more global well-being constructs such as satisfaction with life The Internet ( electronic mail and the World Wide Web ) may provide new opportunities for communication that can help older adults avoid social isolation . This r and omized controlled trial assessed the psychosocial impact of providing Internet access to older adults over a five-month period . One hundred volunteers from four congregate housing sites and two nursing facilities were r and omly assigned to receive Internet training or to a wait list control group . The pre & post measures included the UCLA Loneliness scale , modified CES Depression scale , a measure of locus of control , computer attitudes , number of confidants , and overall quality of life . Participants received nine hours of small group training in six sessions over two weeks . Computers were available for continued use over five months and the trainer was available two hours/week for questions . At the end of the trial , 60 % of the intervention group continued to use the Internet on a weekly basis . Although there was a trend toward decreased loneliness and depression in intervention subjects compared to controls , there were no statistically significant changes from baseline to the end of trial between groups . Among Internet users ( n = 29 ) in the intervention group there were trends toward less loneliness , less depression , more positive attitudes toward computers , and more confidants than among intervention recipients who were not regular users ( n = 19 ) of this technology . Most elderly participants in this trial learned to use the Internet and the majority continued to use it on a weekly basis . The psychosocial impact of Internet use in this sample suggested trends in a positive direction . Further research is needed to determine more precisely , which older adults , residing in which environmental context s are more likely than others to benefit 
    Output:
    
Social isolation and loneliness have also been associated with a number of negative outcomes such as poor health , maladaptive behaviour , and depressed mood .
Higher levels of loneliness have also been associated with increased likelihood of institutionalization .
Both classes of interventions were found to reduce social isolation and loneliness in seniors .
Social support groups were found to effectively decrease social isolation for seniors on wait lists for senior apartments and those living in senior citizen apartments .
Community-based exercise programs featuring health and wellness for physically inactive community-dwelling seniors also effectively reduced loneliness .
Rehabilitation for mild/moderate hearing loss was effective in improving communication disabilities and reducing loneliness in seniors .
Interventions evaluated for informal caregivers of seniors with dementia , however , had limited effectiveness for social isolation or loneliness .
Although effective interventions were identified for social isolation and loneliness in community-dwelling seniors , they were directed at specifically targeted groups and involved only a few of the many potential causes of social isolation .