Can a short internet training program improve social isolation and self-esteem in older adults with psychiatric conditions?

A mixed methods feasibility study of a virtual group-based social support program for older adults in residential care

OBJECTIVES

In response to calls for inventive ways to mitigate risks of physical distancing due to the COVID-19 pandemic for older adults living in residential care, the JAVA Music Club-Digital (JMC-D) was developed. The current feasibility study investigated benefits, usability, and implementation of weekly JMC-D sessions over 6 months.

METHOD

Employing a pre-post mixed methods study, depressive symptoms, loneliness, social isolation, and quality of life were measured at baseline, 3 and 6 months. Qualitative interviews were conducted at 3 months.

RESULTS

Twenty-one residents were recruited. Across the three time points there was a large effect for depressive symptoms, social isolation, and quality of life, though not statistically significant. There was a significant immediate increase in happiness following engagement in the JMC-D sessions. Thematic analysis of semi-structured interviews generated two overarching themes: Experiencing the JMC-D (subthemes: Benefits, Navigating the virtual platform, Feedback) and Considerations for Implementation (subthemes: Perceived purpose, Characteristics that impact the experience, and Infrastructure and resources).

CONCLUSION

Findings are encouraging and suggest that the JMC-D may support emotional and other psychosocial indices of wellness in residential care during times of physical distancing. Appropriate staffing, resources, and internet accessibility are important for implementation and uptake.

CATCH-ON Connect: a tablet intervention to address social isolation and loneliness

Technology can aid in alleviating social isolation and loneliness among older adults, however some older adults lack the knowledge and necessary skills to use the technology.

OBJECTIVES

The purpose of this study was to examine the impact of CATCH-ON Connect, a cellular enabled tablet technical assistance program, on social isolation and loneliness among older adults.

METHODS

This is a single-group pre-post program evaluation of the CATCH-ON Connect program.

RESULTS

While there was no statistically significant change in social isolation, older adult participants reported significantly lower levels of loneliness following intervention.

CONCLUSION

This project demonstrates that tablet programs with technical assistance may benefit older adults. Further investigation is warranted to determine the impact of the internet access itself, the technical assistance, or both.

Life situation of older people living with severe mental illness - A scoping review

An increasing number of older people with severe mental illness (SMI) poses additional challenges to healthcare and social services. This scoping review aimed to investigate the life situation of older people living with severe mental illness and identify the research gaps in the existing literature. The current review followed the methodological framework for conducting scoping reviews by Arksey and O'Malley, consisting of five main stages: (1) identifying the research question (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising, and reporting the results. An optional sixth stage, a consultation exercise, has also been used in this study: The scoping review was conducted in accordance with the PRISMA extension for scoping reviews PRISMA-ScR, and the databases PsychINFO Scopus, Cinahl, Web of Science and PubMed were used. A total of 24 studies were included in the review. The thematic analysis focused on: (1) the perspective of older people with SMI, (2) the perspective of healthcare professionals supporting older people with SMI, and (3) the perspective of informal carers supporting older people with SMI. The results describe the life situation of older people living with SMI, especially in relation to the older peoples' experiences of suffering and well-being. The staff and the informal carers need adequate knowledge to provide support to the older people with SMI. To gain greater knowledge about the life situation and support needed by older people with SMI, we strongly advocate additional research focusing on their own experiences.

Digital Intergenerational Program to Reduce Loneliness and Social Isolation Among Older Adults: Realist Review

BACKGROUND

There is a compelling need for an innovative and creative approach to promote social connectedness among older adults to optimize their well-being and quality of life. One possible solution may be through a digital intergenerational program.

OBJECTIVE

This realist review aimed to identify existing digital intergenerational programs that were used to reduce loneliness or social isolation among older adults and analyze them in terms of strategy, context, mechanisms, and outcomes.

METHODS

We performed a realist review with an extensive search of published and gray literature. For scholarly literature, we searched PubMed, Embase, CINAHL, PsycINFO (Ovid), and Social Sciences Citation Index databases for articles published between January 2000 to August 2020. A grey literature search was performed using the Google search engine, and the search was completed in May 2021. We included programs that evaluated digital intergenerational programs for older adults, which described outcomes of loneliness or social isolation. We included quantitative, mixed methods, and qualitative studies, as well as relevant theoretical papers, policy documents, and implementation documents. The studies were appraised based on their relevance and rigor. We synthesized the available evidence from the literature into Strategy-Context-Mechanism-Outcome (S-C-M-O) configurations to better understand what, when, and how programs work.

RESULTS

A total of 31 documents reporting 27 digital intergenerational programs were reviewed. Our final results identified 4 S-C-M-O configurations. For S-C-M-O configuration 1, we found that for community-dwelling older adults, provision of access to and training in digital technology may increase older adults' self-efficacy in digital devices and therefore increase the use of digital communication with family. In S-C-M-O configuration 2, digital psychosocial support and educational interventions from nurses were found to be useful in reducing loneliness among community-dwelling older adults. In S-C-M-O configuration 3, a video call with a student or family was found to reduce loneliness among older adults residing in long-term residential care facilities. Finally, for S-C-M-O configuration 4, we found that behavioral activation provided through videoconferencing by a lay coach may be useful in reducing loneliness among older adults who are lonely. However, as almost half (11/27, 41%) of the included programs only reported quantitative results, this review focused on screening the discussion section of publications to identify author opinions or any qualitative information to elucidate the mechanisms of how programs work.

CONCLUSIONS

This review identified the key strategy, context, and mechanism influencing the success of programs that promote intergenerational interaction through digital means. This review revealed that different strategies should be adopted for different groups of older adults (eg, older adults who are lonely, older adults who reside in long-term residential care facilities, and community-dwelling older adults). The S-C-M-O configurations should be considered when designing and implementing digital intergenerational programs for older adults.

Digital interventions for subjective and objective social isolation among individuals with mental health conditions: a scoping review

BACKGROUND

Social isolation encompasses subjective and objective concepts. Both are associated with negative health consequences and are more prevalent among people with mental health problems than among the general population. To alleviate social isolation, digital interventions have potential as accessible alternatives or adjuncts to face-to-face interventions. This scoping review aimed to describe the types of digital interventions evaluated for feasibility, acceptability and effectiveness in alleviating social isolation among individuals with mental health problems, and to present an overview of the quantitative evidence yielded to inform future intervention design.

METHODS

We searched five electronic databases for quantitative and mixed methods studies published between January 2000 and July 2020. Studies were included if they evaluated digital interventions for individuals with mental health conditions, had subjective and/or objective social isolation as their primary outcome, or as one of their outcomes if no primary outcome was specified. Feasibility studies were included if feasibility outcomes were the primary outcomes and social isolation was among their secondary outcomes. A narrative synthesis was conducted to present our findings. The protocol was registered on Open Science Framework (doi: https://doi.org/10.17605/OSF.IO/CNX8A ).

RESULTS

Thirty-two studies were included for our review: 16 feasibility studies, seven single-group studies and nine effectiveness trials. There was great variation in the interventions, study designs and sample populations. Interventions included web-based programmes, phone-based programmes, blended interventions, socially assistive robots and virtual reality interventions. Many were feasibility studies, or otherwise not fully powered to detect an effect if one were present, thus preventing clear conclusions about clinical effectiveness. Satisfactory feasibility outcomes indicated potential for future trials to assess these interventions.

CONCLUSION

Our scoping review identified a range of digital approaches utilized to alleviate social isolation among individuals with mental health disorders. Conclusions regarding clinical effectiveness cannot be reached due to variability of approaches and lack of large-scale randomized controlled trials. To make clear recommendations for digital social isolation interventions, future research needs to be based on rigorous methods and larger samples. Future studies should also focus on utilizing theory-driven approaches and improving existing approaches to advance the field.

Online Social Networking and Mental Health among Older Adults: A Scoping Review

As the number of older adults is expected to increase exponentially within the next few decades, loneliness, social isolation, and depression among seniors are growing public health concerns. Although formal treatment options, such as therapy and medication, can be helpful for depression, they can also be expensive and sometimes ineffective. It is therefore important to consider other potential treatment options and social interventions. Alternative methods for addressing mental health issues are especially important for older adults, as they may encounter barriers associated with aging such as limited mobility and decreased social networks. In these circumstances, online social networking may offer a potential "social cure" to alleviate loneliness, social isolation, and depression. The purpose of this scoping review was to gather and summarize the current literature on associations between online social networking and mental health outcomes (e.g., depression, life satisfaction, loneliness) among older adults. An initial search of 3,699 articles resulted in 52 articles that met criteria for inclusion. Five common themes were identified: (1) enhanced communication with family and friends, (2) greater independence and self-efficacy, (3) creation of online communities, (4) positive associations with well-being and life satisfaction, and (5) decreased depressive symptoms. Implications for older adults' mental health, social connectedness, programs and policies are discussed.

Recovery in Supported Accommodations: A Scoping Review and Synthesis of Interventions for People with Severe Mental Illness

Research on the recovery domains beside clinical recovery of people with severe mental illness in need of supported accommodations is limited. The aim of this study was (1) to investigate which recovery interventions exist for this group of people and (2) to explore the scientific evidence. We conducted a scoping review, including studies with different designs, evaluating the effectiveness the recovery interventions available. The search resulted in 53 eligible articles of which 22 focused on societal recovery, six on personal recovery, five on functional recovery, 13 on lifestyle-interventions, and seven on creative and spiritual interventions. About a quarter of these interventions showed added value and half of them initial promising results. The research in this area is still limited, but a number of recovery promoting interventions on other areas than clinical recovery have been developed and evaluated. Further innovation and research to strengthen and repeat the evidence are needed.

Impact of the AGE-ON Tablet Training Program on Social Isolation, Loneliness, and Attitudes Toward Technology in Older Adults: Single-Group Pre-Post Study

Background

The internet and technology can help older adults connect with family and friends. However, many older adults face obstacles to internet and technology use, such as lack of knowledge or self-efficacy.

Objective

The purpose of this study was to explore the impact of the AGE-ON tablet training program on social isolation, loneliness, and quality of life.

Methods

Adults aged >60 years took part in a series of 6 weekly workshops covering the basic features of a tablet. Before and after the program, social isolation, loneliness, social support, and quality of life were assessed. In addition, data on current tablet use and attitudes toward technology use were collected. Satisfaction with the program was also assessed at the end of the study using 6 Likert scale questions.

Results

The participants (N=32; mean age 76.3, SD 8.6 years) were predominantly female (n=20, 63%) and retired (n=30, 94%). The participants reported that they were highly satisfied with the program. After completing the program, no differences in social isolation, loneliness, social support, or quality of life were found. Frequency of tablet use increased and the attitudes of the participants toward technology improved.

Conclusions

The AGE-ON program resulted in increased tablet use frequency and may improve comfort and attitudes toward tablet use among older adults. This program may assist older adults in overcoming obstacles to internet and technology use to better connect with family and friends; however, further work targeting older adults who are socially isolated or at risk of social isolation is needed to more fully understand whether tablet training programs are beneficial in this population.

Trial Registration

ClinicalTrials.gov NCT03472729; https://clinicaltrials.gov/ct2/show/NCT03472729

Modern technology to support carers of care recipients with dementia or functional mental illness: promising progress, but a long road ahead

There is no doubt that family carers who look after a family member with dementia or with a functional mental illness fulfill an important role, not only for their loved one, but also for the health and aged care systems of the countries they live in. Due to increasing life expectancy, but also improved healthcare the number of family carers supporting older care recipients with functional mental illness or dementia is on the rise. While the carer role often can offer rewarding experiences caregivers are at increased risk of stress, depression, sleep problems, and often experience poor health outcomes with increased morbidity and mortality (Oyebode, 2003). Next to the stressors directly associated with the carer role, they often do not have the time to engage in healthy behavior to protect their physical, mental, and cognitive health (Loi et al., 2014). There is a wealth of literature providing evidence about effective strategies to support carers and the recent Lancet Commission on Dementia prevention, intervention, and care highlighted the importance of exploring how the use of technological innovations could support carers better (Livingston et al., 2017). The use of modern technology in this context can mean a variety of approaches, such as internet-based programs to provide education and skill-building, virtual support to assist with monitoring and managing challenging behavior, online support groups, and the use of assistive or therapeutic technology to improve safety, enable positive activities, and support communication between carer and care recipient, to name just a few (D'Onofrio et al., 2017; Ienca et al., 2017; Livingston et al., 2017). More specifically, telehealth approaches via videoconferences have the potential to better support carers who live in rural or remote regions (O'Connell et al., 2014) or who cannot attend face-to-face support programs for other reasons such as inability to leave the care recipient alone at home, being a multiple carer or having a disability themselves to give just some examples.