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

Recommendations for designing conversational companion robots with older adults through foundation models

Companion robots are aimed to mitigate loneliness and social isolation among older adults by providing social and emotional support in their everyday lives. However, older adults' expectations of conversational companionship might substantially differ from what current technologies can achieve, as well as from other age groups like young adults. Thus, it is crucial to involve older adults in the development of conversational companion robots to ensure that these devices align with their unique expectations and experiences. The recent advancement in foundation models, such as large language models, has taken a significant stride toward fulfilling those expectations, in contrast to the prior literature that relied on humans controlling robots (i.e., Wizard of Oz) or limited rule-based architectures that are not feasible to apply in the daily lives of older adults. Consequently, we conducted a participatory design (co-design) study with 28 older adults, demonstrating a companion robot using a large language model (LLM), and design scenarios that represent situations from everyday life. The thematic analysis of the discussions around these scenarios shows that older adults expect a conversational companion robot to engage in conversation actively in isolation and passively in social settings, remember previous conversations and personalize, protect privacy and provide control over learned data, give information and daily reminders, foster social skills and connections, and express empathy and emotions. Based on these findings, this article provides actionable recommendations for designing conversational companion robots for older adults with foundation models, such as LLMs and vision-language models, which can also be applied to conversational robots in other domains.

Trends in the prevalence of social isolation among middle and older adults in China from 2011 to 2018: the China Health and Retirement Longitudinal Study

BACKGROUND

Epidemiological studies have shown that social isolation, which is prevalent in older adults, is associated with a range of adverse health outcomes, but the prevalence of and trends in regard to social isolation remain ambiguous in China. The aim of this study was to elucidate the trends regarding the prevalence of social isolation among middle-aged and older adults in China from 2011 to 2018 and to further identify associated risk factors.

METHODS

A repeated cross-sectional study, The data were derived from panel sample data of four waves conducted from May 2011 to August 2018 in the nationally representative China Health and Retirement Longitudinal Study (CHARLS) using multistage probability sampling. Social isolation was ascertained by the five item Steptoe Social Isolation Index. The potential covariates were demographic characteristics, lifestyle factors, and health status. Linear-by-linear association was used to assess the trends in regard to social isolation over time under the influence of the potential covariates. Linear-by-linear association and an age-period-cohort analysis were used to explore the trends, and two-level (time, individual) generalized estimating equation models (GEE) linked multivariate binary logistic regression were performed to identify risk factors.

RESULTS

A high prevalence of social isolation and a moderate upward trend from 2013 to 2018 were observed among a U-shaped trend prevalence of social isolation from 2011 to 2018 across China, with rates of 38.09% (95% CI = 36.73-39.45) in 2011, 33.66% (32.32-35.00) in 2013, 39.13% (37.59-40.67) in 2015, and 39.95% (38.59-41.31) in 2018 (p < 0.001). The prevalence of social isolation increased with age and educational attainment. Females had a higher prevalence than males. The prevalence of social isolation was found to be significantly lower in pensioners than in non-pensioners between 2011 and 2018 (p < 0.001). The prevalence of social isolation was 38.9%, 34.9%, 38.5%, and 44.08% about three times higher among those who doid not use the Internet and 13.44%, 11.64%, 12.93%, and 16.73% than among those who doid in 2011, 2013, 2015 and 2018 respectively. The participants with short (0-5 h) and long sleep (9 or more hours), and poor self-rated health had a higher prevalence of social isolation than the others. Older age, lower educational attainment, living in a rural region, lack of medical insurance or pension, lack of internet use and poor health were risk factors (p < 0.05).

CONCLUSIONS

We found a U-shaped prevalence of social isolation trends from 2011 to 2018 and revealed increasing trends from 2013 to 2018 among middle-aged and older adults in China. The findings of the study highlight the urgent need for interventions to reduce social isolation including improving sleep quality and internet skills. Disadvantaged groups in terms of age, economic status, and health status should be the focus of such interventions, especially in the era of COVID-19.

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

Background

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

Objectives

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

Search Methods

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

Selection Criteria

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

Data Collection and Analysis

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

Main Results

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

Authors' Conclusions

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

Patterns of Internet Use, and Associations with Loneliness, amongst Middle-Aged and Older Adults during the COVID-19 Pandemic

Loneliness among older adults is a major societal problem with consequences for health and wellbeing; this has been exacerbated by the coronavirus pandemic. The present study investigated associations between internet use, including frequency and type of use, and loneliness in a large UK sample of middle-aged and older adults, aged 55–75 (n = 3500) from the English Longitudinal Study of Ageing (ELSA) cohort study. Our findings indicated a clear relationship between the frequency of internet use and subjective loneliness. Those who used the internet more than once a day reported feeling less lonely than those who used the internet once a week or less. We also found that those who used the internet for e-mail communication were less lonely. However, individuals indicated higher levels of loneliness when the internet was used for information searches about health. Regarding sociodemographic factors underlying internet usage, less frequent use was seen amongst individuals who lived alone, people who were not employed, who had lower education levels, and lower sociodemographic status. Additionally, gender differences were found in the type of internet use: males report using the internet for e-mail communication more than females, while females’ internet use for health-related information searches was higher than in males. In sum, findings suggest that intervention strategies that promote internet access amongst middle-aged and older people could be useful for tackling loneliness and point to the groups within society that should be the focus of such interventions.

Loneliness and Emancipation: A Multilevel Analysis of the Connection between Gender Inequality, Loneliness, and Social Isolation in the ISSP 2017

The present article analyzes the connection between, on the one hand, gender equality and, on the other hand, loneliness and social isolation. It hypothesizes that modern relational institutions that support gender equality, such as no-fault divorce laws, reduce loneliness in close relationships. This hypothesis is put to the test through a multilevel analysis of the International Social Survey Program (ISSP) 2017. The analysis reveals that the data agree, to a large extent, with the theoretical arguments. The prevalence of loneliness is higher in countries with higher levels of gender inequality (as measured by the Gender Inequality Index (GII)). This can be attributed to a moderation effect; at lower levels of gender inequality, partnerships provide better protection from loneliness. These results are robust to controls for demographic composition, level of health, educational attainment, income poverty, and interview mode. Last, the analyses show that the threat of emotional isolation is more widespread in countries with low gender inequality. These findings, however, are only significant before controlling for demographic composition, level of health, educational attainment, income poverty, and interview mode, and they require further analysis. The concluding section relates these findings to the popular tendency to argue that modern society has created a “loneliness epidemic” and discusses policy implications.

The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe

Background

Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation.

Objective

This study specifically aims to clarify the relationship between internet use and social isolation of individuals aged ≥50 years, for which other surveys present contradictory results.

Methods

We performed logistic regression analysis with social isolation as the dependent variable, internet use as the interest variable, and several other sociodemographic, economic, and health characteristics of the individuals as control variables. The sample size was 67,173 individuals aged 50 years and older from 17 European countries (Portugal, Greece, Italy, Spain, Denmark, Sweden, Austria, Belgium, France, Germany, Switzerland, Luxemburg, Poland, Czech Republic, Slovenia, Estonia, and Croatia) plus Israel, who were interviewed in the Survey of Health, Ageing and Retirement in Europe (SHARE), wave 6.

Results

The results show that countries differ in the level of social isolation and rate of internet use by individuals aged 50 years and older. They also evidence that in most of the countries analyzed, social isolation of internet users was lower compared to that of nonusers after controlling for a set of sociodemographic, economic, and health characteristics of the individuals that have been previously described in the literature as determinants of social isolation. Indeed, on average, although 31.4% of individuals in the nonuser group experienced high social isolation, only 12.9% of individuals who used the internet experienced this condition.

Conclusions

Internet users show lower social isolation. This result underlines the importance of promoting e-inclusion in Europe as a way to counter social isolation of individuals aged 50 years and older.

Internet Use and Loneliness of Older Adults Over Time: The Mediating Effect of Social Contact

OBJECTIVES

The internet is increasingly commonly used by older adults. However, it remains controversial in the literature on whether older people are more or less lonely with internet adoption. The current paper aims to test the longitudinal association of internet use and loneliness and to theorize the relationship by examining the mediating effect of social contact.

METHOD

This study employed data from 2006, 2010, and 2014 waves of the Health and Retirement Study. Loneliness was measured with the three-item UCLA loneliness scale, social contact was operationalized as contact frequency with family and friends, and internet use was measured using a self-assessed dichotomous item. Longitudinal associations and mediation effects were tested using hierarchical linear modeling.

RESULTS

Internet use was associated with decreased loneliness over an 8-year period (b = -0.049, p < .001) and more social contact (b = 0.285, p < .001), which was related to lower perceived loneliness (b = -0.088, p < .001). On a scale ranges from 0 to 2 (0 = never lonely, 2 = often lonely), the total effect of internet use on loneliness was -0.060, and the mediated effect was -0.025.

DISCUSSION

These findings imply that internet use may be an effective tool for reducing loneliness in older people by maintaining social contact.

Risk Factors for Depressive Symptoms in Korean Adult Stroke Survivors: The Korea National Health and Nutrition Examination Survey IV-VII (2007-2018)

Depressive symptoms are common in stroke survivors, and they are associated with poor outcomes. Therefore, this study aimed to investigate the depressive symptoms in stroke survivors and the risk factors for depressive symptoms in stroke survivors. We included 33,991 participants who were 19 years or older and had completed a questionnaire about the history of stroke from the Korea National Health and Nutrition Examination Survey (KNHANES) IV–VII (from 2007 to 2018). The mean Patient Health Questionnaire-9 score and the prevalence of major depression, depressive symptoms, antidepressant treatment, suicidal ideation, and suicide attempts were significantly higher in stroke survivors than in non-stroke participants (4.4 vs. 2.6, 16.2% vs. 5.3%, 24.7% vs. 9.3%, 3.8% vs. 1.4%, 21.7% vs. 4.8%, and 2.5% vs. 0.6%, respectively, all p < 0.001). Complex sample multivariate logistic regression analysis revealed that the female sex, unemployment, a low education level, a low family income, and activity limitations were independent risk factors for depressive symptoms in stroke survivors. Activity limitations showed the highest odds ratio among the independent factors, and its causes were further analyzed. The most common causes of activity limitations were stroke sequelae and musculoskeletal problems. To reduce depressive symptoms in stroke survivors, attention needs to be paid to minimizing stroke sequelae and musculoskeletal problems along with regular screening for depressive symptoms.

Rapid systematic review of systematic reviews: what befriending, social support and low intensity psychosocial interventions, delivered remotely, may reduce social isolation and loneliness among older adults and how?

Background: During the COVID-19 pandemic ‘social distancing’ has highlighted the need to minimise loneliness and isolation among older adults (aged 50+). We wanted to know what remotely delivered befriending, social support and low intensity psychosocial interventions may help to alleviate social isolation and loneliness and how they work. Methods: We followed a systematic ‘review of reviews’ approach. Searches of 11 databases from the fields of health, social care, psychology and social science were undertaken during April 2020. Reviews meeting our PICOS criteria were included if they focussed on the evaluation of remote interventions to reduce levels of social isolation or loneliness in adults aged 50+ and were critically appraised using AMSTAR2. Narrative synthesis was used at a review and study level to develop a typology of intervention types and their effectiveness. Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) were used at a study level to explore the characteristics of successful interventions. Results: We synthesised evidence from five systematic reviews and 18 primary studies. Remote befriending, social support and low intensity psychosocial interventions took the form of: (i) supported video-communication; (ii) online discussion groups and forums; (iii) telephone befriending; (iv) social networking sites; and (v) multi-tool interventions. The majority of studies utilised the first two approaches, and were generally regarded positively by older adults, although with mixed evidence around effectiveness. Focussing on processes and mechanisms, using ICA and QCA, we found that the interventions that were most successful in improving social support: (i) enabled participants to speak freely and to form close relationships; (ii) ensured participants have shared experiences/characteristics; (iii) included some form of pastoral guidance. Conclusions: The findings highlight a set of intervention processes that should be incorporated into interventions, although they do not lead us to recommend specific modes of support, due to the heterogeneity of interventions.

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

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

A longitudinal study monitoring the quality of life in a national cohort of older adults in Chile before and during the COVID-19 outbreak

BACKGROUND

Confinement during the COVID-19 pandemic has placed great stress on older adults, which may be affecting their quality of life. Thus, this study aims to describe the changes in mental and physical health, isolation and loneliness, residence and socioeconomic resources in a national cohort of Chilean older adults before and during the COVID-19 outbreak. It also analyzes the changes in depressive symptoms by changes in the other quality of life indicators before and during the COVID-19 outbreak. Possible methodological biases of telephone surveys in older adults living in non-developed countries are also discussed.

METHODS

Between June and September 2020, a random subsample of 720 people who had participated in the face-to-face V National Survey on Quality of Life in Older Adults in Chile conducted at the end of 2019 was followed up by telephone. Descriptive bivariate analyses were performed using t-test and non-parametric tests for independent variables, comparing the baseline sample with the current 2020 follow-up sample during the peak of the pandemic outbreak in Latin America. Furthermore, descriptive bivariate analysis through t-test and non-parametric test for paired samples compared the follow-up subsample at baseline with the not-included sample, examining possible biases of the telephone interview compared with the face-to-face interview.

RESULTS

In the panel, there was no variation in self-rated health. The health symptoms that worsened were memory, stomach, and mood problems. Depressive symptoms and anxiety increased; similarly, smartphone users, social contacts, intergenerational co-residence and resilience increased. The telephone follow-up sample had a higher educational level and greater smartphone use than those not included in the subsample.

CONCLUSIONS

Although some physical and mental health indicators have worsened during the pandemic, older adults mobilized resources that could allow them to maintain their quality of life, such as improved resilience. Thus, these findings can guide future research and the development of efficient strategies to improve these resources among older adults to ensure wellbeing.

Social Network Communications in Chilean Older Adults

The growth of older adults in new regions poses challenges for public health. We know that these seniors live increasingly alone, and this impairs their health and general wellbeing. Studies suggest that social networking sites (SNS) can reduce isolation, improve social participation, and increase autonomy. However, there is a lack of knowledge about the characteristics of older adult users of SNS in these new territories. Without this information, it is not possible to improve the adoption of SNS in this population. Based on decision trees, this study analyzes how the elderly users of various SNS in Chile are like. For this purpose, a segmentation of the different groups of elderly users of social networks was constructed, and the most discriminating variables concerning the use of these applications were classified. The results highlight the existence of considerable differences between the various social networks analyzed in their use and characterization. Educational level is the most discriminating variable, and gender influences the types of SNS use. In general, it is observed that the higher the educational level, the more the different social networking sites are used.

Internet use, social isolation and loneliness in older adults

The aim of this study was to explore associations between internet/email use in a large sample of older English adults with their social isolation and loneliness. Data from the English Longitudinal Study of Ageing Wave 8 were used, with complete data available for 4,492 men and women aged ⩾ 50 years (mean age = 64.3, standard deviation = 13.3; 51.7% males). Binomial logistic regression was used to analyse cross-sectional associations between internet/email use and social isolation and loneliness. The majority of older adults reported using the internet/email every day (69.3%), fewer participants reported once a week (8.5%), once a month (2.6%), once every three months (0.7%), less than every three months (1.5%) and never (17.4%). No significant associations were found between internet/email use and loneliness, however, non-linear associations were found for social isolation. Older adults using the internet/email either once a week (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.49–0.72) or once a month (OR = 0.60, 95% CI = 0.45–0.80) were significantly less likely to be socially isolated than every day users; those using internet/email less than once every three months were significantly more likely to be socially isolated than every day users (OR = 2.87, 95% CI = 1.28–6.40). Once every three months and never users showed no difference in social isolation compared with every day users. Weak associations were found between different online activities and loneliness, and strong associations were found with social isolation. The study updated knowledge of older adults’ internet/email habits, devices used and activities engaged in online. Findings may be important for the design of digital behaviour change interventions in older adults, particularly in groups at risk of or interventions targeting loneliness and/or social isolation.

Computer-mediated communication and social support among community-dwelling older adults: A systematic review of cross-sectional data

OBJECTIVE

To systematically assess the relationship between computer-mediated communication and social function in older adults aged 55 or older.

METHODS

Embase, PsycINFO and PubMed were searched (database inception to December 2018). Where available, effect sizes (correlation r) with 95% confidence intervals and P values were calculated for individual studies. Of 4,139 eligible articles retrieved, 17 studies involving a pooled sample of 17,640 participants were included.

RESULTS

Frequent computer-mediated communication was significantly, albeit weakly, associated with higher levels of social support and connectedness (r range = 0.08 to 0.33, P < 0.05). One discrepant negative relationship was noted (r = -0.16, 95% CI [-0.30, -0.02], P = 0.03), involving a distinct sample of gamers.

CONCLUSIONS

Computer-mediated communication is related to amount of social functioning in older adults, although the causal nature of this relationship requires further longitudinal investigation. Sample confounds (eg socio-economic status and successful ageing) may limit the interpretation of these findings.

Explaining the Use of Social Network Sites as Seen by Older Adults: The Enjoyment Component of a Hedonic Information System

Previous studies suggest that older adults are living increasingly alone and without the company of their close relatives, which cause them depression problems and a detriment to their health and general wellbeing. The use of social network sites (SNS) allows them to reduce their isolation, improve their social participation, and increase their autonomy. Although the adoption of various information technologies by older adults has been studied, some assumptions still predominate, for example, that older adults use SNS only for utilitarian purposes. However, considering SNS as hedonic information systems, and in order to extend the theoretical explanation of the intention to use hedonic systems to their actual use, this study aims to determine the influence of perceived enjoyment, perceived usefulness, and perceived ease of use on the use of SNS by elders in Concepción, Chile. Two hundred fifty-three older adults participated in the cross-sectional study. The results indicate that perceived ease of use is the variable that has the greatest total effect in explaining the use of SNS and that by adding the perceived enjoyment construct, the explanatory power of the model increases significantly. Therefore, advancement in user acceptance models, especially in the use of SNS by elders, can be made by focusing on the type of system, hedonic or utilitarian.

From Intervention to Co-constitution: New Directions in Theorizing about Aging and Technology

We propose directions for future research on aging and technology to address fundamental changes in the experience of later life that come with the "digitization" of societies. Our argument is contextualized by the massive investments of policy makers and companies in gerontechnologies and their failure to create scale and impact. Partly this failure is due to an interventionist logic that positions new technologies as interventions or solutions to the problems of aging. What has been overlooked - at least theoretically - is how aging is already co-constituted by gerontechnology design, the socio-material practices it enacts, and the policy discourse around them. Goals are (a) reviewing elements of the current aging and technology agenda, (b) demonstrating how the interventionist logic has hampered theory development (and practical impact), (c) pulling together key insights from the emerging body of empirical literature at the intersection of social gerontology and Science and Technology Studies (STS), with the objective of (d) providing directions for future research on aging and technology. Our argument presents the theoretical gains that can be made by combining insights from STS and social gerontology to research the co-constitution of aging and technology.

Internet Use and Psychological Well-Being at Advanced Age: Evidence from the English Longitudinal Study of Aging

This work explores the connection between psychological well-being and Internet use in older adults. The study is based on a sample of 2314 participants in the English Longitudinal Study of Aging. The subjects, aged 50 years and older, were interviewed every two years over the 2006-2007 to 2014-2015 period. The connection between the use of Internet/Email and the main dimensions of psychological well-being (evaluative, hedonic and eudaimonic) was analyzed by means of three generalized estimating equation models that were fitted on 2-year lagged repeated measurements. The outcome variables, the scores on three well-being scales, were explained in terms of Internet/Email use, controlling for covariates that included health and socioeconomic indicators. The results support the existence of a direct relationship between Internet/Email use and psychological well-being. The connection between the main predictor and the score of the participants on the scale used to measure the eudaimonic aspect was positive and statistically significant at conventional levels (p-value: 0.015). However, the relevance of digital literacy on the evaluative and the hedonic components could not be confirmed (p-values for evaluative and hedonic dimensions were 0.078 and 0.192, respectively).