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Pickering J, Wister AV, O'Dea E, Chaudhury H. Social isolation and loneliness among older adults living in rural areas during the COVID-19 pandemic: a scoping review. BMC Geriatr 2023; 23:511. [PMID: 37612647 PMCID: PMC10464360 DOI: 10.1186/s12877-023-04196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The causes and consequences of social isolation and loneliness of older people living in rural contexts during the COVID-19 pandemic were systematically reviewed to describe patterns, causes and consequences. METHODS Using the Arksey and O'Malley (2005) scoping review method, searches were conducted between March and December 2022, 1013 articles were screened and 29 were identified for data extraction. RESULTS Findings were summarized using thematic analysis separated into four major themes: prevalence of social isolation and loneliness; rural-only research; comparative urban-rural research; and technological and other interventions. Core factors for each of these themes describe the experiences of older people during the COVID-19 pandemic and related lockdowns. We observed that there are interrelationships and some contradictory findings among the themes. CONCLUSIONS Social isolation and loneliness are associated with a wide variety of health problems and challenges, highlighting the need for further research. This scoping review systematically identified several important insights into existing knowledge from the experiences of older people living in rural areas during the COVID-19 pandemic, while pointing to pressing knowledge and policy gaps that can be addressed in future research.
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Affiliation(s)
- John Pickering
- Gerontology Research Centre, Simon Fraser University, 2800-515 Hastings Street Vancouver, Burnaby, BC, V6B 5K3, Canada.
| | - Andrew V Wister
- Gerontology Research Centre, Simon Fraser University, 2800-515 Hastings Street Vancouver, Burnaby, BC, V6B 5K3, Canada
- Department of Gerontology, Simon Fraser University, British Columbia, Canada
| | - Eireann O'Dea
- Department of Gerontology, Simon Fraser University, British Columbia, Canada
| | - Habib Chaudhury
- Gerontology Research Centre, Simon Fraser University, 2800-515 Hastings Street Vancouver, Burnaby, BC, V6B 5K3, Canada
- Department of Gerontology, Simon Fraser University, British Columbia, Canada
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2
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Kosurko A, Herron RV, Grigorovich A, Bar RJ, Kontos P, Menec V, Skinner MW. Dance wherever you are: the evolution of multi-modal delivery for social inclusion of rural older adults. Innov Aging 2022; 6:igab058. [PMID: 35155836 PMCID: PMC8827315 DOI: 10.1093/geroni/igab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Older adult social inclusion involves meaningful participation that is increasingly mediated by information communication technology and in rural areas requires an understanding of older adults’ experiences in the context of the digital divide. This article examines how the multimodal streaming (live, prerecorded, blended in-person) of the Sharing Dance Older Adults program developed by Canada’s National Ballet School and Baycrest influenced social inclusion processes and outcomes in rural settings. Research Design and Methods Data were collected from on-site observations of dance sessions, research team reflections, focus groups, and interviews with older adult participants and their carers in pilot studies in the Peterborough region of Ontario and the Westman region of Manitoba, Canada (2017–2019). There were 289 participants including older adults, people living with dementia, family carers, long-term care staff, community facilitators, and volunteers. Analytic themes were framed in the context of rural older adult social exclusion. Results Remote delivery addressed barriers of physical distance by providing access to the arts-based program and enhancing opportunities for participation. Constraints were introduced by the use of technology in rural areas and mitigated by in-person facilitators and different streaming options. Meaningful engagement in dynamic interactions in the dance was achieved by involving local staff and volunteers in facilitation of and feedback on the program and its delivery. Different streaming technologies influenced social inclusion in different ways: live-stream enhanced connectedness, but constrained technical challenges; prerecorded was reliable, but less social; blended delivery provided options, but personalization was unsustainable. Discussion and Implications Understanding different participants’ experiences of different technologies will contribute to more effective remote delivery of arts-based programs with options to use technology in various contexts depending on individual and organizational capacities.
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Affiliation(s)
- An Kosurko
- Trent Centre for Aging & Society, Trent University, Peterborough, Canada
| | - Rachel V Herron
- Geography and Environment, Brandon University, Brandon, Manitoba, Canada
| | - Alisa Grigorovich
- Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Rachel J Bar
- Research and Health, Canada's National Ballet School, Toronto, Ontario, Canada
| | - Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Verena Menec
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark W Skinner
- School of the Environment, Trent University, Peterborough, Ontario, Canada
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O'Connell ME, Haase KR, Grewal KS, Panyavin I, Kortzman A, Flath ME, Cammer A, Cosco TD, Peacock S. Overcoming Barriers for Older Adults to Maintain Virtual Community and Social Connections during the COVID-19 Pandemic. Clin Gerontol 2022; 45:159-171. [PMID: 34233600 DOI: 10.1080/07317115.2021.1943589] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We describe the evaluation of remote training, an innovative use of technology to maintain older adults' virtual connection with their community and socialization, which were disrupted by the pandemic. Remote training was conducted via telephone using principles of cognitive rehabilitation and delivered by trained clinicians. METHODS We thematically analyzed trainer reflection notes and interviews with older adult participants. RESULTS The main facilitators were technology training with exposure, and the main barrier was fear of technology. CONCLUSIONS We describe how telephone-based training grounded in principles of cognitive rehabilitation can be used to remotely train older adults to use new technology and to help them maintain their community-based connections and engage in socialization. CLINICAL IMPLICATIONS Fear of technology during the pandemic can cause significant impairment in social functioning for older adults, at least when the only method for socialization is technology mediated such as during the COVID-19 pandemic. Empathically delivered remote training in an understanding manner can reduce fear and increase social and community connections in the era of physical distancing.
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Affiliation(s)
- Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Karl S Grewal
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ivan Panyavin
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - August Kortzman
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Meghan E Flath
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Allison Cammer
- College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Theodore D Cosco
- Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada.,Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Wilding C, Davis H, Rasekaba T, Hamiduzzaman M, Royals K, Greenhill J, O’Connell ME, Perkins D, Bauer M, Morgan D, Blackberry I. Volunteers' Support of Carers of Rural People Living with Dementia to Use a Custom-Built Application. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189909. [PMID: 34574832 PMCID: PMC8472467 DOI: 10.3390/ijerph18189909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
There is great potential for human-centred technologies to enhance wellbeing for people living with dementia and their carers. The Virtual Dementia Friendly Rural Communities (Verily Connect) project aimed to increase access to information, support, and connection for carers of rural people living with dementia, via a co-designed, integrated website/mobile application (app) and Zoom videoconferencing. Volunteers were recruited and trained to assist the carers to use the Verily Connect app and videoconferencing. The overall research design was a stepped wedge open cohort randomized cluster trial involving 12 rural communities, spanning three states of Australia, with three types of participants: carers of people living with dementia, volunteers, and health/aged services staff. Data collected from volunteers (n = 39) included eight interviews and five focus groups with volunteers, and 75 process memos written by research team members. The data were analyzed using a descriptive evaluation framework and building themes through open coding, inductive reasoning, and code categorization. The volunteers reported that the Verily Connect app was easy to use and they felt they derived benefit from volunteering. The volunteers had less volunteering work than they desired due to low numbers of carer participants; they reported that older rural carers were partly reluctant to join the trial because they eschewed using online technologies, which was the reason for involving volunteers from each local community.
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Affiliation(s)
- Clare Wilding
- John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga 3689, Australia; (C.W.); (T.R.); (K.R.)
| | - Hilary Davis
- Centre for Social Impact, Swinburne University, Melbourne 3122, Australia;
| | - Tshepo Rasekaba
- John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga 3689, Australia; (C.W.); (T.R.); (K.R.)
| | | | - Kayla Royals
- John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga 3689, Australia; (C.W.); (T.R.); (K.R.)
| | - Jennene Greenhill
- College of Medicine and Public Health, Flinders University, Renmark 5341, Australia;
| | - Megan E. O’Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK S7N 5E4, Canada;
| | - David Perkins
- Centre for Rural and Remote Mental Health, The University of Newcastle, Orange 2800, Australia;
| | - Michael Bauer
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne 3083, Australia;
| | - Debra Morgan
- Department of Medicine, Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada;
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga 3689, Australia; (C.W.); (T.R.); (K.R.)
- Correspondence: ; Tel.: +61-2-6024-9613
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Haase KR, Cosco T, Kervin L, Riadi I, O'Connell ME. Older Adults' Experiences With Using Technology for Socialization During the COVID-19 Pandemic: Cross-sectional Survey Study. JMIR Aging 2021; 4:e28010. [PMID: 33739929 PMCID: PMC8074950 DOI: 10.2196/28010] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Technology use has become the most critical approach to maintaining social connectedness during the COVID-19 pandemic. Older adults (aged >65 years) are perceived as the most physiologically susceptible population to developing COVID-19 and are at risk of secondary mental health challenges related to the social isolation that has been imposed by virus containment strategies. To mitigate concerns regarding sampling bias, we analyzed a random sample of older adults to understand the uptake and acceptance of technologies that support socialization during the pandemic. OBJECTIVE We aimed to conduct a population-based assessment of the barriers and facilitators to engaging in the use of technology for web-based socialization among older adults in the Canadian province of British Columbia during the COVID-19 pandemic. METHODS We conducted a cross-sectional, population-based, regionally representative survey by using the random-digit dialing method to reach participants aged >65 years who live in British Columbia. Data were analyzed using SPSS (IBM Corporation), and open-text responses were analyzed via thematic analysis. RESULTS Respondents included 400 older adults aged an average of 72 years, and 63.7% (n=255) of respondents were female. Most respondents (n=358, 89.5%) were aware of how to use technology to connect with others, and slightly more than half of the respondents (n=224, 56%) reported that, since the beginning of the pandemic, they used technology differently to connect with others during the pandemic. Additionally, 55.9% (n=223) of respondents reported that they adopted new technology since the beginning of the pandemic. Older adults reported the following key barriers to using technology: (1) a lack of access (including finance-, knowledge-, and age-related issues); (2) a lack of interest (including a preference for telephones and a general lack of interest in computers); and (3) physical barriers (resultant of cognitive impairments, stroke, and arthritis). Older adults also reported the following facilitators: (1) a knowledge of technologies (from self-teaching or external courses); (2) reliance on others (family, friends, and general internet searches); (3) technology accessibility (including appropriate environments, user-friendly technology, and clear instructions); and (4) social motivation (everyone else is doing it). CONCLUSIONS Much data on older adults' use of technology are limited by sampling biases, but this study, which used a random sampling method, demonstrated that older adults used technology to mitigate social isolation during the pandemic. Web-based socialization is the most promising method for mitigating potential mental health effects that are related to virus containment strategies. Providing telephone training; creating task lists; and implementing the facilitators described by participants, such as facilitated socialization activities, are important strategies for addressing barriers, and these strategies can be implemented during and beyond the pandemic to bolster the mental health needs of older adults.
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Affiliation(s)
- Kristen R Haase
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada
| | - Theodore Cosco
- Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada.,Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
| | - Lucy Kervin
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Indira Riadi
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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Herron RV, Newall NEG, Lawrence BC, Ramsey D, Waddell CM, Dauphinais J. Conversations in Times of Isolation: Exploring Rural-Dwelling Older Adults' Experiences of Isolation and Loneliness during the COVID-19 Pandemic in Manitoba, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3028. [PMID: 33804282 PMCID: PMC8000998 DOI: 10.3390/ijerph18063028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/20/2023]
Abstract
Older adults have been described as a vulnerable group in the current context of the COVID-19 pandemic. In Canada, where this study took place, older adults have been encouraged to self-isolate while the rest of the population has been cautioned against in-person contact with them. Prior to COVID-19, social isolation and loneliness among older adults was considered a serious public health concern. Using a series of semi-structured interviews with 26 community-dwelling older adults (65+) living in rural Manitoba, we explore older adults' experiences of isolation and loneliness in the initial stages of the pandemic between the months of May and July 2020. Participants identified a loss of autonomy, loss of activities and social spaces (e.g., having coffee or eating out, volunteering, and going to church), and lack of meaningful connection at home as factors influencing their sense of isolation and loneliness. Although these loses initially influenced participants' self-reported isolation and loneliness, the majority developed strategies to mitigate isolation and loneliness, such as drawing on past experiences of isolation, engaging in physically distanced visits, connecting remotely, and "keeping busy." Our findings call attention to the role of different environments and resources in supporting older adults social and emotional wellbeing, particularly as they adapt to changes in social contact over time.
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Affiliation(s)
- Rachel V. Herron
- Department of Geography and Environment, Brandon University, Brandon, MB R7A 6A9, Canada
| | - Nancy E. G. Newall
- Department of Psychology, Brandon University, Brandon, MB R7A 6A9, Canada;
| | | | - Doug Ramsey
- Department of Rural Development, Brandon University, Brandon, MB R7A 6A9, Canada;
| | - Candice M. Waddell
- Department of Psychiatric Nursing, Brandon University, Brandon, MB R7A 6A9, Canada;
| | - Jennifer Dauphinais
- Centre for Critical Studies of Rural Mental Health, Brandon, MB R7A 6A9, Canada;
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O'Connell ME, Vellani S, Robertson S, O'Rourke HM, McGilton KS. Going From Zero to 100 in Remote Dementia Research: A Practical Guide. J Med Internet Res 2021; 23:e24098. [PMID: 33468448 PMCID: PMC7842855 DOI: 10.2196/24098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/18/2021] [Indexed: 12/26/2022] Open
Abstract
Remote approaches for dementia research are required in the era of COVID-19, but moving a research program from in person to remote involves additional considerations. We recommend using outcome measures that have psychometric properties for remote delivery, and we recommend against adapting in-person scales for remote delivery without evidence for psychometric equivalency. We suggest remote research designs that maximize benefit for participants, which could have implications for control groups. Researchers should plan for flexibility in their methods for remote research and must not assume all participants will be able to videoconference; telephone-only research is possible. We recommend performing an assessment of information communication technology infrastructure and prior exposure to this technology with each participant before making a final choice on remote methods for research. In general, researchers should adapt their methods for remote research to each participant rather than requesting participants to adapt to the researchers. Screening for sensory loss should be conducted, and the impact of this on the use of technology for remote research should be considered. In this viewpoint, we detail how individualized training is required prior to engaging in remote research, how training plans interact with cognitive impairments and, finally, the steps involved in facilitating technology-based remote data collection.
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Affiliation(s)
- Megan E O'Connell
- University of Saskatchewan, Department of Psychology, Saskatoon, SK, Canada
| | - Shirin Vellani
- University Health Network, Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada
| | - Sheryl Robertson
- University Health Network, Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada
| | | | - Kathy S McGilton
- University Health Network, Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada
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Elliot V, Morgan D, Kosteniuk J, Bayly M, Froehlich Chow A, Cammer A, O’Connell ME. Palliative and end-of-life care for people living with dementia in rural areas: A scoping review. PLoS One 2021; 16:e0244976. [PMID: 33444351 PMCID: PMC7808637 DOI: 10.1371/journal.pone.0244976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background and objectives People living with dementia deserve to experience the benefits of receiving palliative care and end-of-life services and supports, yet they often do not receive this care compared to those with other terminal diseases. People living with dementia in rural areas often face additional challenges to accessing such care. The purpose of this scoping review was to systematically review and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature. Methods A collaborative research team approach was used in an iterative process across all stages of this review. Systematic, comprehensive searches were conducted across ten databases and eight targeted websites for relevant peer-reviewed, original research and other less formal literature, published in English, which yielded a total of 4476 results. After duplicate removal, screening, and review, 24 items were included for synthesis. Results All items were described and illustrated by frequency distribution, findings were grouped thematically, and five key themes emerged, including: 1) Knowledge about dementia, 2) Availability, accessibility, and utilization of palliative and end-of-life care services and supports, 3) Decision-making about care, the value of a person-centered approach and collaborative support, 4) Perspectives on artificial nutrition, hydration, and comfort care, and 5) Quality of life and death. The main gap identified was literature pertaining to rural populations, especially from locations other than the United States. The influence of rurality on relevant findings was mixed across rural-urban comparison studies, as was the effect of sex and gender across the literature. Conclusions Several areas were highlighted including the importance of increasing knowledge about dementia, having early conversations about advanced care and treatment options, providing a person-centered approach, and the potential for using technology to address rural access issues. These findings can be used to inform future research and policy and the development of services, supports, and strategies for rural people living with dementia. Further research is recommended.
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Affiliation(s)
- Valerie Elliot
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- * E-mail:
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julie Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melanie Bayly
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Amanda Froehlich Chow
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Megan E. O’Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Soar J, Yu L, Al-Hakim L. Older People’s Needs and Opportunities for Assistive Technologies. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7313296 DOI: 10.1007/978-3-030-51517-1_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Older adults experience a disconnect between their needs and adoption of technologies that have potential to assist and to support more independent living. This paper reviewed research that links people’s needs with opportunities for assistive technologies. It searched 13 databases identifying 923 papers with 34 papers finally included for detailed analysis. The research papers identified needs in the fields of health, leisure, living, safety, communication, family relationship and social involvement. Amongst these, support for activities of daily living category was of most interest. In specific sub-categories, the next most reported need was assistive technology to support walking and mobility followed by smart cooking/kitchen technology and assistive technology for social contacts with family member/other people. The research aimed to inform a program of research into improving the adoption of technologies where they can ameliorate identified needs of older people.
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