Loneliness in older people and COVID-19: Applying the social identity approach to digital intervention design

Chronic loneliness and chronic social isolation among older adults. A systematic review, meta-analysis and meta-regression

OBJECTIVES

We performed a systematic review and meta-analysis to examine the prevalence and antecedents/consequences of chronic loneliness and social isolation (i.e. enduring or persistent experience that extends over a certain period of time) among older adults. Moreover, we conducted a meta-regression to explore sources of heterogeneity.

METHOD

A search was conducted in four electronic databases. We included observational studies that reported prevalence and, where available, antecedents/consequences of chronic loneliness or chronic social isolation amongst older adults. Key characteristics of the studies were extracted.

RESULTS

Across 17 studies included in the meta-analysis, the estimated prevalence of chronic loneliness was 20.8% (95% CI: 16.1-25.5%), including 21.7% among women (95% CI: 16.1-27.4%) and 16.3% among men (95% CI: 10.6-21.9%). One study reported chronic social isolation (13.4%) and found that chronic social isolation predicted higher depression scores. Meta-regressions indicated that loneliness was less prevalent when assessed with single-item measures. Regarding antecedents/consequences, spousal loss can contribute to chronic loneliness which in turn may contribute to adverse health-related outcomes.

CONCLUSION

About one in five older adults experiences chronic loneliness reflecting the need to address chronic loneliness. More longitudinal research is needed on chronic loneliness and social isolation, particularly from low and middle-income countries.

Correlates of Loneliness and Social Isolation among Older Adults during the COVID-19 Outbreak: A Comprehensive Assessment from a National United States Sample

This study examined the correlates of loneliness and social isolation among older adults in the United States (U.S.) during the COVID-19 outbreak. We analyzed data from the 2020 National Health and Aging Trends Study, a nationally representative sample of 3257 U.S. older adults aged 65 years and older. We analyzed and identified the sociodemographic, health, social support, and community correlates of loneliness, higher loneliness during versus before the COVID-19 outbreak, and social isolation using weighted multiple logistic regression models. About 35.2% of U.S. older adults reported loneliness during the COVID-19 outbreak, 21.9% reported higher loneliness compared to before the COVID-19 outbreak, and 32.8% were socially isolated during the outbreak. Correlates for increased odds of loneliness included female gender, higher education, physical activity, depression, anxiety, functional limitations, and virtual communication access (only for higher loneliness during COVID-19 outbreak). Correlates for increased odds of social isolation included higher age, non-Hispanic Black, Hispanic, higher number of household children, and metropolitan residence. Our findings provide insights into evidence-based approaches to address social disconnection among U.S. older adults. The wide range of sociodemographic, health, social support, and community correlates identified in this study warrants multifaceted interventions that traverse individual, community, and societal levels to address the loneliness and social isolation epidemic.

Effectiveness of identity-building interventions on recovery identity and patient-reported health outcomes in chronic diseases: A meta-analysis

This meta-analysis aimed to assess the impact of identity-building interventions on recovery identity and patient-reported health outcomes in chronic disease patients. We identified 15 relevant empirical studies (comprising 2261 patients) from 989 records through extensive keyword searches and manual screening conducted between March 2nd and March 13th, 2023. Utilizing the Cochrane tool, meta-regression, and the GRADE approach, we evaluated these studies for their characteristics, findings, and quality. The analysis revealed that identity-building interventions, encompassing recovery-oriented group, interest group, and linguistic approaches, positively influenced identity synthesis and had varying effects on health outcomes. Notably, multiple regression analysis demonstrated that identity synthesis significantly predicted health outcomes. However, the study identified mild heterogeneity, a high attrition bias risk, and insufficient data on selection and detection bias as limitations. Overall, identity-building interventions proved influential in enhancing recovery identity, a vital predictor of patient-reported health outcomes in chronic disease patients.

Exploring the potential impact of group identity on post-traumatic growth in the aftermath of Corona outbreak: function of social-emotional competence as a mediator

Background

This research endeavors to examine the potential effects of human and societal interactions on individuals' post-traumatic growth in the aftermath of the Corona outbreak. To achieve the aforementioned objective, the current research investigates the correlations between post-traumatic growth and group identity, while also examining the potential mediating function of social-emotional competence.

Methods

A cross-sectional design included a representative sample of 2,637 high school students located in the capital territory of Pakistan using convenience sampling method. To explore the associations, correlation and mediation analyzes utilizing the group identification scale, the social-emotional competence scale, and the post-traumatic growth scale was performed with SPSS PROCESS 4 macro and AMOS.

Results

The findings demonstrated that group identification emerged as a substantial predictor substantially associated with post-traumatic growth. Moreover, the relationship linking group identification and post-traumatic growth was found to be partially moderated by social-emotional competence.

Conclusion

The phenomenon of group identification can exert influence on post-traumatic growth through both direct and mediating pathways, with the latter being essentially mediated by social-emotional competence. The aforementioned outcomes possess significant academic and practical implications concerning the promotion of post-traumatic growth and the improvement of psychological well-being after the Corona outbreak.

Performance of T-Track® SARS-CoV-2, an Innovative Dual Marker RT-qPCR-Based Whole-Blood Assay for the Detection of SARS-CoV-2-Reactive T Cells

T-cell immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a central role in the control of the virus. In this study, we evaluated the performance of T-Track® SARS-CoV-2, a novel CE-marked quantitative reverse transcription-polymerase chain reaction (RT-qPCR) assay, which relies on the combined evaluation of IFNG and CXCL10 mRNA levels in response to the S1 and NP SARS-CoV-2 antigens, in 335 participants with or without a history of SARS-CoV-2 infection and vaccination, respectively. Of the 62 convalescent donors, 100% responded to S1 and 88.7% to NP antigens. In comparison, of the 68 naïve donors, 4.4% were reactive to S1 and 19.1% to NP. Convalescent donors <50 and ≥50 years of age demonstrated a 100% S1 reactivity and an 89.1% and 87.5% NP reactivity, respectively. T-cell responses by T-Track® SARS-CoV-2 and IgG serology by recomLine SARS-CoV-2 IgG according to the time from the last immunisation (by vaccination or viral infection) were comparable. Both assays showed a persistent cellular and humoral response for at least 36 weeks post immunisation in vaccinated and convalescent donors. Our results demonstrate the very good performance of the T-Track® SARS-CoV-2 molecular assay and suggest that it might be suitable to monitor the SARS-CoV-2-specific T-cell response in COVID-19 vaccinations trials and cross-reactivity studies.

The Association Between Group Identity and Post-Traumatic Growth in the Post COVID-19 Era: The Mediating Effect of Social-Emotional Competence

Purpose

To investigate the impact of human-society relationships on individual post-traumatic growth (PTG) in the post COVID-19 era, this study examined the association between group identity (GI) and PTG, and explored the mediating role of social-emotional competence (SEC).

Patients and Methods

In this cross-sectional study, we surveyed 1203 high school students in an eastern region of China using the GI Scale, the SEC Scale, and the PTG Scale. We conducted correlation and mediation analyses using SPSS 23.0 and PROCESS software.

Results

The results indicated that GI was a significant positive predictor of PTG (β=0.219, p<0.001), and that the pathway between GI and PTG was partially mediated by SEC (Effect=0.074, 95% CI= [0.045,0.104]).

Conclusion

GI can have both direct and indirect effects on PTG, with the latter mediated by SEC. These findings hold important theoretical and practical implications for promoting PTG and enhancing mental health in the post COVID-19 era.

From tech to tact: emotion dysregulation in online communication during the COVID-19 pandemic

Recent theorizing argues that online communication technologies provide powerful, although precarious, means of emotional regulation. We develop this understanding further. Drawing on subjective reports collected during periods of imposed social restrictions under COVID-19, we focus on how this precarity is a source of emotional dysregulation. We make our case by organizing responses into five distinct but intersecting dimensions wherein the precarity of this regulation is most relevant: infrastructure, functional use, mindful design (individual and social), and digital tact. Analyzing these reports, along with examples of mediating technologies (i.e., self-view) and common interactive dynamics (e.g., gaze coordination), we tease out how breakdowns along these dimensions are sources of affective dysregulation. We argue that the adequacy of available technological resources and competencies of various kinds matter greatly to the types of emotional experiences one is likely to have online. Further research into online communication technologies as modulators of both our individual and collective well-being is urgently needed, especially as the echoes of the digital push that COVID-19 initiated are set to continue reverberating into the future.

No Substitute for In-Person Interaction: Changing Modes of Social Contact during the Coronavirus Pandemic and Effects on the Mental Health of Adults in the UK

Life-course theories on how social relationships affect mental health are limited in causal claims. The restrictions in social contact during the coronavirus pandemic provided a natural experiment that modified the frequency of in-person contact and allowed us to estimate the effect of changes in in-person social contact frequency on mental health in four large nationally representative age-cohorts of adults living in the UK. There was consistent evidence of a small but statistically significant effect of less frequent social contact on anxiety-depression. Online modes of social contact did not compensate for the restrictions in in-person social contact during the pandemic. Young adults who increased their online social media frequency during the pandemic experienced a deterioration in mental health. Life-course theories cannot ignore the importance of the mode of social contact for social relationships, especially during young adulthood.

Breaking the vicious cycle: The interplay between loneliness, metabolic illness, and mental health

Loneliness, or perceived social isolation, is a leading predictor of all-cause mortality and is increasingly considered a public health epidemic afflicting significant portions of the general population. Chronic loneliness is itself associated with two of the most pressing public health epidemics currently facing the globe: the rise of mental illness and metabolic health disorders. Here, we highlight the epidemiological associations between loneliness and mental and metabolic health disorders and argue that loneliness contributes to the etiology of these conditions by acting as a chronic stressor that leads to neuroendocrine dysregulation and downstream immunometabolic consequences that manifest in disease. Specifically, we describe how loneliness can lead to overactivation of the hypothalamic-pituitary-adrenal axis and ultimately cause mitochondrial dysfunction, which is implicated in mental and metabolic disease. These conditions can, in turn, lead to further social isolation and propel a vicious cycle of chronic illness. Finally, we outline interventions and policy recommendations that can reduce loneliness at both the individual and community levels. Given its role in the etiology of the most prevalent chronic diseases of our time, focusing resources on alleviating loneliness is a vitally important and cost-effective public health strategy.

Stakeholder's experiences of living and caring in technology-rich supported living environments for tenants living with dementia

BACKGROUND

Technology innovation provides an opportunity to support the rising number of people living with dementia globally. The present study examines experiences of people who have dementia and live in technology enriched supported care models. Additionally, it explores caregiver's attitudes towards technology use with the housing scheme.

METHODS

A qualitative research design was adopted, and eight housing schemes consented to take part in the study. A technology audit was undertaken in addition to participant interviews and caregiver survey. Seven peer researchers conducted semi-structured interviews with 22 people living with dementia. Interviews were analysed using thematic analysis. Informal and formal caregivers were invited to complete a survey to capture their attitudes towards technology use. A total of 20 informal and 31 formal caregiver surveys were returned. All surveys were input into Survey Monkey and downloaded into excel for analysis. Closed questions were analysed using descriptive statistics and open-ended questions were organised into themes and described descriptively.

RESULTS

The technology audit identified that technologies were in place from as early as 2002. Technology heterogeneity of, both passive and active devices, was found within the housing schemes. Technologies such as wearable devices were reportedly used according to need, and mobile phone use was widely adopted. The themes that developed out of the tenant interviews were: Attitudes and Engagement with Technology; Technology Enhancing Tenants Sense of Security; Seeking Support and Digital Literacy; and Technology Enabled Connection. A lack of awareness about living alongside technology was a major finding. Technologies enabled a sense of reassurance and facilitated connections with the wider community. The interaction with technology presented challenges, for example, remembering passwords, access to Wi-Fi and the identification of its use in an emergency. The caregiver survey reported a range of facilitators and barriers for the use of technology within care. Both types of caregivers held relatively similar views around the benefits of technology, however their views on issues such as privacy and consent varied. Safety was considered more important than right to privacy by family caregivers.

CONCLUSIONS

The present study provides new insight into stakeholder's experiences of living, working and caregiving alongside technology in supported living environments. As the generation of people living with dementia become more tech savvy, harnessing everyday technologies to support care could enable holistic care and support the transition through the care continuum. Advance care planning and technology assessments are at the very core of future technology provision. It is evident that a paternalistic attitudes towards technology use could impact the multitude of benefits technology can play in both health and leisure for people living with dementia and their caregivers.

Digital Intervention in Loneliness in Older Adults: Qualitative Analysis of User Studies

BACKGROUND

Loneliness is a significant well-being issue that affects older adults. Existing, commonly used social connection platforms do not contain facilities to break the cognitive cycle of loneliness, and loneliness interventions implemented without due processes could have detrimental effects on well-being. There is also a lack of digital technology designed with older adults.

OBJECTIVE

We aimed to iteratively design a user-centered smartphone app that can address loneliness in older adults. The aim of this study was to investigate the loneliness-related psychological processes that our conceptual smartphone app promotes. We also identified the emergent needs and concerns that older adults raised regarding the potential benefits and detriments of the app.

METHODS

We used technology probes to elicit older adults' reflections on the concept of using the app in 2 studies as follows: concept focus groups (n=33) and concept interviews (n=10). We then conducted a prototype trial with 1 week of use and follow-up interviews (n=12).

RESULTS

Thematic analysis explored the experiences and emergent challenges of our app through the design process. This led to the development of 4 themes as follows occurring in all 3 qualitative data sets: reflection on a digital social map is reassuring; app features encourage socializing; the risk of compounding loneliness; and individuals feel more control with mutual, socially beneficial activities.

CONCLUSIONS

Smartphone apps have the potential to increase older adults' awareness of the richness of their social connections, which may support loneliness reduction. Our qualitative approach to app design enabled the inclusion of older adults' experiences in technology design. Thus, we conclude that the older adults in our study most desired functionalities that can support mutual activities and maintain or find new connections rather than enable them to share an emotional state. They were wary of the app replacing their preferred in-person social interaction. Participants also raised concerns about making the user aware of the lack of support in their social network and wanted specific means of addressing their needs. Further user-centered design work could identify how the app can support mutual activities and socializing.

COVID-19 hospitalizations and patients' age at admission: The neglected importance of data variability for containment policies

Introduction

An excess in the daily fluctuation of COVID-19 in hospital admissions could cause uncertainty and delays in the implementation of care interventions. This study aims to characterize a possible source of extravariability in the number of hospitalizations for COVID-19 by considering age at admission as a potential explanatory factor. Age at hospitalization provides a clear idea of the epidemiological impact of the disease, as the elderly population is more at risk of severe COVID-19 outcomes. Administrative data for the Veneto region, Northern Italy from February 1, 2020, to November 20, 2021, were considered.

Methods

An inferential approach based on quasi-likelihood estimates through the generalized estimation equation (GEE) Poisson link function was used to quantify the overdispersion. The daily variation in the number of hospitalizations in the Veneto region that lagged at 3, 7, 10, and 15 days was associated with the number of news items retrieved from Global Database of Events, Language, and Tone (GDELT) regarding containment interventions to determine whether the magnitude of the past variation in daily hospitalizations could impact the number of preventive policies.

Results

This study demonstrated a significant increase in the pattern of hospitalizations for COVID-19 in Veneto beginning in December 2020. Age at admission affected the excess variability in the number of admissions. This effect increased as age increased. Specifically, the dispersion was significantly lower in people under 30 years of age. From an epidemiological point of view, controlling the overdispersion of hospitalizations and the variables characterizing this phenomenon is crucial. In this context, the policies should prevent the spread of the virus in particular in the elderly, as the uncontrolled diffusion in this age group would result in an extra variability in daily hospitalizations.

Discussion

This study demonstrated that the overdispersion, together with the increase in hospitalizations, results in a lagged inflation of the containment policies. However, all these interventions represent strategies designed to contain a mechanism that has already been triggered. Further efforts should be directed toward preventive policies aimed at protecting the most fragile subjects, such as the elderly. Therefore, it is essential to implement containment strategies before the occurrence of potentially out-of-control situations, resulting in congestion in hospitals and health services.

The impact of mobile Internet use on mental distress among Chinese adults during the COVID-19 pandemic

With the rapid development of digital technology, mobile Internet use is increasing in popularity in China. Previous studies have shown that mobile Internet use has a positive or negative effect on mental distress. Using CFPS2020 data, this paper finds that mobile Internet use significantly alleviates mental distress in Chinese adults. Heterogeneity analysis indicates that mobile Internet use can significantly alleviate mental distress among adults between the ages of 30 and 70, without a bachelor's degree or residing outside the province of Hubei. Furthermore, mobile Internet use significantly reduces mental distress through two mediators: trust and happiness. It also shows that watching short videos or learning online is associated with reduced mental distress, as opposed to online shopping, chatting, or playing games. However, the mental distress of new mobile Internet users in 2020 has not been alleviated. This paper enriches the relevant theoretical research and provides a practical reference for using the mobile Internet to ease mental distress during epidemics.

On the Use of Assistive Technology during the COVID-19 Outbreak: Results and Lessons Learned from Pilot Studies

As a consequence of the COVID-19 emergency, frail citizens felt isolated because of social isolation, suspended and/or strongly reduced home assistance, and limited access to hospitals. In this sense, assistive technology could play a pivotal role in empowering frail older adults reducing their isolation, as well as in reinforcing the work of formal caregivers and professionals. In this context, the goal of this paper is to present four pilot studies-conducted from March 2020 to April 2021-to promptly react to COVID-19 by providing assistive technology solutions, aiming to (1) guarantee high-quality service to older adults in-home or in residential facility contexts, (2) promote social inclusion, and (3) reduce the virus transmission. In particular, four services, namely, telepresence service, remote monitoring service, virtual visit, and environmental disinfection, were designed, implemented, and tested in real environments involving 85 end-users to assess the user experience and/or preliminary assess the technical feasibility. The results underlined that all the proposed services were generally accepted by older adults and professionals. Additionally, the results remarked that the use of telepresence robots in private homes and residential facilities increased enjoyment reducing anxiety, whereas the monitoring service supported the clinicians in monitoring the discharged COVID-19 patients. It is also worth mentioning that two new services/products were developed to disinfect the environment and to allow virtual visits within the framework of a hospital information system. The virtual visits service offered the opportunity to expand the portfolio of hospital services. The main barriers were found in education, technology interoperability, and ethical/legal/privacy compliance. It is also worth mentioning the key role played by an appropriate design and customer needs analysis since not all assistive devices were designed for older persons.

The use of digital technologies by people with mild-to-moderate dementia during the COVID-19 pandemic: A positive technology perspective

A growing body of research has shown that people with dementia are using digital technologies to enhance lived experience. The COVID-19 pandemic has brought new digital opportunities and challenges and so provides a unique opportunity to understand how people with dementia have adapted to this new digital landscape. Semi-structured interviews were conducted with 19 people with dementia and analysed thematically. We generated five themes, showing how participants used digital means to combat the stresses of the pandemic by facilitating social connection, self-actualisation, enhanced well-being and by assisting with activities of daily life. These technologies helped to reduce isolation, provide access to support groups, create opportunities for cognitive stimulation and self-development, and engendered a sense of identity at a time of perceived loss. Despite these benefits, participants also reported challenges regarding cognitive fatigue and usability issues. We recommend that training on how to use digital technologies is co-produced with people with dementia and designers engage with the voices of people with dementia throughout the design process. In turn, this could promote the social connectedness, well-being and self-worth of people with dementia.