Interventions to Reduce Loneliness in Community-Living Older Adults: a Systematic Review and Meta-analysis

BACKGROUND

The problem of loneliness has garnered increased attention from policymakers, payors, and providers due to higher rates during the pandemic, particularly among seniors. Prior systematic reviews have in general not been able to reach conclusions about effectiveness of interventions.

METHODS

Computerized databases were searched using broad terms such as "loneliness" or "lonely" or "social isolation" or "social support" from Jan 1, 2011 to June 23, 2021. We reference mined existing systematic reviews for additional and older studies. The Social Interventions Research & Evaluation Network database and Google were searched for gray literature on Feb 4, 2022. Eligible studies were RCTs and observational studies of interventions to reduce loneliness in community-living adults that used a validated loneliness scale; studies from low- or middle-income countries were excluded, and studies were excluded if restricted to populations where all persons had the same disease (such as loneliness in persons with dementia).

RESULTS

A total of 5971 titles were reviewed and 60 studies were included in the analysis, 36 RCTs and 24 observational studies. Eleven RCTs and 5 observational studies provided moderate certainty evidence that group-based treatment was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.27, 95% CI - 0.48, - 0.08). Five RCTs and 5 observational studies provided moderate certainty evidence that internet training was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.22, 95% CI - 0.30, - 0.14). Low certainty evidence suggested that group exercises may be associated with very small reductions in loneliness. Evidence was insufficient to reach conclusions about group-based activities, individual in-person interactions, internet-delivered interventions, and telephone-delivered interventions.

DISCUSSION

Low-to-moderate certainty evidence exists that group-based treatments, internet training, and possibly group exercises are associated with modest reductions in loneliness in community-living older adults. These findings can inform the design of supplemental benefits and the implementation of evidence-based interventions to address loneliness.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO ( CRD42021272305 ).

Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map

Background

Social isolation and loneliness are more common in older adults and are associated with a serious impact on their well-being, mental health, physical health, and longevity. They are a public health concern highlighted by the COVID-19 pandemic restrictions, hence the need for digital technology tools to enable remotely delivered interventions to alleviate the impact of social isolation and loneliness during the COVID-19 restrictions.

Objectives

To map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings.

Search Methods

We searched the following databases from inception to May 16, 2021, with no language restrictions. Ovid MEDLINE, Embase, APA PsycInfo via Ovid, CINAHL via EBSCO, Web of Science via Clarivate, ProQuest (all databases), International Bibliography of the Social Sciences (IBSS) via ProQuest, EBSCO (all databases except CINAHL), Global Index Medicus, and Epistemonikos.

Selection Criteria

Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate following the eligibility criteria.

Data Collection and Analysis

We developed and pilot tested a data extraction code set in Eppi-Reviewer and data were individually extracted and coded based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map.

Main Results

We included 200 articles (103 primary studies and 97 systematic reviews) that assessed the effects of digital interventions to reduce social isolation and/or loneliness in older adults. Most of the systematic reviews (72%) were classified as critically low quality, only 2% as high quality and 25% were published since the COVID-19 pandemic. The evidence is unevenly distributed with clusters predominantly in high-income countries and none in low-income countries. The most common interventions identified are digital interventions to enhance social interactions with family and friends and the community via videoconferencing and telephone calls. Digital interventions to enhance social support, particularly socially assistive robots, and virtual pets were also common. Most interventions focused on reducing loneliness and depression and improving quality of life of older adults. Major gaps were identified in community level outcomes and process indicators. No included studies or reviews assessed affordability or digital divide although the value of accessibility and barriers caused by digital divide were discussed in three primary studies and three reviews. Adverse effects were reported in only two studies and six reviews. No study or review included participants from the LGBTQIA2S+ community and only one study restricted participants to 80 years and older. Very few described how at-risk populations were recruited or conducted any equity analysis to assess differences in effects for populations experiencing inequities across PROGRESS-Plus categories.

Authors' Conclusions

The restrictions placed on people during the pandemic have shone a spotlight onto social isolation and loneliness, particularly for older adults. This evidence and gap map shows available evidence on the effectiveness of digital interventions for reducing social isolation or loneliness in older adults. Although the evidence is relatively large and recent, it is unevenly distributed and there is need for more high-quality research. This map can guide researchers and funders to consider areas of major gaps as priorities for further research.

The effectiveness of facilitator-led remote interactive intervention for loneliness, quality of life, and social support among seniors in communities during the COVID-19 pandemic: a randomized controlled experiment

OBJECTIVE

This study investigated the impact of a 12-week remote interaction intervention on loneliness, quality of life, and social support for seniors living in a community during the COVID-19 pandemic.

METHODS

This study adopted a randomized controlled trial design. Participants in the intervention group received a 12-week bidirectional remote interaction intervention, while participants in the control group received a 12-week unidirectional remote interaction intervention. The study's primary assessment tools were the UCLA Loneliness Scale (UCLA) and the World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF).

RESULTS

The main findings indicate that the intervention group scored significantly higher than the control group on the WHOQOL-BREF in the physical health and social relationships domains after the intervention. In addition, intervention group participants with low loneliness scored significantly higher than their control group counterparts in the physical health and social relationships domains of the WHOQOL-BREF. Similarly, intervention group participants with high loneliness scored significantly higher than their control group counterparts in the social relationships domain of the WHOQOL-BREF. However, there was no significant difference in loneliness scores between the intervention and control groups.

CONCLUSIONS

This result confirms that providing intensive bidirectional interaction benefits seniors' quality of life during the COVID-19 pandemic.

Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources

BACKGROUND

Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community.

OBJECTIVE

This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults.

METHODS

A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources.

RESULTS

The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services.

CONCLUSIONS

A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.

The association between information and communication technologies, loneliness and social connectedness: A scoping review

Older adults are at a higher risk of loneliness, compared to other demographics. The use of Internet Communication and Technologies (ICTs) among older adults is steadily increasing and given ICTs provide a means of enhancing social connectedness suggests they may have positive effects on reducing loneliness. Therefore, the aim of this scoping review was to examine the research that explores how ICTs may be implicated in mitigating loneliness and increasing social connectedness among older adults. After the examination of 54 articles, we identified three major themes within the literature: (1) ICTs were associated with a reduction in loneliness and increase in wellbeing. (2) ICTs promoted social connectedness by facilitating conversations. (3) Factors such as training, self-efficacy, self-esteem, autonomy, and the design/features, or affordances, of ICTs contribute toward the associations between ICT use and wellbeing. The heterogeneity of methodologies, statistical reporting, the small sample sizes of interventional and observational studies, and the diversity of the experimental contexts underline the challenges of quantitative research in this field and highlights the necessity of tailoring ICT interventions to the needs and contexts of the older users.

Validating Habitual and Goal-Directed Decision-Making Performance Online in Healthy Older Adults

Everyday decision-making is supported by a dual-system of control comprised of parallel goal-directed and habitual systems. Over the past decade, the two-stage Markov decision task has become popularized for its ability to dissociate between goal-directed and habitual decision-making. While a handful of studies have implemented decision-making tasks online, only one study has validated the task by comparing in-person and web-based performance on the two-stage task in children and young adults. To date, no study has validated the dissociation of goal-directed and habitual behaviors in older adults online. Here, we implemented and validated a web-based version of the two-stage Markov task using parameter simulation and recovery and compared behavioral results from online and in-person participation on the two-stage task in both young and healthy older adults. We found no differences in estimated free parameters between online and in-person participation on the two-stage task. Further, we replicate previous findings that young adults are more goal-directed than older adults both in-person and online. Overall, this work demonstrates that the implementation and use of the two-stage Markov decision task for remote participation is feasible in the older adult demographic, which would allow for the study of decision-making with larger and more diverse samples.

Internet Use, Life Satisfaction, and Subjective Well-Being Among the Elderly: Evidence From 2017 China General Social Survey

Purpose: The research objectives of this study are to test the scientific propositions of whether Internet use promotes life satisfaction among the elderly, whether there is variability in the effect of Internet use on the well-being of the elderly, and through what channels Internet use affects the elderly's life satisfaction. Method: Using data from the 2017 Chinese General Social Survey (CGSS), this paper employed linear regression, ordered logit model, and the propensity score matching (PSM) approach to investigate the association of Internet use with life satisfaction among the elderly in China. Results: The results show that Internet use was significantly and negatively associated with the life satisfaction of the Chinese elderly. Further analysis on group heterogeneity demonstrates that the negative association was more prominent among the participants who were males, at a lower age, had lower income and education, non-agricultural registered, and relatively healthy. Finally, the mediating effect indicates that Internet use may affect life satisfaction among the elderly through the channel of reducing their perceptions of social justice. Conclusions: In order to avoid the negative effects of using the Internet, the following policy suggestions are put forward: Improve the elderly's attitudes toward Internet use; pay attention to the sense of fairness of the elderly to improve life satisfaction; guide the elderly to reduce the time of using the Internet.

Understanding older adults’ use of social technology and the factors influencing use

Having access and skills to use social technology, i.e. social internet use, social media and social applications, are considered as being vital to online social connection. Whilst evidence exists around facilitators and barriers to general technology use, evidence is limited with regards to the motivators, skills and tangible offline benefits older technology users experience with social technology. Therefore, this study used a qualitative, exploratory method to understand older adults’ experiences of using social technology to connect with others. Semi-structured interviews were conducted with 20 older adults (65+ years) across England, Scotland and Wales. Despite having access to social technology for social connection, and using this technology regularly, multiple barriers impacted motivators and skills for use, namely perceived self-efficacy and fear, the culture of online communication, absence of social capital and physical functioning. Some of these barriers of social technology use are reminiscent of barriers of wider technology use and emphasise the importance of addressing these barriers for digital exclusion, as well as social connection. However, some of these barriers were specific to social technology use and should be considered when providing guidance or interventions to increase older adults’ online social connection. Social connection was a clear tangible outcome to social technology use, and individuals discussed the benefits of using social technology, particularly visual communication tools, for online connection.

User-Centered Development of a Web Platform Supporting Community-Based Health Care Organizations for Older Persons in Need of Support: Qualitative Focus Group Study

Background

The ongoing changes in population demographics increase the relevance of dignified aging across Europe. Community-based health care (CBHC) organizations are necessary to provide sustainable strategies for organizing care for older persons in need of support. To support the digitalization of these organizations, new business models and suitable web platforms are necessary.

Objective

This study, which is part of the European Active and Assisted Living (AAL) project called “ICareCoops”, aimed to explore concepts, approaches, and workflows of CBHC organizations to achieve a comprehensive understanding of extant services offered and relevant requirements to support these services with information and computer technology (ICT) solutions.

Methods

A qualitative study with six focus groups (FGs) with 40 participants was conducted in Switzerland and Slovenia to identify potential stakeholders’ needs and requirements for the user-centered development of a web platform. Data were collected from three different stakeholder groups: (1) older persons in need of support as care receivers, (2) significant others of older persons in need of support, and (3) managers or care providers of CBHC organizations. A semistructured interview guide with open questions was used for data collection. FG sessions were audio-recorded and transcribed verbatim. Thematic content analysis was used to analyze the content of the FG sessions. To assist with further web platform development, the responses of the FG participants were translated into user stories to describe technical requirements.

Results

By analyzing the transcripts, five main categories were identified: (1) ICT usage behavior of users, (2) challenges of web platform usage, (3) content and technical requirements for the web platform, (4) form and services of CBHC organizations, and (5) rationales of CBHC organizations. The main issues identified were the need for seniors to have individual contact with the CBHC organization and the possibility to coordinate routine services via the web platform, such as ordering meals-on-wheels or booking a caregiver to accompany an older person to the doctor.

Conclusions

The majority of participants showed a lack of familiarity with the usage of ICT. Nevertheless, they were open-minded regarding web platform usage to facilitate workflows and to benefit CBHC organizations. Cooperatives as an organizational model demonstrate a high potential to address users’ needs. Therefore, the web platform offers an essential tool for innovative health care models in the future. Searching for care services, contacting care providers, and communicating with care providers was preferred via personal contact and seemed to be the key element for user acceptance and for the successful implementation of a web platform like “ICareCoops” to support CBHC organizations.

Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review

BACKGROUND

A significant proportion of the worldwide population is at risk of social isolation and loneliness as a result of the COVID-19 pandemic. We aimed to identify effective interventions to reduce social isolation and loneliness that are compatible with COVID-19 shielding and social distancing measures.

METHODS AND FINDINGS

In this rapid systematic review, we searched six electronic databases (Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews and SCOPUS) from inception to April 2020 for systematic reviews appraising interventions for loneliness and/or social isolation. Primary studies from those reviews were eligible if they included: 1) participants in a non-hospital setting; 2) interventions to reduce social isolation and/or loneliness that would be feasible during COVID-19 shielding measures; 3) a relevant control group; and 4) quantitative measures of social isolation, social support or loneliness. At least two authors independently screened studies, extracted data, and assessed risk of bias using the Downs and Black checklist. Study registration: PROSPERO CRD42020178654. We identified 45 RCTs and 13 non-randomised controlled trials; none were conducted during the COVID-19 pandemic. The nature, type, and potential effectiveness of interventions varied greatly. Effective interventions for loneliness include psychological therapies such as mindfulness, lessons on friendship, robotic pets, and social facilitation software. Few interventions improved social isolation. Overall, 37 of 58 studies were of "Fair" quality, as measured by the Downs & Black checklist. The main study limitations identified were the inclusion of studies of variable quality; the applicability of our findings to the entire population; and the current poor understanding of the types of loneliness and isolation experienced by different groups affected by the COVID-19 pandemic.

CONCLUSIONS

Many effective interventions involved cognitive or educational components, or facilitated communication between peers. These interventions may require minor modifications to align with COVID-19 shielding/social distancing measures. Future high-quality randomised controlled trials conducted under shielding/social distancing constraints are urgently needed.

Internet Use in Old Age: Results of a German Population-Representative Survey

Background

The internet has the potential to foster healthy lifestyles and to support chronic disease management. Older adults could benefit from using the internet and other information and communication technology to access health-related information and interventions available online.

Objective

The aim of this study was to investigate factors influencing internet use in older and oldest age groups and to determine the frequency of internet use for health-related purposes.

Methods

Using data from a nationally representative telephone survey of older adults aged 75 years and over, a sample of 999 people was assessed using structured clinical interviews. Descriptive and binary logistic regression analyses were performed.

Results

Overall, 42.6% (418/999) of participants used the internet. Among those, 55.7% (233/417) searched the internet for health-related information. Regression analyses revealed that internet use was significantly associated with younger age (odds ratio [OR] 0.89, 95% CI 0.85-0.92; P<.001), male gender (OR 2.84, 95% CI 2.02-4.00; P<.001), higher education levels (OR 6.69, 95% CI 4.48-9.99; P<.001), a wider social network (OR 1.04, 95% CI 1.01-1.07; P=.01), higher health-related quality of life (OR 1.02, 95% CI 1.00-1.03; P=.006), lower levels of depressive symptoms (OR 0.89, 95% CI 0.80-0.99; P=.04), and higher rates of chronic illness (OR 1.12, 95% CI 1.04-1.21; P<.004).

Conclusions

This study provides population-representative data on internet use in old age in Germany. People in the older and oldest age groups participate in online activities. Understanding the factors that are associated with older adults internet use can contribute to developing tailored interventions and eHealth (electronic health) services to improve well-being in older adults.

The Relevance of Online Social Relationships Among the Elderly: How Using the Web Could Enhance Quality of Life?

This observational study analyzes the impact of Internet use on the quality of life and well-being of the elderly. Specifically, it seeks to understand and clarify the effects of Internet use on relationships in terms of self-esteem, life satisfaction, and Online and Offline Social Support in a sample of senior and elderly Italian people (over 60 years of age). A cohort of 271 elderly people (133 males and 138 females) aged between 60 and 94 years old participated in the study: 236 were Internet Users while the other 35 were Non-Internet Users. The results showed that the time elderly people spend online has a negative effect on their perception of Offline Social Support (Offline Emotional and Informational and Offline Affective Social Support) and a positive effect on their perception of Online Social Support (particularly on Online Positive Social Interactions). Surprisingly, Internet use among elderly people seems to positively affect the perception of Offline Social Support. Indeed, elderly Internet Users have a more positive perception of Offline Social Support (particularly Offline Positive Social Interactions and Offline Affective Social Support) than Non-Internet Users. A discussion of this finding is provided, positing that the Internet seems to represent the technological side of a functional organ that allows the elderly to stay in closer touch with their family and friends and in doing so to also overcome some age-related difficulties.

Information and communicative technology use enhances psychological well-being of older adults: the roles of age, social connectedness, and frailty status

OBJECTIVES

Information and communicative technology (ICT) use is a potential vehicle for improving the psychological well-being (PWB) of older people. We examined the roles of age, frailty, and social connectedness in the relationship between ICT use and PWB.

METHOD

Telephone interviews were conducted in mid-2016 with 1201 participants aged 50 and above (55.7% female) residing in Hong Kong, China. The participants reported PWB, ICT use (frequency of using the Internet and smart devices), frailty status, contact with family, friends, and neighbors, self-rated health, subjective financial sufficiency, education level, and employment status.

RESULTS

We found that the association between ICT and PWB was moderated by age: ICT was associated with PWB only among old-olds (75+), but not in other age groups. This moderation was mediated by contact with family, but not with friends or neighbors. The moderation was further qualified by frailty status: the ICT-by-age moderation was found only among frail, but not pre-frail or robust older adults.

CONCLUSION

The findings suggest that ICT use can potentially enhance the PWB of older adults aged 75+ through facilitating their contact with family members. These benefits might be particularly salient for those who were frail. Improving ICT access and literacy among older adults may be promising.

Comparison of prompting procedures to teach internet skills to older adults

The Internet and information and communications technologies (ICTs) have been found to produce meaningful social interactions and greater social support among older adults (White et al., ). Despite these benefits, the Internet and ICTs are not widely used among the older-adult population (Cresci, Yarandi, & Morrell, ). The purpose of the current study was to compare the effectiveness and efficiency of video prompting and text-based instructions on the acquisition of three tablet-based tasks: emailing, video calling (FaceTime® application), and searching for a YouTube™ video. Both video prompting and text-based instructions were effective for all three participants, with text-based instructions being slightly more efficient for one participant and video prompting being more efficient for two participants, suggesting that both prompting procedures can be used to teach older adults Internet and ICT skills.

What do we know about the relationship between internet-mediated interaction and social isolation and loneliness in later life?

Purpose

Social isolation and loneliness are recognised social, health and wellbeing problems that particularly affect later life. They have been the subject of many recent studies. Studies examining the role of the internet in addressing these problems have multiplied. However, it is still not known whether internet-mediated social interaction has any role in mitigating social isolation and or loneliness. To address this gap, the purpose of this paper is to review previous research that investigates the relationship between internet use for communication and social isolation and loneliness.

Design/methodology/approach

This paper reviews the empirical literature published since 2000 and expands on previous literature reviews by including a variety of research designs and disciplines.

Findings

Despite the recent increase in studies, there is still little evidence to show internet effects on social isolation and loneliness. It is concluded that future research programmes aimed at reducing them by the use of the internet should include more robust methodological and theoretical frameworks, employ longitudinal research designs and provide a more nuanced description of both the social phenomena (social isolation and loneliness) and internet-mediated social interaction.

Originality/value

Previous reviews are not restricted to internet-based studies and include several types of interventions aiming at reducing social isolation and/or loneliness. They do not attempt to disentangle the internet effects of social isolation and loneliness.

Interventions for alleviating loneliness among older persons: a critical review

OBJECTIVES

Loneliness is common among older persons and has been associated with health and mental health risks. This systematic review examines the utility of loneliness interventions among older persons.

DATA SOURCE

Thirty-four intervention studies were used. STUDY INCLUSION CRITERIA: The study was conducted between 1996 and 2011, included a sample of older adults, implemented an intervention affecting loneliness or identified a situation that directly affected loneliness, included in its outcome measures the effects of the intervention or situation on loneliness levels or on loneliness-related measures (e.g., social interaction), and included in its analysis pretest-posttest comparisons.

DATA EXTRACTION

Studies were accessed using the databases PsycINFO, MEDLINE, ScienceDirect, AgeLine, PsycBOOKS, and Google Scholar for the years 1996-2011.

DATA SYNTHESIS

Interventions were classified based on population, format, and content and were evaluated for quality of design and efficacy.

RESULTS

Twelve studies were effective in reducing loneliness according to the review criteria, and 15 were evaluated as potentially effective. The findings suggest that it is possible to reduce loneliness by using educational interventions focused on social networks maintenance and enhancement.

CONCLUSIONS

Multiple approaches show promise, although flawed design often prevents proper evaluation of efficacy. The value of specific therapy techniques in reducing loneliness is highlighted and warrants a wider investigation. Studies of special populations, such as the cognitively impaired, are also needed.

Comparing Older and Younger Adults' Traversal Time in Expandable and Non-Expandable Hierarchical Structures

The present study investigates time and click error differences when older and younger computer users traversed expandable and non-expandable online hierarchical information structures to reach a target. The results show that older users were slower but did not make more errors than their younger counterparts, suggesting more cautious decision making. The study did not show superiority of either hierarchy in terms of traversal time but the expandable hierarchy resulted in fewer errors to get to the target. Although older users significantly rated their computer and Internet experience lower than younger participants, experience did not alter the significance of age and hierarchy differences.

Parity in computer-based health education: designing culturally relevant Alzheimer’s disease information

Disparities that exist for racial and ethnic minority groups in healthcare status and access are compounded in the presence of Alzheimer’s disease (AD). Recent improvements in the diagnosis and care of persons with AD need to be paralleled in minority communities with early recognition and timely evaluation. Innovative information technologies can help reduce health disparities. A qualitative study was conducted with 48 participants: to understand how cultural values influence responses to signs of memory loss and to critique a CD-ROM memory loss educational program for the purpose of tailoring it to better meet the needs and preferences of African American and Chinese American users. Traditions of close family relationships, respect for elderly and the commitment to care, central to both groups, provided the basis for the frequently parallel recommendations for a revised program. Principles of adult education and web-based program design proved essential in developing a culturally relevant program.

Gender Differences in Social Adaptation to a Retirement Community: Longitudinal Changes and the Role of Mediated Communication

Many American elders migrate to age-restricted planned communities in the Sun Belt. Women and men may react differently to these migrations. For women in particular, the use of mediated communication may preserve supportive relationships with distant persons. Men may be advantaged by relocation to planned communities with highly structured social environments. Results are reported from a 4-year longitudinal study of 255 migrants. During the study period, men reported gains in persons providing emotional support, practical assistance, advice, and help with illness. Women reported losses or no change. Consistent with previous work on long-distance relationships, women reported more e-mail contact with their children. For both sexes, the use of e-mail was positively correlated with perceived social support after 4 years of residency. For women, contact with distant friends was particularly associated with levels of emotional support. The role of mediated communication in compensating for negative relocation effects is discussed.

Population Aging in the European Information Societies: Towards a Comprehensive Research Agenda in eHealth Innovations for Elderly

Population ageing is one of the major social and economic challenges of our contemporary societies. With the advent of the information society, new research and technological developments have been promoted in the field of assistive technologies and information and communication technologies of benefit to elderly people. This article examines the potentialities of new informatics developments in generating solutions to better address elderly people's daily-life, especially those with chronic illness and/or low autonomy. The authours attempt to propose a research agenda, by exposing various strengts and weaknesses of eHealth innovations for elderly, mainly grounded in secondary sources analysis.

Internet use and well-being in older adults

The Internet has become an important social context in the lives of older adults. Extant research has focused on the use of the Internet and how it influences well-being. However, conflicting findings exist. The purpose of the study was to develop an integrative research model in order to determine the nature of the relationships among Internet use, loneliness, social support, life satisfaction, and psychological well-being. Specifically, loneliness and social support were tested as potential mediators that may modify the relationship between Internet use and indicators of well-being. Data from the U.S. Health and Retirement Study (HRS) were used, and the association among Internet use, social support, loneliness, life satisfaction, and psychological well-being was explored. The sample consisted of 5,203 older adults (aged 65 years and older). The results indicated that higher levels of Internet use were significant predictors of higher levels of social support, reduced loneliness, and better life satisfaction and psychological well-being among older adults.

The personalized reminder information and social management system (PRISM) trial: rationale, methods and baseline characteristics

Technology holds promise in terms of providing support to older adults. To date, there have been limited robust systematic efforts to evaluate the psychosocial benefits of technology for older people and identify factors that influence both the usability and uptake of technology systems. In response to these issues, we developed the Personal Reminder Information and Social Management System (PRISM), a software application designed for older adults to support social connectivity, memory, knowledge about topics, leisure activities and access to resources. This trail is evaluating the impact of access to the PRISM system on outcomes such as social isolation, social support and connectivity. This paper reports on the approach used to design the PRISM system, study design, methodology and baseline data for the trial. The trial is multi-site randomized field trial. PRISM is being compared to a Binder condition where participants received a binder that contained content similar to that found on PRISM. The sample includes 300 older adults, aged 65-98 years, who lived alone and at risk for being isolated. The primary outcome measures for the trial include indices of social isolation and support and well-being. Secondary outcomes measures include indices of computer proficiency, technology uptake and attitudes towards technology. Follow-up assessments occurred at 6 and 12 months post-randomization. The results of this study will yield important information about the potential value of technology for older adults. The study also demonstrates how a user-centered iterative design approach can be incorporated into the design and evaluation of an intervention protocol.

Alignment or struggle? Exploring socio-demographic correlates of individual modernity in Chinese older people

It is noteworthy that while modernisation, together with population ageing, has happened in Western countries for a rather long period of time, China must confront the challenges of an ageing population before it really becomes an advanced industrial society. Facing rapid societal changes, citizens may react differently to this process. By conducting questionnaire surveys with 445 elders in Wuhan, China, this study examines Chinese older adults' individual modernity modes and reveals its socio-demographic correlates. The results show that facing rapid changes in societal modernisation, participants have reacted differently to this process, with 23.8 per cent of Chinese older participants using an accommodation mode, 27.0 per cent using a resistance mode, 13.3 per cent using a withdrawal mode and 36.2 per cent using a coping mode. In addition, socio-demographic factors such as urban–rural residence, age, gender, socio-economic status, living arrangement and daily activities have been identified as significant correlates of Chinese older participants' individual modernity modes. It is further suggested that governments at all levels should allow for options and opportunities for older people to align themselves in the modernisation process by removing the barriers that may hinder their integration and empowerment efforts. While it is important to respect older adults' different responses in the face of modernisation, their participation in societies should be encouraged and respected by the wider society in the context of modernisation.

Distinct associations of different sedentary behaviors with health-related attributes among older adults

OBJECTIVE

Leisure-time sedentary behaviors (LTSBs) have been associated adversely with health outcomes. However, limited research has focused on different categories of LTSB. We aimed at identifying categories of LTSBs and examining their separate associations with indices of health among Japanese older adults.

METHODS

A postal survey collected data on self-reported health, psychological distress, body mass index, moderate-to-vigorous physical activity (MVPA), LTSBs (five behaviors) and socio-demographic characteristics from 1,580 Japanese older adults (67% response rate; 65-74 years) in 2010. Exploratory factor analysis was used to classify LTSBs. Odds ratios (ORs) were calculated for associations of LTSB categories with self-reported health, psychological distress, overweight, and lower MVPA. Data were analyzed in 2013.

RESULTS

Two categories of LTSB: passive sedentary time (consisting of TV time, listening or talking while sitting, and sitting around) and mentally-active sedentary time (consisting of computer-use and reading books or newspapers) were identified. Higher passive sedentary time was associated with a higher odds of being overweight (OR: 1.39, [95% CI: 1.08-1.80]), and lower MVPA (1.26, [1.02-1.54]). Higher mentally-active sedentary time was associated with lower odds of lower MVPA (0.70, [0.57-0.86]).

CONCLUSIONS

Two types of sedentary time-passive and mentally-active-may play different roles in older adults' well-being.

The impact of activity interventions on the well-being of older adults in continuing care communities

As the U.S. population ages, interventions are needed to ensure quality of life continues as boomers enter assisted and independent living communities (AICs). These transitions can significantly affect quality of life. Activity and continuity theories maintain that participation in discretionary/informal activities is crucial for psychosocial health and well-being (aspects of quality of life). This study evaluates the impacts of participation in discretionary activities on life satisfaction, social isolation, and loneliness, using data from a longitudinal study of older adults in AICs. Older adults who participated in 8 weeks of discretionary activities reported greater life satisfaction and lower levels of social isolation compared with non-participants. Forming alliances and group identities is the key for building new relationships and maintaining relationships in the community. Determining the impact participation in activities has on residents is vital to being able to help develop a more comprehensive understanding of how quality of life can be maintained in AICs.

Internet use and depression among retired older adults in the United States: a longitudinal analysis

OBJECTIVES

The purpose of this study is to examine the association between Internet use among retired older adults in the United States and changes in a commonly used predictor of depression (the CES-D).

METHOD

Analyzing data from four waves (2002-2008) of the Health and Retirement Survey, we assess whether an available and commonly used index of a depression state was affected by prior values of the index and Internet use. The sample includes 3,075 respondents observed over 4 waves of data, yielding a total of 12,300 observations. We analyzed the effect on depression of Internet use and past depression in a full sample and a matched sample. We also conducted informal tests for confounders. Finally, we tested a basic mediation model to determine whether Internet use affected depression through its relationship with loneliness and social isolation.

RESULTS

Across methods, we found a positive contribution of Internet use to mental well-being of retired older adults in the United States, where Internet use reduced the probability of a depression state by one third. We found no evidence of confounding. Some evidence of mediation was found.

DISCUSSION

Our dynamic probit model indicates that for retired older adults in the United States, Internet use was found to reduce the probability of a depressed state by about 33%. Number of people in the household partially mediates this relationship, with the reduction in depression largest for people living alone. This provides some evidence that the mechanism linking Internet use to depression is the remediation of social isolation and loneliness. Encouraging older adults to use the Internet may help decrease isolation and depression.

Targeting Socially Isolated Older Adults: A Process Evaluation of the Senior Centre Without Walls Social and Educational Program

The Seniors Centre Without Walls (SCWOW) program provides free social and educational programming for older adults via telephone. The target population for SCWOW is socially isolated older adults, a hard to reach population. The aim of this process evaluation was to examine whether SCWOW was reaching its target population and to gather participant feedback about program implementation and the perceived satisfaction and impact of the program. Telephone interviews were conducted with 26 participants (92% females; aged 57-85 years). Forty-two percent of the sample was socially isolated and more than half reported being lonely. Participants reported having no difficulty using the telephone system. On average, participants were very satisfied with the program and reported that SCWOW had several positive effects (e.g., connecting to the larger community, affecting mental well-being). Importantly, no barriers to participation were identified. The study suggests that telephone-based programs can successfully reach socially isolated older adults.

Attitudes Towards and Limitations to ICT Use in Assisted and Independent Living Communities: Findings from a Specially-Designed Technological Intervention

While much literature has been devoted to theoretical explanations of the learning processes of older adults and to the methods of teaching best utilized in older populations, less has focused on the education of older adults who reside in assisted and independent living communities (AICs), especially with regards to information and communication technology (ICT) education. The purpose of this study is to determine whether participants' attitudes and views towards computers and the Internet are affected as a result of participating in an eight-week training program designed to enhance computer and Internet use among older adults in such communities. Specifically, we examine if ICT education specially designed for AIC residents results in more positive attitudes towards ICTs and a perceived decrease in factors that may limit or prevent computer and Internet use. We discuss the implications of these results for enhancing the quality of life for older adults in AICs and make recommendations for those seeking to decrease digital inequality among older adults in these communities through their own ICT classes.

Skill acquisition with text-entry interfaces: particularly older users benefit from minimized information-processing demands

Operating information technology challenges older users if it requires executive control, which generally declines with age. Especially for novel and occasional tasks, cognitive demands can be high. We demonstrate how interface design can reduce cognitive demands by studying skill acquisition with the destination entry interfaces of two customary route guidance systems. Young, middle-aged, and older adults performed manual destination entry either with a system operated with multiple buttons in a dialogue encompassing spelling and list selection, or with a system operated by a single rotary encoder, in which an intelligent speller constrained destination entry to a single line of action. Each participant performed 100 training trials. A retention test after at least 10 weeks encompassed 20 trials. The same task was performed faster, more accurately, and produced much less age-related performance differences especially at the beginning of training if interface design reduced demand for executive control, perceptual processing, and motor control.

Impact of internet use on loneliness and contact with others among older adults: cross-sectional analysis

Background

Older adults are at increased risk of experiencing loneliness and depression, particularly as they move into different types of care communities. Information and communication technology (ICT) usage may help older adults to maintain contact with social ties. However, prior research is not consistent about whether ICT use increases or decreases isolation and loneliness among older adults.

Objective

The purpose of this study was to examine how Internet use affects perceived social isolation and loneliness of older adults in assisted and independent living communities. We also examined the perceptions of how Internet use affects communication and social interaction.

Methods

One wave of data from an ongoing study of ICT usage among older adults in assisted and independent living communities in Alabama was used. Regression analysis was used to determine the relationship between frequency of going online and isolation and loneliness (n=205) and perceptions of the effects of Internet use on communication and social interaction (n=60).

Results

After controlling for the number of friends and family, physical/emotional social limitations, age, and study arm, a 1-point increase in the frequency of going online was associated with a 0.147-point decrease in loneliness scores (P=.005). Going online was not associated with perceived social isolation (P=.14). Among the measures of perception of the social effects of the Internet, each 1-point increase in the frequency of going online was associated with an increase in agreement that using the Internet had: (1) made it easier to reach people (b=0.508, P<.001), (2) contributed to the ability to stay in touch (b=0.516, P<.001), (3) made it easier to meet new people (b=0.297, P=.01, (4) increased the quantity of communication with others (b=0.306, P=.01), (5) made the respondent feel less isolated (b=0.491, P<.001), (6) helped the respondent feel more connected to friends and family (b=0.392, P=.001), and (7) increased the quality of communication with others (b=0.289, P=.01).

Conclusions

Using the Internet may be beneficial for decreasing loneliness and increasing social contact among older adults in assisted and independent living communities.

You can teach an old dog new tricks: a qualitative analysis of how residents of senior living communities may use the web to overcome spatial and social barriers

For adults in senior living communities, information and communication technologies (ICTs) can be used to increase and expand communication for a population that is often spatially and socially separated from the general public. Using qualitative observational data from a longitudinal study of the impact of ICT usage on the quality of life among residents in assisted and independent living communities, the authors examine whether ICTs can mitigate the effects of social and spatial barriers. The authors find that ICTs have the potential to allow individuals to transcend social and spatial barriers, providing residents with the ability to maintain and enhance social networks as well as provide a greater sense of connection to the world at large.

Predictors of computer use in community-dwelling, ethnically diverse older adults

OBJECTIVE

In this study, we analyzed self-reported computer use, demographic variables, psychosocial variables, and health and well-being variables collected from 460 ethnically diverse, community-dwelling elders to investigate the relationship computer use has with demographics, well-being, and other key psychosocial variables in older adults.

BACKGROUND

Although younger elders with more education, those who employ active coping strategies, or those who are low in anxiety levels are thought to use computers at higher rates than do others, previous research has produced mixed or inconclusive results regarding ethnic, gender, and psychological factors or has concentrated on computer-specific psychological factors only (e.g., computer anxiety). Few such studies have employed large sample sizes or have focused on ethnically diverse populations of community-dwelling elders.

METHOD

With a large number of overlapping predictors, zero-order analysis alone is poorly equipped to identify variables that are independently associated with computer use. Accordingly, both zero-order and stepwise logistic regression analyses were conducted to determine the correlates of two types of computer use: e-mail and general computer use.

RESULTS

Results indicate that younger age, greater level of education, non-Hispanic ethnicity, behaviorally active coping style, general physical health, and role-related emotional health each independently predicted computer usage.

CONCLUSION

Study findings highlight differences in computer usage, especially in regard to Hispanic ethnicity and specific health and well-being factors.

APPLICATION

Potential applications of this research include future intervention studies, individualized computer-based activity programming, or customizable software and user interface design for older adults responsive to a variety of personal characteristics and capabilities.

Interventions targeting social isolation in older people: a systematic review

BACKGROUND

Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people.

METHODS

Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data.

RESULTS

Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting.

CONCLUSIONS

More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.

A meta-analysis of interventions to reduce loneliness

Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.