Interventions to address social connectedness and loneliness for older adults: a scoping review

Peer-to-Peer Health Communication in Older Adults' Online Communities: Protocol for a Qualitative Netnographic Study and Co-Design Approach

Background

Online communities provide an environment in which people with similar health concerns can interact and access content that can support the self-management of long-term conditions (LTCs). Recently, the importance of online social networks as sources of health information and social support has been brought into focus with the emergence and widespread societal impacts of COVID-19. Although online communities exist for older adults, little is known about the specific health and self-care topics that older people discuss in such environments and how these relate to users’ support needs and outcomes. A better understanding of users’ needs and peer-to-peer communication in these communities is necessary to inform the design of information and communication technology (ICT) interventions that are relevant to older people and their peer supporters.

Objective

This study aims to use a two-phase, web-based ethnographic (netnography) and co-design approach to explore specific health care and self-care topics that older adults discuss in a UK-based online community and how peer supporters respond to these queries with informational and/or social support and engage with stakeholders to define the needs and requirements for new ICT-based interventions capable of reducing social isolation and facilitating LTC self-management support.

Methods

The first phase of the research will involve a qualitative netnographic analysis of posts in discussion forums in a publicly accessible online community. The second phase will involve co-design workshops with health care consumers (ie, older adults and carers) and service providers to determine the needs and requirements for new ICT-based interventions and digital innovations. Constructivist grounded theory will be used in the first phase; in the second phase, the co-design workshops will be audiorecorded and analyzed thematically.

Results

This research project is in progress. Permission was obtained from the website administrator to use materials from the social media forum; data collection for the first phase began in April 2020. The second phase of the study is expected to begin in late 2020. This study is due to be completed by the end of 2021.

Conclusions

This study is the first, to the best of our knowledge, to combine qualitative netnography with an iterative co-design framework to specify the needs and requirements for new ICT-based interventions. The findings from this study will inform the next phase of the multiphase knowledge translation project and will provide insights into the potential of online peer health communities to reduce social isolation and facilitate chronic illness self-management support and self-care.

International Registered Report Identifier (IRRID)

PRR1-10.2196/19834

Protocol for a partially nested randomised controlled trial to evaluate the effectiveness of the scleroderma patient-centered intervention network COVID-19 home-isolation activities together (SPIN-CHAT) program to reduce anxiety among at-risk scleroderma patients

OBJECTIVE

Contagious disease outbreaks and related restrictions can lead to negative psychological outcomes, particularly in vulnerable populations at risk due to pre-existing medical conditions. No randomised controlled trials (RCTs) have tested interventions to reduce mental health consequences of contagious disease outbreaks. The primary objective of the Scleroderma Patient-centered Intervention Network COVID-19 Home-isolation Activities Together (SPIN-CHAT) Trial is to evaluate the effect of a videoconference-based program on symptoms of anxiety. Secondary objectives include evaluating effects on symptoms of depression, stress, loneliness, boredom, physical activity, and social interaction.

METHODS

The SPIN-CHAT Trial is a pragmatic RCT that will be conducted using the SPIN-COVID-19 Cohort, a sub-cohort of the SPIN Cohort. Eligible participants will be SPIN-COVID-19 Cohort participants without a positive COVID-19 test, with at least mild anxiety (PROMIS Anxiety 4a v1.0 T-score ≥ 55), not working from home, and not receiving current counselling or psychotherapy. We will randomly assign 162 participants to intervention groups of 7 to 10 participants each or waitlist control. We will use a partially nested RCT design to reflect dependence between individuals in training groups but not in the waitlist control. The SPIN-CHAT Program includes activity engagement, education on strategies to support mental health, and mutual participant support. Intervention participants will receive the 4-week (3 sessions per week) SPIN-CHAT Program via videoconference. The primary outcome is PROMIS Anxiety 4a score immediately post-intervention.

ETHICS AND DISSEMINATION

The SPIN-CHAT Trial will test whether a brief videoconference-based intervention will improve mental health outcomes among at-risk individuals during contagious disease outbreak.

Preventing Social Isolation: A Holistic Approach to Nursing Interventions

The current need for social distancing due to the COVID-19 pandemic can lead to social isolation in the older adult population. Social isolation contributes to multiple health problems for older adults residing in the community and residential care facilities. Mitigating the effects of social isolation requires a holistic approach, focusing interventions on the physical, psychological, and psychosocial needs of older adults. Nurses possess a unique expertise in developing holistic interventions and using creativity to counteract the negative health sequelae resulting from social isolation. The nursing role in holistic care serves to protect the older adult's ego integrity, improve quality of life, and maintain wellness during this time of mandated social distancing. [Journal of Psychosocial Nursing and Mental Health Services, 58(7), 11-13.].

Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health

Background

Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness.

Purpose

This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning.

Results

Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention.

Conclusions

We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.

Aging and Feeling Valued Versus Expendable During the COVID-19 Pandemic and Beyond: a Review and Commentary of Why Mattering Is Fundamental to the Health and Well-Being of Older Adults

The current commentary and review examines the potentially protective role of feelings of mattering among elderly people during typical times and the current atypical times associated with the COVID-19 global pandemic. Mattering is the feeling of being important to others in ways that give people the sense that they are valued and other people care about them. We contrast this feeling with messages of not mattering and being expendable and disposable due to ageism, gaps in the provision of care, and apparently economically focused positions taken during the pandemic that disrespect the value, worth, and merits of older persons. We provide a comprehensive review of past research on individual differences in mattering among older adults and illustrate the unique role of mattering in potentially protecting older adults from mental health problems. Mattering is also discussed in terms of its links with loneliness and physical health. This article concludes with a discussion of initiatives and interventions that can be modified and enhanced to instill a sense of mattering among older adults. Key directions for future research are also highlighted along with ways to expand the mattering concept to more fully understand and appreciate the relevance of mattering among older adults.

Trajectory of Psychosocial Measures amongst Informal Caregivers: Case-Controlled Study of 1375 Informal Caregivers from the English Longitudinal Study of Ageing

Informal caregivers provide vital support for older adults living in the community with chronic illnesses. The purpose of this study was to assess the psychosocial status of informal caregivers of community-dwelling adults over an eight-year period. Informal caregivers of adult care-recipients were identified from Wave 1 of the English Longitudinal Study of Ageing (ELSA) cohort. Multivariate regression analysis models were constructed to assess the association between participant's psychosocial characteristics and informal caregiving. Multilevel modelling explored the psychosocial changes between caregivers and non-caregivers over eight years. 1375 informal caregivers and 2750 age-matched non-caregivers were analyzed. Self-reported loneliness (Odd Ratio (OR): 0.26; 95% confidence intervals (CI): 0.01-0.51) and relationship status (OR: 0.36; 95% CI: 0.16-0.46) were independently associated with caregiving. Caregivers were more socially isolated with less holidaying abroad (OR: 0.51; 95% CI: 0.35-0.66), attendance to church (OR: 0.30; 95% CI: 0.11-0.49), or charity groups (OR: 0.35; 95% CI: 0.14-0.55). On multilevel analysis, over time (eight-years), caregivers reported greater loneliness (p < 0.01), change in relationship status (p = 0.01) and reduced control, autonomy, and pleasure (p ≤ 0.01) compared to non-caregivers. Given the deleterious effects caregiving can place on health and wellbeing, further interventions are required to improve these psychosocial factors.

The meanings of loneliness for older persons

Objectives: We identify and describe the meanings of loneliness among older persons, the kinds of relationships they are seeking in order to alleviate it, and the barriers they face in developing these connections.Method: Study participants were 35 older persons between the ages of 66 and 92 years from Tel Aviv, Israel, who participated in an intervention which involved group activities and individual meetings. The transcriptions of the individual meetings in which participants described their loneliness and explored potential solutions formed the data for thematic analysis.Results: Participants experienced loneliness in highly individualized ways. They were more likely to experience it when alone in the evening and on weekends, and when distracting activities were not available. While most sought companionship, many focused on a specific type of relationship, ranging from instrumental companionships to intimate and spousal relationships. Participants often had particular preferences about the demographic and socioeconomic characteristics they desired in a companion. Barriers to alleviating loneliness included cognitive sets, social skills deficits, rejection of others, technological illiteracy, and physical, sensory, and cognitive limitations. External factors included economic hardship and community programming which failed to promote socialization.Conclusion: New approaches are needed to counter and prevent loneliness among older persons by addressing the types of particular desires raised in our findings, as well as the psychological barriers to realizing them. Public policy and societal initiatives should tackle external barriers through programming which promotes social engagement and the development of other innovative strategies.

Social support for older adults with cancer: Young International Society of Geriatric Oncology review paper

Older adults with cancer have increasing needs in physical, cognitive, and emotional domains, and they can experience decline in all domains with the diagnosis and treatment of cancer. Social support plays a key role in supporting these patients, mitigating negative effects of diagnosis and treatment of cancer, and improving cancer outcomes. We review the importance of social support in older adults with cancer, describe the different components of social support and how they are measured, discuss current interventions that are available to improve social support in older adults, and describe burdens on caregivers. We also highlight Dr. Arti Hurria's contributions to recognizing the integral role of social support to caring for older adults with cancer.

The Relationships between Loneliness, Social Support, and Resilience among Latinx Immigrants in the United States

Globally, international migrants are at elevated risk for experiencing loneliness due to separation from social networks in their countries of origin. In the United States, the political rhetoric has been particularly exclusionary against Latinx immigrants, exposing them to discrimination and fear of deportation. Such environments may result in heightened levels of social isolation, which may contribute to greater risk of poor mental and physical health outcomes. Latinx immigrants, however, may access social support in their destination communities that buffers against these negative outcomes. This study sought to examine how social support and loneliness shape Latinx immigrants' abilities to address the challenges related to migration. Multivariate linear regression analyses were conducted with survey data collected from Latinx immigrants in New York City (n=306). Results revealed that Latinx immigrants with greater social support and less feelings of loneliness were more resilient. Specifically, findings suggest that social support may partially protect against the negative impact of isolation on Latinx immigrants' capacity to thrive. Clinical social workers who work with immigrant groups may consider how migration during the life course affects immigrants' social supports and experiences of loneliness. Social work interventions that integrate strategies to increase social support may provide opportunities to address social isolation and other obstacles associated with migration. Such approaches acknowledge loneliness not only as a psychological symptom, but also as a consequence of unfavorable social environments towards immigrant populations. Future research may develop and assess culturally relevant strategies to promote social support and reduce loneliness among marginalized immigrants.

Revisiones Sistemáticas Exploratorias como metodología para la síntesis del conocimiento científico

Introducción: En la actualidad los sistemas de salud alrededor del mundo apuestan por una toma decisiones clínicas basadas en la evidencia científica. Para ello, es necesario que los profesionales de la salud consulten los resultados de las investigaciones científicas. Sin embargo, dada la gran cantidad de literatura, los investigadores han desarrollado metodologías de revisión para compilar los estudios científicos dentro de un área específica. Aun cuando existen más de 10 tipos de metodologías para la revisión de la literatura, la Revisión Sistemática Exploratoria (RSE) ha recibido poca atención en la literatura sobre métodos de investigación científica de habla hispana. Objetivo: Detallar la metodología de la RSE, sus propósitos y las fases para su desarrollo. Desarrollo: Este trabajo detalla las generalidades de la RSE basándose en la metodología propuesta por Arksey & O’Malley. Así mismo, se describen las áreas o ámbitos donde este tipo de revisión se puede emplear, las fases para desarrollar la revisión y ejemplos de las RSE. Conclusiones: Las RSE tienen la fortaleza de hacer saber a los profesionales de la salud sobre un tema en específico que permita incidir en las políticas públicas. Al igual que las Revisiones Sistemáticas, las RSE utilizan una metodología clara y replicable, aportando datos confiables y científicos para los profesionales de la salud.

"It's a lifeline": Generating a sense of social connectedness through befriending parents of disabled children or children with additional need

OBJECTIVES

This study explored the influence of a parent-to-parent peer support scheme on the wellbeing of parents of disabled children or children with additional need who joined a befriending scheme.

METHODS

A longitudinal concurrent mixed methods (qualitative and quantitative) research design collected data (telephone interviews, Footsteps Tool, Resilience Scale-14) with 33 befriendees (1:1 or group support) and 33 befrienders at time-point 1 (TP1). TP2 data were collected from 20 befriendees and 16 befrienders 6-9 months after recruitment.

RESULTS

There was some improvement on average scores between TP1 and TP2 on both tools. The strongest evidence of change - 'a sense of positivity and hope' and 'connection, belonging and sharing' - was in the parents' reports of how the scheme helped them to build secure and valued social connections within a community of other parents who understood their lives.

CONCLUSION

Both the befriendees and befrienders reported the sense of hope and a feeling of belonging as key benefits that resulted from the social connections they gained from the scheme.

PRACTICE IMPLICATIONS

Social connectedness is likely to be a more useful concept than resilience in examining change.

To Meet, to Matter, and to Have Fun: The Development, Implementation, and Evaluation of an Intervention to Fulfil the Social Needs of Older People

Interventions for older people are often not evaluated and, if evaluated, are not proven successful. Based on a systematic literature review and two qualitative studies about the social needs of older people, an intervention has been developed, implemented, and evaluated. Important social needs that emerged from these studies are connectedness, meaningfulness, and independence. Samsam, the developed intervention, aims to fulfil these needs. Samsam is a place where older (native Dutch speaking) people teach the Dutch language to expats, refugees, and immigrants. Two group interviews and one interview with a total of seven older participants were held to find out what the experiences are with this intervention to fulfil the social needs of older people. After analysis, three themes emerged: (1) The general experience of Samsam, (2) connectedness, and (3) meaningfulness and status. Results indicate that the volunteers are content with the conditions of the intervention, although it is sometimes hard work. The older participants indicated that helping other people and contributing to society is important for them. The intervention also has a strong social and fun element which contributes to their feeling of connectedness. The intervention fulfils various social needs, such as connectedness, meaningfulness, and status. When participating in Samsam, participants feel connected to each other, to the students, and to society. The older participants want to have meaningful lives and use their skills and talents. Samsam offers possibilities for them to do so. We further found that participants have some common characteristics such as an openness to others and to other cultures. An openness towards others and to society helps older people to connect. Most interventions focus on stimulating contact between older people, primarily on their need for affection. We conclude that meaningfulness and status are important social needs. Successful interventions for older people should focus more on fulfilling these needs-for example, by engaging in purposeful activities. It becomes easier to connect when a person feels useful.

An Evaluation of a Low-Intensity Cognitive Behavioral Therapy mHealth-Supported Intervention to Reduce Loneliness in Older People

There is a high prevalence of loneliness among older people, especially in residential care settings. Loneliness is often accompanied by maladaptive cognitions which can affect the maintenance and establishment of meaningful social connections. This study implemented and evaluated a low-intensity Cognitive Behavior Therapy (LI-CBT) mHealth-supported intervention which targeted maladaptive cognitions in older people (≥60 years) experiencing loneliness. The three-month intervention using WhatsApp was implemented with older people in four inner-city residential care facilities. The intervention included three components: technology acceptance, psycho-education, and individualized positively worded messages addressing maladaptive cognitions. The intervention was evaluated using a randomized control design. Key outcomes were measured pre-, post-, and one month after the intervention. There were significant changes in social cognition (YSQ-SF T₀-T₁-T₂, X² = 9.69, p = 0.008) and loneliness levels (total loneliness T₀-T₁-T₂, X² = 14.62, p = 0.001), and an increase in WhatsApp usage (T₀ = 26% vs. T₁ = 60%, X²=15.22, p = 0.019). At 1-month follow-up, even with a significant reduction in WhatsApp usage, a significant reduction in loneliness was maintained. LI-CBT delivered via instant messaging may be effective in reducing loneliness experienced by older people.