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Tan XR, Wilson IM, Tay PKC, Win PPS, Song CF, Wee SL. Mapping of technological strategies for reducing social isolation in homebound older adults: A scoping review. Arch Gerontol Geriatr 2024; 125:105478. [PMID: 38776697 DOI: 10.1016/j.archger.2024.105478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Homebound older adults (HOAs) are particularly vulnerable to social isolation and loneliness, which engender a poorer physical and mental health, and greater cognitive decline. The purpose of this review is to map the literature to identify potential technological strategies that reduce social isolation in HOAs, and to understand facilitators and barriers for adoption and implementation. METHODS Six databases including PubMed (MEDLINE), Google Scholar, Cochrane Database, EBSCOHost, National Library ProQuest, Web of Science, and the Journal of Medical Internet Research were searched for relevant articles. Peer-reviewed literature published in English from Jan 2014 to Feb 2024 that employed technological strategies applicable to HOAs and assessed social isolation or connectedness as an outcome measure were included. RESULTS 107 studies were reviewed and classified into different technological categories based on their functions and features. A social technology framework encompassing delivery, hardware, software, content, training, and support was conceptualized with core characteristics identified from the reviewed technological strategies. Cost and complexity of technology, and resource commitment were identified as barriers while user-friendliness, content curation and a supportive ecosystem may facilitate the adoption of a technological strategy to address social isolation in HOAs. CONCLUSION There is a need for early and concerted effort to identify HOAs, provide technology training, and empower them to tap on the digital world to complement and/or supplement social interactions. Development of cost-effective and rapid-to-implement technology is vital for HOAs who are at highest risk to social isolation.
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Affiliation(s)
- Xiang Ren Tan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ingrid M Wilson
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore; Latrobe University, Melbourne, Australia
| | - Peter Kay Chai Tay
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Phoo Pyae Sone Win
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Cai Feng Song
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Shiou-Liang Wee
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore; Geriatric Education and Research Institute, Singapore
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2
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Pengpid S, Peltzer K. Loneliness and associated factors among middle-aged and older adults: cross-sectional and longitudinal survey results from the HAALSI cohort in South Africa. Aging Ment Health 2024; 28:1179-1187. [PMID: 38726552 DOI: 10.1080/13607863.2024.2345777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/15/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES Longitudinal studies on chronic loneliness and before and during the COVID-19 pandemic are lacking in Africa. The study aimed to estimate the prevalence and associated factors of loneliness and chronic loneliness using cross-sectional and longitudinal data from middle-aged and older adults from rural South Africa. METHOD The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,418, aged 40 years and older). Loneliness was assessed with a single and 3-item measure. RESULTS The proportion of loneliness was 19.5% in the 2021/2022 survey, the incidence of chronic loneliness (having loneliness in wave 2 and 3, and free of loneliness in wave 1) was 18.9%, and the 7-year incidence of loneliness was 41.0%. Comparing the 2019 (pre-COVID-19) to 2021/2022 (during COVID-19 pandemic) surveys participants experienced a significant reduction of loneliness. In cross-sectional and/or longitudinal analyses, we found that younger age, living alone, food insecurity, lack of social engagement, depressed mood, poor life satisfaction, poor sleep quality, impaired cognition, poor self-rated health, functional disability, underweight, obesity, and not living with HIV were associated with a higher prevalence, incidence and/or increases in loneliness. CONCLUSION One in five aging adults had acute or chronic loneliness. Several social, mental, and physical health factors were identified as associated with loneliness.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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3
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Winkler K, Lincoln TM, Wiesjahn M, Jung E, Schlier B. How does loneliness interact with positive, negative and depressive symptoms of psychosis? New insights from a longitudinal therapy process study. Schizophr Res 2024; 271:179-185. [PMID: 39032430 DOI: 10.1016/j.schres.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/19/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
Cross-sectional research suggests an association between loneliness and psychotic symptoms, but the causal direction of this association is still unclear. Even though loneliness has been proposed as a potential treatment target to improve psychotherapy for psychosis, not much is known about its role in the treatment process. In this study, we re-analyzed data from a therapy process study to investigate the temporal dynamics between loneliness and psychotic symptoms throughout therapy and to explore whether state-of-the-art CBT for psychosis (CBTp) decreases loneliness. Over the course of up to 45 weekly sessions of CBTp, 57 patients reported their feelings of loneliness and current positive, negative and depressive symptom levels at each session. Multilevel regression revealed a reduction in all symptoms over time, but no reduction in loneliness. Time-lagged multilevel regression showed that loneliness predicted subsequent negative and depressive symptoms, whereas positive symptom levels predicted subsequent loneliness. Thus, changes in loneliness seem to be both cause and consequence of psychotic symptom changes. These findings highlight the importance of loneliness as a treatment target, particularly in patients with negative symptoms and depression. Future research should address loneliness-specific interventions as an augmentation of state-of-the-art CBTp.
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Affiliation(s)
- Katharina Winkler
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania M Lincoln
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Martin Wiesjahn
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Esther Jung
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Björn Schlier
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany; University of Wuppertal, Institute of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Gaußstraße 20, 42119 Wuppertal, Germany
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4
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McDonald B, Reiter AMF, Kanske P. Theater-based interventions as a means of reducing social isolation and loneliness, facilitating successful aging, and strengthening social cognition in older adults. Front Psychol 2024; 15:1364509. [PMID: 39006549 PMCID: PMC11240220 DOI: 10.3389/fpsyg.2024.1364509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/20/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Brennan McDonald
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Andrea M F Reiter
- German Center of Prevention Research on Mental Health, Würzburg, Bavaria, Germany
- Department of Psychology, Faculty of Medicine, University of Würzburg, Würzburg, Germany
- Clinic and Polyclinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Saxony, Germany
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5
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Leton N. Senescence Seclusion Syndrome: Appraising the Efficacy of Current Interventions. Cureus 2024; 16:e62684. [PMID: 39036158 PMCID: PMC11259019 DOI: 10.7759/cureus.62684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
The proportion of senior citizens in the global population has been on a steady rise, and the current population is forecasted to double in a few decades. Against this backdrop, the prevalence of senescence seclusion syndrome, characterized by prolonged social isolation in the elderly, is increasing concurrently. Given the profound threats this syndrome poses to the mental, physical, and social well-being of this vulnerable demographic, implementing effective interventions is imperative to mitigate these threats and enhance the quality of life. This review aims to assess the efficacy of the interventional modalities critically. Studies were reviewed following comprehensive searches in databases such as PubMed, Scopus, and Google Scholar, and focusing on empirical studies from 2019 to 2024 that evaluated the efficacy of the major intervention categories - social, technological, psychological, and physical interventions. The findings indicate that initiatives that promote consistent social engagement, such as community-organized social events and structured group activities, significantly reduced loneliness and bolstered social connections. Furthermore, technological interventions, including artificial intelligence and virtual reality, have notably enhanced elderly connectivity with their communities. Additionally, psychological interventions, such as cognitive-behavioral therapy, have also been effective in alleviating symptoms of anxiety and depression associated with the syndrome, with group sessions enhancing social interaction and significantly diminishing isolation. Moreover, physical interventions involving group exercises and other activities have fostered improvements in the physical, mental, and social well-being of the elderly. This study underscores the importance of a multifaceted approach that is individualized according to preference and circumstance in addressing senescence seclusion syndrome.
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Affiliation(s)
- Noah Leton
- Department of Physiology, Neuroscience and Behavioral Sciences, St. George's University, St. George's, GRD
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6
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Sanprakhon P, Suriyawong W, Chusri O, Rattanaselanon P. Exploring the Association Between Loneliness, Subjective Cognitive Decline, and Quality of Life Among Older Thai Adults: A Convergent Parallel Mixed-Method Study. J Appl Gerontol 2024:7334648241253989. [PMID: 38742470 DOI: 10.1177/07334648241253989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Examining the rising prevalence of subjective cognitive decline as an early indicator of dementia in adults, this study investigates its complex interaction with loneliness and quality of life in individuals with preclinical dementia. Using a convergent parallel mixed-method approach, we employed Structural Equation Modeling on a cohort of 149 older adults. Qualitative insights were derived from focused group discussions and in-depth semi-structured interviews with a cohort of 23 older adults. Loneliness emerges as a pivotal contributor, exerting a discernible partial indirect effect on quality of life through subjective cognitive decline (indirect effect = -0.145, p = .006). Noteworthy differentials surfaced, with the impact of subjective cognitive decline on quality of life heightened in those with chronic diseases (△χ2 = 6.139, p = .013). Loneliness, wielding a palpable impact, intricately interlaces with quality of life, the nexus of which is intricately mediated by subjective cognitive decline.
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Affiliation(s)
| | | | - Orranuch Chusri
- Faculty of Nursing, Suan Dusit University, Bangkok, Thailand
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7
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Hsu HC, Chang SC, Liang CY, Ting JR. Intervention to reduce loneliness among older adults in the community: Making friends with volunteers. Geriatr Gerontol Int 2024; 24 Suppl 1:240-245. [PMID: 38323733 DOI: 10.1111/ggi.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
AIM This study aimed to examine the effects of providing a program that introduced volunteers to make friends with older adults to reduce loneliness and increase loneliness literacy. METHODS Eight community development associations in Taiwan participated in the study. In the first stage, older people living alone or with only a spouse, or those with a family, but without substantial interactions, were screened for loneliness. Older adults with a higher risk of loneliness were given priority to be invited to participate in this intervention. This 3-month intervention program was designed by each community development association and delivered at the older adults' homes. A total of 87 older persons completed both waves of the interviews. RESULTS Loneliness was reduced (UCLA-6 Loneliness Scale scores decreased from 13.5 to 11.6), and loneliness literacy improved (loneliness literacy scores increased from 38.9 to 42.0) compared with what it was before the program. In a generalized linear model, when controlling for covariates, loneliness was reduced, but not significantly (B = -0.934, P > 0.05), whereas loneliness literacy improved significantly for older participants (B = 2.088, P < 0.05). CONCLUSIONS Making friends with older adults who are lonely might improve their loneliness literacy. Geriatr Gerontol Int 2024; 24: 240-245.
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Affiliation(s)
- Hui-Chuan Hsu
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | | | - Chun-Yu Liang
- Federation for the Welfare of the Elderly, Taipei, Taiwan
| | - Jie-Rong Ting
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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8
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Morello K, Schäfer SK, Kunzler AM, Priesterroth LS, Tüscher O, Kubiak T. Cognitive reappraisal in mHealth interventions to foster mental health in adults: a systematic review and meta-analysis. Front Digit Health 2023; 5:1253390. [PMID: 37927578 PMCID: PMC10623449 DOI: 10.3389/fdgth.2023.1253390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background An increasing number of mHealth interventions aim to contribute to mental healthcare of which interventions that foster cognitive reappraisal may be particularly effective. Objectives To evaluate the efficacy of mHealth interventions enhancing cognitive reappraisal to improve mental health in adult populations. Methods The literature search (four databases) yielded 30 eligible randomized controlled trials (comprising 3,904 participants). We performed a multi-level meta-analysis to examine differences between intervention and comparator conditions at post-intervention assessment. Moderator analyses were conducted for potential moderator variables (e.g., type of comparators). Results Most interventions were CBT-based with other training components in addition to cognitive reappraisal. We found preliminary evidence for a small to medium effect favouring mHealth interventions to enhance cognitive reappraisal over comparators, M(SMD) = 0.34, p = .002. When analysing single symptoms, there was evidence for a small to medium effect of mHealth interventions on anxiety and depressive symptoms, but not for psychological distress and well-being. All analyses showed substantial heterogeneity. Moderator analyses revealed evidence for more favourable effects in studies with passive comparators. There was an overall high risk of bias in most of the studies. Conclusions We found preliminary evidence for a small to medium effect of mHealth interventions including a cognitive reappraisal component to improve mental health. However, most of the interventions were complex (i.e., reappraisal was provided alongside other components), which prevents us from examining reappraisal-specific effects beyond general mental health promotion in mHealth. Dismantling studies examining the effects of single intervention components are warranted to corroborate these promising results. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142149, identifier [CRD42019142149].
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Affiliation(s)
- Karolina Morello
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
| | - Sarah K Schäfer
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Clinical Psychology, Psychotherapy and Diagnostics, Technische Universität Braunschweig, Brunswick, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Oliver Tüscher
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
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9
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Choi HK, Lee K, Lee SH. Developmental Study on "Smart Silver Care": A Mobile Application to Alleviate Loneliness in Older Adults within the Community. Healthcare (Basel) 2023; 11:2376. [PMID: 37685410 PMCID: PMC10486451 DOI: 10.3390/healthcare11172376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Loneliness poses a significant threat to the quality of life of older adults. Therefore, it is essential to implement non-face-to-face services to solve the loneliness of older adults in the community. OBJECTIVES This study used the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model to develop mobile applications as a loneliness intervention for older adults living in the community. METHODS A mobile application was developed using the ADDIE model to alleviate loneliness in older adults living in the community. The development process included a systematic review, a face-to-face preference survey, and an experts' evaluation. From 11 to 15 June 2021, the following six databases were used to search for related articles: Ovid-Medline, Ovid-EMBASE, Cochrane Library, KISS, Korea Med, RISS. A preference analysis was conducted on 100 adults aged 65 or older living in the community from 15 July to 31 August 2021. RESULTS A mobile application for community-dwelling older adults was developed. Its contents included emotional support, cognition, physical activity, health data, nutrition, and motivation. They were organized through a systematic review and preference survey in the analysis stage. They were also designed as main menus and sub-content at the design stage. They also designed the structure, functionality, and interface layout. The application was developed by integrating the designed content and determining the operating system, language, access method, privacy, and server history. Then, experts evaluated the validity of the application. CONCLUSIONS The prototype mobile application incorporates emotional support, cognition, physical activity, health data, nutrition, and motivation. It is expected to help older adults achieve their goals by promoting participation. By incorporating expert validity into the content development process of early prototypes, we have improved the usability and acceptability of our products. Future pilot trials are needed to evaluate the effectiveness of this mobile application among older adults.
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Affiliation(s)
| | | | - Seon-Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 21936, Republic of Korea; (H.-K.C.); (K.L.)
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10
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Zhu D, Al Mahmud A, Liu W. Social connections and participation among people with mild cognitive impairment: barriers and recommendations. Front Psychiatry 2023; 14:1188887. [PMID: 37476544 PMCID: PMC10356108 DOI: 10.3389/fpsyt.2023.1188887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Objective Social connections and participation are essential for individuals with mild cognitive impairment (MCI) to prevent the progression of cognitive decline and enhance their overall well-being. However, existing research has primarily focused on environmental barriers, overlooking personal factors and the interconnected nature of these barriers. Moreover, there is a lack of understanding regarding social connections and participation challenges specific to people with MCI in low- and middle-income countries. Therefore, this study aimed to explore the barriers that hinder social connections and participation among people with MCI in China and investigate opportunities to design appropriate supportive interventions. Methods Thirty-one people with MCI (13 males and 18 females; mean age = 82.74 years, SD = 7.69; mean MoCA score = 21.26, SD = 2.44) and 13 caregivers were recruited to attend focus groups. In addition, 10 therapists were interviewed using a semi-structured interview guide. Focus groups and interviews were audio-recorded, transcribed, and analyzed using a framework analysis approach. Results We found that the ability to build social connections among people with MCI is affected by mobility challenges, intensive grandparenting responsibilities, availability of suitable activities, and feelings of exclusion in a closed-minded community environment. Personal reasons, such as lower social efficacy, inability to find suitable social activities, and intensive family responsibilities, discourage people with MCI from social participation. The digital literacy of people with MCI depends on their motivation to learn and use digital tools; people with MCI who live in a community have a higher digital literacy than those living in care centers. The motivation to achieve digital literacy is affected by perceived benefits, costs of technology use, and social influence. Conclusion Multidimensional initiatives are needed to address barriers to social connections, participation, and technology adoption among individuals with MCI. This includes organizing and engaging in social activities, promoting awareness and education on the importance of social participation, and exploring technology-based interventions to improve memory and storytelling abilities. These efforts can create a supportive environment and empower individuals with MCI to participate actively in social interactions, enhancing their overall well-being.
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Affiliation(s)
- Di Zhu
- Swinburne University of Technology, Hawthorn, VIC, Australia
- Beijing Normal University, Beijing, China
| | | | - Wei Liu
- Beijing Normal University, Beijing, China
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11
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Moretti FA, Scazufca M, Nakamura CA, Souza CHQD, Seward N, Araya R, Moreno-Agostino D. Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth. CAD SAUDE PUBLICA 2023; 38:e00093422. [PMID: 36651419 DOI: 10.1590/0102-311xen093422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/30/2022] [Indexed: 01/15/2023] Open
Abstract
This study aimed to investigate the relationship between sociodemographic characteristics, depressive symptomatology, mobile phone ownership, and different uses of WhatsApp among older adults enrolled in primary care clinics in Guarulhos, São Paulo State, Brazil. This is a secondary data analysis, using data collected in the screening of participants to be included in the PROACTIVE cluster randomized trial. Individuals aged ≥ 60 years, registered in primary care clinics in Guarulhos, were assessed for sociodemographic characteristics, depressive symptoms according to the PHQ-9, mobile phone ownership, and use of WhatsApp. We performed multiple logistic regression models to investigate characteristics of the potential users of digital interventions. Of 3,356 older adults screened for depression, 45.7% said they use WhatsApp to receive/send messages. In the subsample that presented depressive symptomatology (n = 1,020), 41.9% stated using WhatsApp. Younger older adults and those with better socioeconomic status used more WhatsApp and were more likely to own a mobile phone. Participants with higher levels of symptoms of depression were less likely to use WhatsApp. Gender, age, schooling level, income, and depressive symptomatology are variables associated with the possession of a cell phone and with the use of WhatsApp by the older adults of the sample. These findings can help to implement digital health programs better suited to disadvantaged populations in Brazil and other low- and middle-income countries through mental telehealth interventions using WhatsApp and mobile health services to the older people.
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Affiliation(s)
- Felipe Azevedo Moretti
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
- Instituto D'Or de Pesquisa e Ensino, São Paulo, Brasil
| | - Márcia Scazufca
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | | | | | - Nadine Seward
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - Ricardo Araya
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - Darío Moreno-Agostino
- Centre for Longitudinal Studies, University College London, London, U.K
- Centre for Society and Mental Health, King's College London, London, U.K
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Jarvis MA, Pillay SR, Norton LM, Hiraman N, Baloyi OB. Delivering a psychosocial program for older people living in retirement homes during the Covid-19 pandemic: A process evaluation and recommendations for community interventions. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:31-50. [PMID: 35562188 PMCID: PMC9348144 DOI: 10.1002/jcop.22876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
The Covid-19 pandemic lockdown regulations caused retirement homes to temporarily ban in-person visitation potentially increasing the mental health risks of older people. An opportunity arose for a multistakeholder community collaboration to design a mental health program for older people. To evaluate the process of delivering a 12-week psychosocial program aimed at preventing loneliness, countering boredom, and providing older people in restricted settings with education about Covid-19 during the lockdown, in Durban, South Africa. A qualitative retrospective design was used. Data from two focus groups and six semistructured individual interviews conducted with stakeholders (volunteers, social workers, and residents) postproject were analyzed using reflexive thematic analysis. Stakeholders had varied experiences of the project, in terms of content, processes of engagement, and implementation, resulting in five themes. The study concluded with recommendations. A strong need exists for multistakeholder community collaborations when implementing a program where the context restricts physical access.
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Affiliation(s)
- Mary Ann Jarvis
- School of Nursing and Public Health, College of Health SciencesUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Suntosh R. Pillay
- King Dinuzulu Hospital ComplexDurbanSouth Africa
- Department of Clinical Medicine (Psychiatry), Nelson R. Mandela School of MedicineUniversity of KwaZulu‐Natal (UKZN)DurbanSouth Africa
| | - Lynn M. Norton
- South African Depression and Anxiety Group (SADAG)KwaZulu‐NatalSouth Africa
| | - Nemisha Hiraman
- Lead Behavioural TherapistThe Star AcademyDurbanSouth Africa
| | - Olivia B. Baloyi
- School of Nursing and Public Health, College of Health SciencesUniversity of KwaZulu‐NatalDurbanSouth Africa
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Pretorius TB, Padmanabhanunni A, Isaacs SA. The dynamics of Appraisal II: a meta-analysis of the relationship between fortitude and the indices of psychological well-being. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221140245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Identifying the factors that contribute to differential vulnerability in the face of adversity is key to psychology fulfilling its mandate as a helping profession. One such factor, fortitude, which is described as the psychological strength to manage adversity and to stay well, has consistently been linked to psychological well-being. The objective of the research was to statistically integrate studies examining the relationship between fortitude and the indices of psychological well-being by using a meta-analysis. We used a random-effects model for the meta-analysis. In addition to the overall effect size, we examined publication bias and the moderating role of age and methodological quality. We also performed a subgroup analysis to compare between studies with positive and negative indicators of psychological well-being. In addition, we used robust variance estimation to account for effect-size dependencies, as some studies have reported more than one correlation coefficient. A total of 13 studies reporting 35 correlation coefficients pertaining to the relationship between fortitude and the indices of psychological well-being were extracted. The meta-analysis revealed a significant overall effect ( r = .44, p < .001). The results also indicated that age and methodological quality did not influence the effect size. Subgroup analysis indicated that the overall effect size for studies that used positive indicators ( r = .49, p < .001) was higher than that for studies that used negative indicators ( r = .36, p < .001). In addition, no visual or statistical evidence of publication bias was observed. The robust variance estimation results also confirmed that the effect-size dependencies did not influence the overall effect size. The study results provide strong evidence regarding the association between fortitude and psychological well-being. This finding has several implications for promoting mental health and suggests that interventions aimed at building fortitude can be leveraged to mitigate psychological distress.
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Affiliation(s)
| | | | - Serena Ann Isaacs
- Department of Psychology, University of the Western Cape, South Africa
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Littlewood E, McMillan D, Chew Graham C, Bailey D, Gascoyne S, Sloane C, Burke L, Coventry P, Crosland S, Fairhurst C, Henry A, Hewitt C, Baird K, Ryde E, Shearsmith L, Traviss-Turner G, Woodhouse R, Webster J, Meader N, Churchill R, Eddy E, Heron P, Hicklin N, Shafran R, Almeida O, Clegg A, Gentry T, Hill A, Lovell K, Dexter-Smith S, Ekers D, Gilbody S. Can we mitigate the psychological impacts of social isolation using behavioural activation? Long-term results of the UK BASIL urgent public health COVID-19 pilot randomised controlled trial and living systematic review. EVIDENCE-BASED MENTAL HEALTH 2022; 25:e49-e57. [PMID: 36223980 PMCID: PMC9811092 DOI: 10.1136/ebmental-2022-300530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Behavioural and cognitive interventions remain credible approaches in addressing loneliness and depression. There was a need to rapidly generate and assimilate trial-based data during COVID-19. OBJECTIVES We undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trial ISRCTN94091479). We also assimilate these data in a living systematic review (PROSPERO CRD42021298788) of cognitive and/or behavioural interventions. METHODS Participants (≥65 years) with long-term conditions were computer randomised to behavioural activation (n=47) versus care as usual (n=49). Primary outcome was PHQ-9. Secondary outcomes included loneliness (De Jong Scale). Data from the BASIL-C19 trial were included in a metanalysis of depression and loneliness. FINDINGS The 12 months adjusted mean difference for PHQ-9 was -0.70 (95% CI -2.61 to 1.20) and for loneliness was -0.39 (95% CI -1.43 to 0.65).The BASIL-C19 living systematic review (12 trials) found short-term reductions in depression (standardised mean difference (SMD)=-0.31, 95% CI -0.51 to -0.11) and loneliness (SMD=-0.48, 95% CI -0.70 to -0.27). There were few long-term trials, but there was evidence of some benefit (loneliness SMD=-0.20, 95% CI -0.40 to -0.01; depression SMD=-0.20, 95% CI -0.47 to 0.07). DISCUSSION We delivered a pilot trial of a behavioural intervention targeting loneliness and depression; achieving long-term follow-up. Living meta-analysis provides strong evidence of short-term benefit for loneliness and depression for cognitive and/or behavioural approaches. A fully powered BASIL trial is underway. CLINICAL IMPLICATIONS Scalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.
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Affiliation(s)
| | - Dean McMillan
- Health Sciences, University of York, York, UK
- Centre for Health and Population Science, Hull York Medical School, Hull, UK
| | | | | | | | | | | | - Peter Coventry
- Health Sciences, University of York, York, UK
- York Environmental Sustainability Institute, University of York, York, UK
| | | | | | | | | | | | - Eloise Ryde
- Health Sciences, University of York, York, UK
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | | | | | | | - Judith Webster
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Nick Meader
- Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders Group, University of York, York, UK
| | - Elizabeth Eddy
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Paul Heron
- Health Sciences, University of York, York, UK
| | - Nisha Hicklin
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Roz Shafran
- PPP, University College London Institute of Child Health, London, UK
- Paediatric Psychology Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Osvaldo Almeida
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Clegg
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Tom Gentry
- Health and Care Policy, Age UK, London, UK
| | - Andrew Hill
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Sarah Dexter-Smith
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - David Ekers
- Health Sciences, University of York, York, UK
- Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Simon Gilbody
- Health Sciences, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, York, UK
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15
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Hoang P, King JA, Moore S, Moore K, Reich K, Sidhu H, Tan CV, Whaley C, McMillan J. Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2236676. [PMID: 36251294 PMCID: PMC9577679 DOI: 10.1001/jamanetworkopen.2022.36676] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Loneliness and social isolation are public health concerns faced by older adults due to physical, cognitive, and psychosocial changes that develop with aging. Loneliness and social isolation are associated with increased morbidity and mortality. OBJECTIVE To evaluate interventions, targeting older adults, associated with a reduction in loneliness and social isolation. DATA SOURCES OVID, CINAHL, CENTRAL, Embase, PsychINFO, Web of Science, and Scopus were searched from inception to March 2020. STUDY SELECTION Peer-reviewed randomized clinical trials measuring loneliness and social isolation or support in adults aged 65 years or older. Only English language articles were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened studies, extracted data, and assessed risk of bias. Random-effects models were performed to pool the overall effect size by intervention. Statistical heterogeneity was evaluated with the I2 statistic and by estimating prediction intervals. Data were analyzed from November 2021 to September 2022. MAIN OUTCOMES AND MEASURES Quantitative measures of loneliness, social isolation, or social support based on an effect size of standardized mean differences. RESULTS Seventy studies were included in the systematic review (8259 participants); 44 studies were included in the loneliness meta-analysis (33 in the community with 3535 participants; 11 in long-term care with 1057 participants), with participants' ages ranging from 55 to 100 years. Study sizes ranged from 8 to 741 participants. Interventions included animal therapy, psychotherapy or cognitive behavioral therapy, multicomponent, counseling, exercise, music therapy, occupational therapy, reminiscence therapy, social interventions, and technological interventions. Most interventions had a small effect size. Animal therapy in long-term care, when accounting for studies with no active controls, had the largest effect size on loneliness reduction (-1.86; 95% CI, -3.14 to -0.59; I2 = 86%) followed by technological interventions (videoconferencing) in long-term care (-1.40; 95% CI, -2.37 to -0.44; I2 = 70%). CONCLUSIONS AND RELEVANCE In this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size's magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low. Future studies should consider measures of social isolation in long-term care and identify the contextual components that are associated with a reduction in loneliness.
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Affiliation(s)
- Peter Hoang
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James A. King
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, Alberta, Canada
- Data and Analytics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sarah Moore
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kim Moore
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Krista Reich
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harman Sidhu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chin Vern Tan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin Whaley
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jacqueline McMillan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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16
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Vallières F, Murphy J, McBride O, Shevlin M, Gilmore B, Travers Á, Nolan A, Butter S, Karatzias T, Bentall R, Hyland P. The role of psychosocial factors in explaining sex differences in major depression and generalized anxiety during the COVID-19 pandemic. BMC Public Health 2022; 22:1563. [PMID: 35978320 PMCID: PMC9382004 DOI: 10.1186/s12889-022-13954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background Understanding how pandemics differentially impact on the socio-protective and psychological outcomes of males and females is important to develop more equitable public health policies. We assessed whether males and females differed on measures of major depression and generalized anxiety during the COVID-19 the pandemic, and if so, which sociodemographic, pandemic, and psychological variables may affect sex differences in depression and anxiety. Methods Participants were a nationally representative sample of Irish adults (N = 1,032) assessed between April 30th to May 19th, 2020, during Ireland’s first COVID-19 nationwide quarantine. Participants completed self-report measures of anxiety (GAD-7) and depression (PHQ-9), as well as 23 sociodemographic pandemic-related, and psychological variables. Sex differences on measures of depression and anxiety were assessed using binary logistic regression analysis and differences in sociodemographic, pandemic, and psychological variables assessed using chi-square tests of independence and independent samples t-tests. Results Females were significantly more likely than males to screen positive for major depressive disorder (30.6% vs. 20.7%; χ2 (1) = 13.26, p < .001, OR = 1.69 [95% CI = 1.27, 2.25]), and generalised anxiety disorder (23.3% vs. 14.4%; χ2 (1) = 13.42, p < .001, OR = 1.81 [95% CI = 1.31, 2.49]). When adjusted for all other sex-varying covariates however, sex was no longer significantly associated with screening positive for depression (AOR = 0.80, 95% CI = 0.51, 1.25) or GAD (AOR = 0.97, 95% CI = 0.60, 1.57). Conclusion Observed sex-differences in depression and anxiety during the COVID-19 pandemic in the Republic of Ireland are best explained by psychosocial factors of COVID-19 related anxiety, trait neuroticism, lower sleep quality, higher levels of loneliness, greater somatic problems, and, in the case of depression, increases in childcaring responsibilities and lower trait consciousnesses. Implications of these findings for public health policy and interventions are discussed.
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Affiliation(s)
- Frédérique Vallières
- Trinity Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland.
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Brynne Gilmore
- Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, University College Dublin, Dublin, Ireland
| | - Áine Travers
- Trinity Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland
| | - Ann Nolan
- Trinity Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland
| | - Sarah Butter
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Richard Bentall
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
| | - Philip Hyland
- Trinity Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland.,Department of Psychology, Maynooth University, Kildare, Ireland
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17
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Fu Z, Yan M, Meng C. The effectiveness of remote delivered intervention for loneliness reduction in older adults: A systematic review and meta-analysis. Front Psychol 2022; 13:935544. [PMID: 35967719 PMCID: PMC9372715 DOI: 10.3389/fpsyg.2022.935544] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRemotely delivered intervention is widely applied to loneliness treatment in older adults, but the effect is controversial. This study aimed to evaluate the effects of remotely delivered intervention on loneliness using a systematic review and meta-analysis.MethodsThe PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL (EBSCO), PsycINFO (EBSCO) databases were searched for studies, the search ended on 7 July 2021. Thirteen randomized controlled trials of remotely delivered intervention compared with usual care, brief contact, or no intervention for loneliness were included. A random-effects model measured estimation of loneliness reduction. Furthermore, standardized mean differences (SMDs), 95% confidence intervals (CIs), publication bias, and heterogeneity were calculated. Subgroup analysis was used to explore the factors that might affect the treatment effects.ResultsThe evidence of remotely delivered intervention on loneliness reduction was certain (SMD = −0.41 [95% CI, −0.70 to −0.13]). Media subgroup analysis supported the effectiveness of intervention delivered by video call (SMD = −0.54 [95% CI, −0.83 to −0.25]); treatment strategy subgroup analysis found evidence to support the effectiveness of increasing social support and maladaptive social cognition treatment strategy (SMD = −0.47 [95% CI, −0.77 to −0.18] and SMD = −1.04 [95% CI, −1.98 to −0.10], respectively); participants subgroup analysis shown the effectiveness of intervention for older adults living in LTC and social isolation (SMD = −1.40 [95% CI, −2.43 to −0.36] and SMD = −0.55 [95% CI, −0.74 to −0.36], respectively); group format subgroup analysis testified the effectiveness of intervention carried out in individual format (SMD = −0.39 [95% CI, −0.71 to −0.07]); measurement time points subgroup analysis found the positive effect of intervention at 3 months and 3 to 6 months stage (SMD = −0.33 [95% CI, −0.52 to −0.14] and SMD = −0.32 [95% CI, −0.57 to −0.07], respectively). Significant publication bias was detected (p < 0.05), and the heterogeneity of the studies was substantial.ConclusionThis systematic review and meta-analysis demonstrate that remotely delivered intervention can reduce loneliness in older adults, and it appears to be affected by media type, treatment strategy, participants characteristics, group format, and measurement time points.
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Affiliation(s)
- Zhengke Fu
- Department of Computational Communication, School of Media and Law, Ningbo Tech University, Ningbo, China
- *Correspondence: Zhengke Fu,
| | - Mengsi Yan
- Department of Japanese Language Study, School of Humanity, Ningbo University of Finance and Economics, Ningbo, China
| | - Chao Meng
- Department of Computational Communication, School of Media and Law, Ningbo Tech University, Ningbo, China
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18
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Sutin AR, Luchetti M, Aschwanden D, Lee JH, Sesker AA, Stephan Y, Terracciano A. Sense of purpose in life and concurrent loneliness and risk of incident loneliness: An individual-participant meta-analysis of 135,227 individuals from 36 cohorts. J Affect Disord 2022; 309:211-220. [PMID: 35483500 PMCID: PMC9133197 DOI: 10.1016/j.jad.2022.04.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sense of purpose, the feeling that one's life is goal-oriented and driven, tends to be protective for psychological health. Less is known about its relation with social health, particularly loneliness. We test whether the cross-sectional association between purpose and loneliness is replicable and whether purpose protects against the development of incident loneliness over time. METHODS Participants from 36 cohorts (total N = 135,227; age range 18-109) reported on their sense of purpose, loneliness, and psychological distress. Follow-up measures of loneliness were available in 28 cohorts that ranged from six weeks to 15 years. Prospective, random-effect meta-analysis was used to summarize the cross-sectional and longitudinal associations from each cohort. RESULTS Sense of purpose was associated significantly with less loneliness in all 36 cohorts, controlling for sociodemographic factors (meta-analytic mean effect estimate = -0.31, 95% CI = -0.34, -0.29, p < .001). This association was stronger among participants experiencing concurrent severe psychological distress. Sense of purpose was protective against the development of new incident loneliness (meta-analytic mean hazard ratio estimate = 0.85, 95% CI = 0.82, 0.87, p < .001). Age did not moderate any of the associations. LIMITATIONS Limitations include the lack of lower-income countries. The mechanisms that explain this association also need to be identified in future research. CONCLUSIONS Sense of purpose is associated with less loneliness and with protection against developing loneliness over time, associations that replicated across cohorts from North America, South America, Europe, and the Middle East. Sense of purpose may be a useful target of intervention to prevent or reduce loneliness, especially among individuals suffering from psychological distress.
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Affiliation(s)
| | | | | | - Ji Hyun Lee
- Florida State University College of Medicine, United States
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19
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Aung MN, Koyanagi Y, Nagamine Y, Nam EW, Mulati N, Kyaw MY, Moolphate S, Shirayama Y, Nonaka K, Field M, Cheung P, Yuasa M. Digitally Inclusive, Healthy Aging Communities (DIHAC): A Cross-Cultural Study in Japan, Republic of Korea, Singapore, and Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126976. [PMID: 35742230 PMCID: PMC9223148 DOI: 10.3390/ijerph19126976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/10/2022]
Abstract
One out of three people in Japan will be an older person before 2040. Half of those currently do not utilize the internet, smartphone apps, or digital technology. On the other hand, more than 70% of seniors in Republic of Korea use the internet, and 55% in Singapore had access to it in 2019. The use of digital technology for health promotion has the potential to promote individual and community empowerment, advocating for healthy, active aging. Maintaining equity in health promotion practice requires the digital inclusion of every senior. Therefore, we propose a cross-cultural study to explain the contextual influences of digital inclusion and its consequences on healthy aging in Japan, Korea, Singapore, and Thailand. Quantitatively: digital skills, e-health literacy, participation in health promotion, and quality of life will be analyzed in structural equation models. Qualitatively: thematic analysis will be developed to identify cultural patterns and contextual factors, making sense of what older persons in different countries materialize, say, do, think, and feel to reveal deeper beliefs and core values about digital inclusion and healthy aging. Logics and methods from this protocol would be useful to replicate the study in many countries globally. Evidence from this study is expected to pave the way to digitally inclusive, healthy aging communities (DIHAC) across Japan and Asia.
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Affiliation(s)
- Myo Nyein Aung
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Advanced Research Institute for Health Sciences, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
- Correspondence:
| | - Yuka Koyanagi
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Department of Judo Therapy, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
| | - Yuiko Nagamine
- Department of Family Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| | - Eun Woo Nam
- Department of Health Administration, Software Digital Healthcare Convergence College, Yonsei University, Wonju 26493, Korea;
| | - Nadila Mulati
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
| | - Myat Yadana Kyaw
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai 50300, Thailand;
| | - Yoshihisa Shirayama
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
| | - Kumiko Nonaka
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
| | - Malcolm Field
- Faculty of Social Sciences, Kyorin University, Tokyo 181-8611, Japan;
- Faculty of International Liberal Arts, Waseda University, Tokyo 169-0051, Japan
| | - Paul Cheung
- Asia Competitiveness Institute (ACI), Lee Kuan Yew School of Public Policy, Singapore 259772, Singapore;
| | - Motoyuki Yuasa
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
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20
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Pech M, Gbessemehlan A, Dupuy L, Sauzéon H, Lafitte S, Bachelet P, Amieva H, Pérès K. Experimentation of the SoBeezy program in older adults during the COVID-19 pandemic: what lessons have we learned? (Preprint). JMIR Form Res 2022; 6:e39185. [DOI: 10.2196/39185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/08/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
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21
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Zagic D, Wuthrich VM, Rapee RM, Wolters N. Interventions to improve social connections: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2022; 57:885-906. [PMID: 34796368 DOI: 10.1007/s00127-021-02191-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/31/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The importance of both frequent and high-quality social connections is widely recognised. Previous reviews of interventions for promoting social connections found mixed results due to the inclusion of uncontrolled studies and merging of objective and subjective dimensions of social connections. This study aimed to compare the effectiveness of interventions designed to promote 'objective social contact' and the 'quality of social connections'; and compare the effectiveness of interventions from different theoretical orientations on these social dimensions through a systematic review and meta-analysis of controlled trials. METHODS A systematic search of electronic databases Medline, Embase, PsycINFO and PubMed was conducted to identify randomised controlled trials of interventions for social isolation, loneliness, social participation and/or social connectedness in adults. Data were analysed using Stata V.16.0. RESULTS Fifty-eight studies met inclusion criteria (mean age = 62 years). Overall, interventions led to significant improvements in objective social contact (Hedges' g = 0.43) and perceived quality of social connections (Hedges' g = - 0.33). Increasing access to other people was the most effective strategy for promoting objective social contact (Hedges' g = 0.67). Providing adults with skills to manage maladaptive attributional biases, fear-related avoidance of social situations, and barriers to social contact, was the most effective strategy for addressing deficits in perceived quality of social connections (Hedges' g = - 0.53). CONCLUSION In summary, different interventions had differential effects on the frequency and quality of social relationships and associated emotional distress. Psychological interventions hold the most promise for increasing meaningful social connections and reducing distress.
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Affiliation(s)
- Dino Zagic
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia. .,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia.
| | - Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Nine Wolters
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Faculty of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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22
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Sturm N, Krisam J, Szecsenyi J, Bentner M, Frick E, Mächler R, Schalhorn F, Stolz R, Valentini J, Joos S, Straßner C. Spirituality, Self-Care, and Social Activity in the Primary Medical Care of Elderly Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:124-131. [PMID: 34939916 PMCID: PMC9160422 DOI: 10.3238/arztebl.m2022.0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/27/2021] [Accepted: 12/02/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Self-efficacy is decisive for the quality of life of elderly, multimorbid persons. It may be possible to strengthenpatients' self-efficacy can be strengthened by the targeted reinforcement of individual spirituality, social activity, and self-care.This hypothesis was tested with the aid of a complex intervention. METHODS A non-blinded, exploratory, cluster-randomized, controlled trial was carried out, with primary care practices as therandomization unit (registration number DRKS00015696). The patients included were at least 70 years of age, had at least threechronic diseases, were taking at least three medications, and were participating in a disease management program. In theintervention group, primary care physicians took a spiritual history, and medical assistants advised the patients on the use ofhome remedies (e.g., tea, application of heat/cold) and on regionally available programs for the elderly. The primary endpoint-health-related self-efficacy, measured using the SES6G scale-and further, secondary endpoints were evaluated withmultistep regression analyses. RESULTS Data from 297 patients treated in 24 primary care practices were evaluated. The analysis of the primary endpointindicated no effect (mean difference between study arms 0.30 points, 95% confidence interval [-0.21; 0.81], d = 0.14, p = 0.25).Subgroup analysis revealed the following situation for the secondary endpoint "mental well-being" (SF-12 subscale): patientswho had already been using home remedies before the trial began experienced a marked improvement (a difference of 7.3points on a scale from 0 to 100; d = 0.77, p < 0.001). This was also the case for patients who stated that spirituality played amajor role in their lives (a difference of 6.2 points on a scale from 0 to 100; d = 0.65; p = 0.002). CONCLUSION The main hypothesis concerning health-related self-efficacy was not confirmed. The results of the analysis ofsecondary parameters indicate that some subgroups of patients can benefit from the interventional approach.
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Affiliation(s)
- Noemi Sturm
- Department of General Practice and Health Services Research, University Hospital Heidelberg
| | - Johannes Krisam
- Department of Medical Biometry at the Institute of Medical Biometry and Informatics, University Hospital Heidelberg
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg
| | - Martina Bentner
- Department of General Practice and Health Services Research, University Hospital Heidelberg
| | - Eckhard Frick
- Professorship of Spiritual Care and Psychosomatic Health, Rechts der Isar Hospital, Technical University of Munich
| | - Ruth Mächler
- Professorship of Spiritual Care and Psychosomatic Health, Rechts der Isar Hospital, Technical University of Munich
| | - Friederike Schalhorn
- Institute for General Practice and Interprofessional Care, University of Tübingen
| | - Regina Stolz
- Institute for General Practice and Interprofessional Care, University of Tübingen
| | - Jan Valentini
- Institute for General Practice and Interprofessional Care, University of Tübingen
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University of Tübingen
| | - Cornelia Straßner
- Department of General Practice and Health Services Research, University Hospital Heidelberg,*Universitatsklinikum Heidelberg Allgemeinmedizin und Versorgungsforschung Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Wolfers MEG, Stam BE, Machielse A. Correlates of emotional and social loneliness among community dwelling older adults in Rotterdam, the Netherlands. Aging Ment Health 2022; 26:355-367. [PMID: 33502244 DOI: 10.1080/13607863.2021.1875191] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Loneliness is seen as an important problem, contributing to serious health problems. As a baseline measurement for the evaluation of a community project aimed at reducing loneliness in Rotterdam, loneliness was measured, as well as potential correlates. This article describes models of social and emotional loneliness among older adults. METHODS This study was conducted among 3,821 randomly selected community dwelling citizens of 65 years and older. Loneliness was measured by using the Jong-Gierveld loneliness questionnaire/scale. As potential correlates demographic, health and psychological and social variables were included. Data were subjected to multiple hierarchically regression analysis. RESULTS Emotional loneliness was reported by 60% and social loneliness by 47% of the sample. Women were more emotionally lonely than men , while men reported more social loneliness than women. Emotional social support and quality of life were strongest in predicting emotional loneliness and social capital in the neighbourhood, companionship and instrumental support were strongest predictors for social loneliness. Demographic variables predicted variability in emotional loneliness. CONCLUSIONS The strength of the correlates differed between the two dimensions of loneliness. In the design of interventions to prevent and reduce loneliness among older adults, strategies should be developed aimed at the specific dimensions of loneliness.
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Affiliation(s)
- Mireille E G Wolfers
- Department Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, the Netherlands
| | - Bianca E Stam
- Department Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, the Netherlands
| | - Anja Machielse
- University for Humanistic Studies, Utrecht, the Netherlands
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24
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Ju J, Qi WB, Zhang J, Cao ZJ, Tsai CL, Liu P. A Cross-Sectional Study on the Cross-Talk of the COVID-19-Related Degree of Loneliness and the Etiological Factors Among the Elderly in Central China. Front Psychiatry 2022; 13:805664. [PMID: 35237190 PMCID: PMC8883135 DOI: 10.3389/fpsyt.2022.805664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The outbreak of COVID-19 has undoubtedly influenced the normal lifestyle of people worldwide, including the Chinese population. This study attempted to do supplementary research to the current situation of loneliness as well as the related risk factors among the elderly in the province in central Chinese during the COVID-19. METHODS We conducted a cross-sectional study in one of the central Chinese provinces (Henan Province) from December 2020 to March 2021 using a multistage sampling method, and 568 elderly people without cognitive impairment were interviewed. The UCLA Loneliness Scale, Pittsburgh Sleep Quality Index (PSQI), Physical Activity Rating Scale (PARS-3), and Quality of Life Questionnaire SF-36 were adopted to collect information. We used univariate and multivariate logistic regressions to analyze the factors resulting in severe loneliness among the elderly with seldom or regular participation in physical exercises. RESULTS During the epidemic in central China, the elderly suffering from loneliness syndrome accounted for 34.2%, of which 15.5% were severely lonely. Risk factors for severe loneliness were quality of life (OR: 7.129), sleep quality (OR: 3.778), seldom exercise (OR: 4.170), poor economic status (OR: 1.769), and negative attitude toward the prospects for the epidemic control (OR: 4.033). By grouping the participants in terms of physical activity, we found that the quality of life (OR:5.778) was a significant risk factor than sleep quality (OR:2.939) in the seldom exercise group, while the only risk factor in the regular exercise group was the quality of life (OR: 5.021). CONCLUSION There was an increase in the degree of loneliness among the elderly during the epidemic, and physical activity played an active role in relieving the severe loneliness of the elderly. Therefore, for the sake of the elderly, regular participation in physical exercises should be encouraged during the duration of the epidemic.
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Affiliation(s)
- Jie Ju
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Wen-Bo Qi
- Department of Psychiatry, Qingdao Mental Health Center, Qingdao, China
| | - Jia Zhang
- Department of Psychiatry, Qingdao Mental Health Center, Qingdao, China
| | - Zhi-Jun Cao
- Basic Courses Department, Shanghai I&C Foreign Languages School, Shanghai, China
| | - Chi-Lun Tsai
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Peng Liu
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
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25
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Ann Jarvis M, Smith L. Distanced behind the mask: The use of non-verbal communication when counselling the elderly during the COVID-19 pandemic. Health SA 2021; 26:1665. [PMID: 34909231 PMCID: PMC8661110 DOI: 10.4102/hsag.v26i0.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022] Open
Abstract
The stressors caused by the coronavirus disease 2019 (COVID-19) pandemic have influenced both the physical and the mental health of the elderly, increasing their vulnerability. Counselling by the mental healthcare nurse is a critical protective factor in mitigating the mental health effects of COVID-19. However, counselling is unintentionally interrupted by the effects of the mask as a barrier to non-verbal communication. This commentary aims at conscientisation of mental healthcare nursing practice interruptions to non-verbal communication, brought upon by the pandemic. Practice recommendations focus on mask-wearing becoming less of a stressor to offset the challenges experienced by both the elderly and the mental healthcare nurses. CONTRIBUTION The authors conclude that a need exists to revisit the fundamentals of counselling, and show initiative to addressing the practice challenges created by the wearing of masks yet simultaneously contribute to #flatten_the_mental_illness_curve.
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Affiliation(s)
- Mary Ann Jarvis
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lourett Smith
- School of Clinical Care Sciences and Medicinal Sciences, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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26
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Juang C, Huh JWT, Iyer S, Beaudreau SA, Gould CE. Feasibility, Acceptance, and Initial Evaluation of a Telephone-Based Program Designed to Increase Socialization in Older Veterans. J Geriatr Psychiatry Neurol 2021; 34:594-605. [PMID: 32744165 DOI: 10.1177/0891988720944242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Loneliness is a public health issue, particularly for older Veterans. To increase older Veterans' access for socialization opportunities, a community-based telephone-delivered activity program was developed, in which Veterans can call in and engage in social activities through telephone. This paper illustrates the feasibility, acceptance, and preliminary outcomes of this program using a mixed-methods design. Thirty-two Veterans enrolled in the program, with 14 attendees who called in to the program at least once. Attendees were more likely to be depressed than those who did not call in at baseline. Program was acceptable with high client satisfaction. Perceived benefits included a structured program with interesting topics to spend time on and the opportunity to socialize, exchange ideas, and connect with other Veterans. Individual challenges (e.g., hearing difficulty) and program-level challenges (e.g., complicated procedures) were reported during qualitative interviews. Among attendees, a significant decrease in loneliness from baseline to 3-months was found but should be interpreted with caution based on the small sample size. While positive findings emerged regarding feasibility, acceptance, preliminary benefits of this program, further refinement is needed to improve future program implementation.
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Affiliation(s)
- Christine Juang
- Psychology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - J W Terri Huh
- Psychology Service, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sowmya Iyer
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sherry A Beaudreau
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine E Gould
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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27
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Hernández Gómez MA, Fernández Domínguez MJ, Sánchez Sánchez NJ, Blanco Ramos MÁ, Perdiz Álvarez MC, Castro Fernández P. Soledad y envejecimiento. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2021. [DOI: 10.55783/rcmf.140305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
El objetivo del estudio es conocer la prevalencia de soledad y aislamiento social en mayores de 65 años en Ourense y sus factores asociados.
Métodos: estudio descriptivo trasversal, muestra aleatoria de personas mayores de 65 años a las que se realizó una entrevista entre junio de 2010 y junio de 2011. Tamaño muestral: 486 pacientes (soledad estimada del 35%). Se administró la escala OARS-MFAQ (Olders American Resource and Services Multidimensional Functional Assessment Questionnaire), que recoge variables sociodemográficas, recursos sociales, económicos, salud física, mental y la capacidad para llevar a cabo actividades básicas de la vida diaria (ABVD) y actividades instrumentales de la vida diaria (AIVD). Se les hizo la pregunta «¿Se encuentra usted sola/solo?», con cuatro posibles respuestas: siempre, a menudo, casi nunca, nunca.
Resultados: se entrevistó a 572 personas de una edad media de 79 años (desviación estándar [DE]: 6,79). Soledad: 32,7%; vive sola/solo: 17%; sin contacto semanal: 18,9%; aislamiento social: 1,4%. Fueron factores asociados a la percepción de soledad: ser mujer, tener pensión y nivel educativo bajos, depresión, deterioro cognitivo, pérdida de visión, dependencia para las AVBD, tomar psicofármacos en los 6 meses previos y la necesidad de mejoras en la vivienda. La práctica de ejercicio regular constituyó un factor protector.
Conclusiones: la soledad en nuestra población es similar a la descrita en otros ámbitos, se asocia a desigualdad de género, factores sociales y demográficos, depresión y deterioro cognitivo. Los profesionales de Atención Primaria deben identificarla y abordarla.
Palabras clave: soledad, personas mayores, aislamiento social, promoción de la salud, condicionantes sociales de la salud.
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Affiliation(s)
- Mercedes Adelaida Hernández Gómez
- Doctora en Medicina. Especialista en Medicina Familiar y Comunitaria. Centro de Salud Novoa Santos-Ourense. Servicio Galego de Saúde. Ourense (España)
| | - María José Fernández Domínguez
- Doctora en Medicina. Especialista en Medicina Familiar y Comunitaria. Centro de Salud de Leiro-Ribadavia. Servicio Galego de Saúde. Ourense (España)
| | - Néstor Javier Sánchez Sánchez
- Especialista en Medicina Familiar y Comunitaria. Centro de Salud de Maceda. Servicio Galego de Saúde. Ourense (España)
| | - Manuel Ángel Blanco Ramos
- Doctor en Medicina. Especialista en Medicina Familiar y Comunitaria. Director ejecutivo de Government Affairs & Market Access en Organon. Madrid (España)
| | - María Celsa Perdiz Álvarez
- Trabajadora social. Doctora en Psicopedagogía. Centro de Salud Novoa Santos-Ourense. Servicio Galego de Saúde. Ourense (España)
| | - Pedro Castro Fernández
- Estudiante en la Facultad de Medicina. Universidad de Santiago de Compostela. Santiago de Compostela. A Coruña (España)
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Bennett RJ, Kelsall-Foreman I, Donaldson S, Olaithe M, Saulsman L, Badcock JC. Exploring Current Practice, Knowledge, and Training Needs for Managing Psychosocial Concerns in the Audiology Setting: Perspectives of Audiologists, Audiology Reception Staff, and Managers. Am J Audiol 2021; 30:557-589. [PMID: 34139126 DOI: 10.1044/2021_aja-20-00189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The purpose of this study was to explore the current practices and training requirements for supporting clients experiencing psychosocial concerns in the audiology setting, from the perspectives of audiology clinicians, managers, and reception staff. Method Convenience sampling was used to recruit audiologists, reception staff, and clinic managers (N = 13, M age = 32.2 ± 8.1, range: 25-47 years, 11 female) through a large hearing services provider in Western Australia. A semistructured focus group was used to elicit participant views regarding current experiences relating to clients who express psychosocial concerns in the audiology setting, familiarity with psychosocial interventions, and training requirements for delivery of psychosocial interventions in the audiological setting. Results Twenty-four subthemes were identified across six themes: (1) awareness of psychosocial well-being, (2) the role of others, (3) identifying client's psychosocial needs, (4) managing client's psychosocial needs, (5) barriers to providing psychosocial support, and (6) broadening audiological services to include psychosocial support. Conclusions Participants reported an awareness of their clients' psychosocial challenges within the audiology setting, yet they described uncertainty in how best to respond in providing support and whether this was within their scope of practice. A majority of audiology staff expressed desire and motivation to broaden the scope of their service in order to better address their clients' hearing loss-related psychosocial needs.
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Affiliation(s)
- Rebecca J. Bennett
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, The University of Western Australia, Crawley, Australia
| | - India Kelsall-Foreman
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Sara Donaldson
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Michelle Olaithe
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Lisa Saulsman
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Johanna C. Badcock
- School of Psychological Science, The University of Western Australia, Crawley, Australia
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29
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Hickin N, Käll A, Shafran R, Sutcliffe S, Manzotti G, Langan D. The effectiveness of psychological interventions for loneliness: A systematic review and meta-analysis. Clin Psychol Rev 2021; 88:102066. [PMID: 34339939 DOI: 10.1016/j.cpr.2021.102066] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/26/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022]
Abstract
Chronic loneliness is associated with a range of mental health difficulties. Previous theory and research indicate that psychological interventions show promise for reducing loneliness, however, there have been no systematic reviews or meta-analyses to ascertain the efficacy of these interventions across the lifespan. The aim of this study was to synthesise, meta-analyse and explore the heterogeneity in RCTs of psychological interventions for loneliness in order to establish their efficacy. Five databases (Ovid Embase, Ovid Medline, PsycINFO, Web of Science and CINAHL) were systematically searched in order to identify relevant studies. Included studies were required to be peer-reviewed RCTs examining psychological interventions for loneliness. Two independent coders examined the abstracts of the 3973 studies and 103 full texts, finding 31 studies that met inclusion criteria, 28 of which contained sufficient statistical information to be included in the meta-analysis. The quality of included studies was assessed using the Cochrane Risk of Bias Tool. The 31 studies (N = 3959) that were included in the systematic review were conducted with participants from a diverse range of cultures, age groups and populations. The interventions were of mixed quality and were mostly face to face, group-based and delivered weekly. The most common type of intervention was Cognitive Behavioural Therapy (CBT). 28 studies (N = 3039) were included in a meta-analysis which found that psychological interventions significantly reduced loneliness compared to control groups, yielding a small to medium effect size (g = 0.43). Subgroup analysis and meta-regressions were conducted in order to explore heterogeneity and found that type of psychological intervention was approaching significance as a moderator of the effectiveness of psychological interventions for loneliness. In conclusion, psychological interventions for loneliness across the lifespan are effective. This finding should inform policy makers, researchers and clinicians going forward, especially in the context of increased loneliness due to the COVID-19 pandemic. There was considerable heterogeneity in the effectiveness of the interventions, suggesting that future research should also explore what works for whom and consider personalising psychological treatment.
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Affiliation(s)
- Nisha Hickin
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Anton Käll
- Division of Psychology, Linköping University, 581 83 Linköping, Sweden
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, UK
| | - Sebastian Sutcliffe
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, UK
| | - Grazia Manzotti
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, UK
| | - Dean Langan
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, UK
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30
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Shah SGS, Nogueras D, van Woerden HC, Kiparoglou V. Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e24712. [PMID: 34085942 PMCID: PMC8214187 DOI: 10.2196/24712] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/09/2020] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Loneliness is a serious public health issue, and its burden is increasing in many countries. Loneliness affects social, physical, and mental health, and it is associated with multimorbidity and premature mortality. In addition to social interventions, a range of digital technology interventions (DTIs) are being used to tackle loneliness. However, there is limited evidence on the effectiveness of DTIs in reducing loneliness, especially in adults. The effectiveness of DTIs in reducing loneliness needs to be systematically assessed. OBJECTIVE The objective of this study is to assess the effectiveness of DTIs in reducing loneliness in older adults. METHODS We conducted electronic searches in PubMed, MEDLINE, CINAHL, Embase, and Web of Science for empirical studies published in English from January 1, 2010, to July 31, 2019. The study selection criteria included interventional studies that used any type of DTIs to reduce loneliness in adults (aged ≥18 years) with a minimum intervention duration of 3 months and follow-up measurements at least 3 months after the intervention. Two researchers independently screened articles and extracted data using the PICO (participant, intervention, comparator, and outcome) framework. The primary outcome measure was loneliness. Loneliness scores in both the intervention and control groups at baseline and at follow-up at 3, 4, 6, and 12 months after the intervention were extracted. Data were analyzed via narrative synthesis and meta-analysis using RevMan (The Cochrane Collaboration) software. RESULTS A total of 6 studies were selected from 4939 screened articles. These studies included 1 before and after study and 5 clinical trials (4 randomized clinical trials and 1 quasi-experimental study). All of these studies enrolled a total of 646 participants (men: n=154, 23.8%; women: n=427, 66.1%; no gender information: n=65, 10.1%) with an average age of 73-78 years (SD 6-11). Five clinical trials were included in the meta-analysis, and by using the random effects model, standardized mean differences (SMDs) were calculated for each trial and pooled across studies at the 3-, 4-, and 6-month follow-ups. The overall effect estimates showed no statistically significant difference in the effectiveness of DTIs compared with that of usual care or non-DTIs at follow-up at 3 months (SMD 0.02; 95% CI -0.36 to 0.40; P=.92), 4 months (SMD -1.11; 95% CI -2.60 to 0.38; P=.14), and 6 months (SMD -0.11; 95% CI -0.54 to 0.32; P=.61). The quality of evidence was very low to moderate in these trials. CONCLUSIONS Our meta-analysis shows no evidence supporting the effectiveness of DTIs in reducing loneliness in older adults. Future research may consider randomized controlled trials with larger sample sizes and longer durations for both the interventions and follow-ups. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2019-032455.
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Affiliation(s)
- Syed Ghulam Sarwar Shah
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David Nogueras
- EvZein Limited, Holley Crescent, Headington, Oxford, United Kingdom
| | - Hugo Cornelis van Woerden
- Public Health Agency Northern Ireland, Belfast, United Kingdom
- Division of Rural Health and Wellbeing, University of the Highlands and Islands, Inverness, United Kingdom
- Institute of Nursing and Health Research, Ulster University, Belfast, United Kingdom
| | - Vasiliki Kiparoglou
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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31
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Haase KR, Cosco T, Kervin L, Riadi I, O'Connell ME. Older Adults' Experiences With Using Technology for Socialization During the COVID-19 Pandemic: Cross-sectional Survey Study. JMIR Aging 2021; 4:e28010. [PMID: 33739929 PMCID: PMC8074950 DOI: 10.2196/28010] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Technology use has become the most critical approach to maintaining social connectedness during the COVID-19 pandemic. Older adults (aged >65 years) are perceived as the most physiologically susceptible population to developing COVID-19 and are at risk of secondary mental health challenges related to the social isolation that has been imposed by virus containment strategies. To mitigate concerns regarding sampling bias, we analyzed a random sample of older adults to understand the uptake and acceptance of technologies that support socialization during the pandemic. OBJECTIVE We aimed to conduct a population-based assessment of the barriers and facilitators to engaging in the use of technology for web-based socialization among older adults in the Canadian province of British Columbia during the COVID-19 pandemic. METHODS We conducted a cross-sectional, population-based, regionally representative survey by using the random-digit dialing method to reach participants aged >65 years who live in British Columbia. Data were analyzed using SPSS (IBM Corporation), and open-text responses were analyzed via thematic analysis. RESULTS Respondents included 400 older adults aged an average of 72 years, and 63.7% (n=255) of respondents were female. Most respondents (n=358, 89.5%) were aware of how to use technology to connect with others, and slightly more than half of the respondents (n=224, 56%) reported that, since the beginning of the pandemic, they used technology differently to connect with others during the pandemic. Additionally, 55.9% (n=223) of respondents reported that they adopted new technology since the beginning of the pandemic. Older adults reported the following key barriers to using technology: (1) a lack of access (including finance-, knowledge-, and age-related issues); (2) a lack of interest (including a preference for telephones and a general lack of interest in computers); and (3) physical barriers (resultant of cognitive impairments, stroke, and arthritis). Older adults also reported the following facilitators: (1) a knowledge of technologies (from self-teaching or external courses); (2) reliance on others (family, friends, and general internet searches); (3) technology accessibility (including appropriate environments, user-friendly technology, and clear instructions); and (4) social motivation (everyone else is doing it). CONCLUSIONS Much data on older adults' use of technology are limited by sampling biases, but this study, which used a random sampling method, demonstrated that older adults used technology to mitigate social isolation during the pandemic. Web-based socialization is the most promising method for mitigating potential mental health effects that are related to virus containment strategies. Providing telephone training; creating task lists; and implementing the facilitators described by participants, such as facilitated socialization activities, are important strategies for addressing barriers, and these strategies can be implemented during and beyond the pandemic to bolster the mental health needs of older adults.
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Affiliation(s)
- Kristen R Haase
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada
| | - Theodore Cosco
- Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada.,Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
| | - Lucy Kervin
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Indira Riadi
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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Shapira S, Yeshua-Katz D, Goren G, Aharonson-Daniel L, Clarfield AM, Sarid O. Evaluation of a Short-Term Digital Group Intervention to Relieve Mental Distress and Promote Well-Being Among Community-Dwelling Older Individuals During the COVID-19 Outbreak: A Study Protocol. Front Public Health 2021; 9:577079. [PMID: 33898369 PMCID: PMC8062707 DOI: 10.3389/fpubh.2021.577079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
Older individuals are at an increased risk of experiencing adverse social and health consequences due to both the COVID-19 pandemic and the measures taken to manage it, such as social distancing. To promote community-dwelling older individuals' well-being during this time, the aims of the current project are to develop effective strategies in order (a) to increase older individuals' digital literacy, and (b) to help them acquire behavioral and cognitive skills that will improve their coping abilities with the stressful situation created as a result of the pandemic, as well as reducing adverse mental health effects. The project comprises an intervention arm that includes digital group sessions for older individuals meant to improve their digital literacy, promote their effective coping, and relieve their mental distress and loneliness. Subjects receive a short-term (seven sessions), twice-weekly, digitally guided group intervention through Zoom (a video conferencing app), and WhatsApp (instant messaging app). The wait list control-group participants receive twice-weekly telephone calls from a research assistant during a parallel period. Web-based questionnaires are filled in pre- and post-participation. The effectiveness of the intervention will be analyzed by comparing pre- and post-measures, between intervention and control groups. This protocol offers a model for helping to support vulnerable populations during the COVID-19 pandemic. However, it is applicable regardless of the outbreak of a global health crisis or the imposition of lockdown rules; in fact, it has the potential to contribute to the social inclusion of vulnerable populations during routine times as well as during emergencies. Furthermore, ideas for future expansion include the integration of multilingual facilitators in order to reach seniors from underserved minority groups in various social contexts, even across borders.
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Affiliation(s)
- Stav Shapira
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- PREPARED Center for Emergency Response Research, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Daphna Yeshua-Katz
- Department of Communication Studies, Faculty of Humanities and Social Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ganit Goren
- The Spitzer Department of Social Work, Faculty of Humanities and Social Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Limor Aharonson-Daniel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- PREPARED Center for Emergency Response Research, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - A. Mark Clarfield
- Faculty of Health Sciences, Medical School for International Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
- The Department of Geriatrics, McGill University, Montreal, QC, Canada
| | - Orly Sarid
- The Spitzer Department of Social Work, Faculty of Humanities and Social Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Savage RD, Wu W, Li J, Lawson A, Bronskill SE, Chamberlain SA, Grieve J, Gruneir A, Reppas-Rindlisbacher C, Stall NM, Rochon PA. Loneliness among older adults in the community during COVID-19: a cross-sectional survey in Canada. BMJ Open 2021; 11:e044517. [PMID: 33811054 PMCID: PMC8023743 DOI: 10.1136/bmjopen-2020-044517] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Physical distancing and stay-at-home measures implemented to slow transmission of novel coronavirus disease (COVID-19) may intensify feelings of loneliness in older adults, especially those living alone. Our aim was to characterise the extent of loneliness during the first wave in a sample of older adults living in the community and assess characteristics associated with loneliness. DESIGN Online cross-sectional survey between 6 May and 19 May 2020. SETTING Ontario, Canada. PARTICIPANTS Convenience sample of members of a national retired educators' organisation. PRIMARY OUTCOME MEASURES Self-reported loneliness, including differences between women and men. RESULTS 4879 respondents (71.0% women; 67.4% 65-79 years) reported that in the preceding week, 43.1% felt lonely at least some of the time, including 8.3% who felt lonely always or often. Women had increased odds of loneliness compared with men, whether living alone (adjusted OR (aOR) 1.52, 95% CI 1.13 to 2.04) or with others (2.44, 95% CI 2.04 to 2.92). Increasing age group decreased the odds of loneliness (aOR 0.69 (95% CI 0.59 to 0.81) 65-79 years and 0.50 (95% CI 0.39 to 0.65) 80+ years compared with <65 years). Living alone was associated with loneliness, with a greater association in men (aOR 4.26, 95% CI 3.15 to 5.76) than women (aOR 2.65, 95% CI 2.26 to 3.11). Other factors associated with loneliness included: fair or poor health (aOR 1.93, 95% CI 1.54 to 2.41), being a caregiver (aOR 1.18, 95% CI 1.02 to 1.37), receiving care (aOR 1.47, 95% CI 1.19 to 1.81), high concern for the pandemic (aOR 1.55, 95% CI 1.31 to 1.84), not experiencing positive effects of pandemic distancing measures (aOR 1.94, 95% CI 1.62 to 2.32) and changes to daily routine (aOR 2.81, 95% CI 1.96 to 4.03). CONCLUSIONS While many older adults reported feeling lonely during COVID-19, several characteristics-such as being female and living alone-increased the odds of loneliness. These characteristics may help identify priorities for targeting interventions to reduce loneliness.
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Affiliation(s)
- Rachel D Savage
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Joyce Li
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea Lawson
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Andrea Gruneir
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Reppas-Rindlisbacher
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan M Stall
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula A Rochon
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Choi HK, Lee SH. Trends and Effectiveness of ICT Interventions for the Elderly to Reduce Loneliness: A Systematic Review. Healthcare (Basel) 2021; 9:293. [PMID: 33800099 PMCID: PMC8002106 DOI: 10.3390/healthcare9030293] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/22/2023] Open
Abstract
Elderly people are sensitive to loneliness, which may contribute to mental and physical health, serious illness, and increased mortality. This study investigates the development trend of information communication technology (ICT) interventions designed for the elderly to reduce loneliness and synthesize its effect. We searched relevant articles on 23 May 2020 using three databases: Ovid-Medline, Ovid-EMBASE, and the Cochrane library. Data extraction and quality assessment were independently performed by two authors. The development is changing from animal robots to online social platforms and from simple emotional support to a multifaceted system that promotes social participation, cognition, physical activity, and nutrition. Our systematic review reported that ICT interventions are being developed to alleviate loneliness and increase social participation. Our study revealed an increase in the use of ICT interventions among the elderly and a positive change in their attitude toward ICT interventions. ICT interventions in the field of nursing should continue to be developed in the future to meet social, health, and safety needs. In the context of coronavirus disease 2019 (COVID-19), ICT interventions are needed to respond effectively to the needs of the elderly. This study is expected to provide basic knowledge for the development of ICT interventions for the elderly.
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Affiliation(s)
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 21936, Korea;
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Boucher EM, McNaughton EC, Harake N, Stafford JL, Parks AC. The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group. JMIR Ment Health 2021; 8:e26617. [PMID: 33498011 PMCID: PMC7872202 DOI: 10.2196/26617] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common. OBJECTIVE Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness. METHODS A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020. RESULTS Participants' responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic. CONCLUSIONS The heterogeneity in participants' experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely.
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Padmanabhanunni A, Pretorius T. The unbearable loneliness of COVID-19: COVID-19-related correlates of loneliness in South Africa in young adults. Psychiatry Res 2021; 296:113658. [PMID: 33360428 PMCID: PMC9754815 DOI: 10.1016/j.psychres.2020.113658] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/14/2020] [Indexed: 01/10/2023]
Abstract
This is the first study to examine the association between COVID-19 related variables and loneliness among young adults in South Africa during COVID-19. Participants (N=337) were university students who completed the UCLA Loneliness Scale and five selected subscales of the WHO COVID-19 Behavioural Insights Tool. The mean loneliness scores were significantly higher than previous studies in other contexts as well as studies conducted in the time of COVID-19. Correlational analysis found that greater perceived risk of infection, limited perceived knowledge of COVID-19 and lower appraisals of resilience were associated with increased loneliness. In a regression analysis, when all COVID-19 variables were considered simultaneously, only resilience, self-rated knowledge, and risk perception emerged as significant correlates of loneliness. These findings suggest that loneliness is a significant public health concern in South Africa in the time of COVID-19. It also suggests that self-efficacy and resilience can potentially be reinforced by public health campaigns that focus on enhancing COVID-19-related knowledge and preparedness.
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Affiliation(s)
- A. Padmanabhanunni
- Department of Psychology, University of the Western Cape, Western Cape Province, South Africa,Corresponding author at:Private Bag X17, Department of Psychology, University of the Western Cape, Bellville, Cape Town, Western Cape, South Africa
| | - T.B. Pretorius
- Department of Psychology, University of the Western Cape, Western Cape Province, South Africa
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Typologies of Loneliness, Isolation and Living Alone Are Associated with Psychological Well-Being among Older Adults in Taipei: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249181. [PMID: 33302603 PMCID: PMC7764280 DOI: 10.3390/ijerph17249181] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Loneliness, isolation, and living alone are emerging as critical issues in older people's health and well-being, but the effects are not consistent. The purpose of this study was to examine the clustering of loneliness, isolation, and living alone, the risk factors and the associations with psychological well-being. METHODS The data were collected from the 2019 Taipei City Senior Citizen Condition Survey by face-to-face interviews and included a community-based sample (n = 3553). Loneliness, isolation, and living arrangement were analyzed by cluster analysis to define Loneliness-Isolation-Living-Alone clusters. Multinomial logistic regression was used to examine the factors related to Loneliness-Isolation-Living-Alone clusters, and linear regression was used to examine association of clusters with psychological well-being. RESULTS Five clusters of older adults were identified and named as follows: Not Lonely-Connected-Others (53.4%), Not Lonely-Isolated-Others (26.6%), Not Lonely-Alone (5.0%), Lonely-Connected (8.1%), and Lonely-Isolated-Others (6.9%). Demographics, financial satisfaction, physical function, family relationship, and social participation were related to the Loneliness-Isolation-Living-Alone clusters. Compared with the Not Lonely-Connected-Others cluster, the Lonely-Connected cluster and Lonely-Isolated-Others cluster had higher depressive symptoms and lower life satisfaction, and the Not Lonely-Isolated-Others cluster reported lower life satisfaction; the Not Lonely-Alone cluster was not different. DISCUSSION Loneliness and isolation are negatively associated with psychological well-being, and living arrangement is not the determinant to loneliness or isolation. Older adults are suggested to strengthen their informal social support, and the government may encourage social care and create an age friendly environment to reduce loneliness and isolation.
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Loneliness Relates to Functional Mobility in Older Adults with Type 2 Diabetes: The Look AHEAD Study. J Aging Res 2020; 2020:7543702. [PMID: 33178459 PMCID: PMC7647748 DOI: 10.1155/2020/7543702] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/19/2020] [Indexed: 12/25/2022] Open
Abstract
Objective Little is known about the impact of loneliness on physical health among elderly individuals with diabetes. Here, we examined the relationship of loneliness with disability, objective physical function, and other health outcomes in older individuals with type 2 diabetes and overweight or obesity. Method Data are drawn from the Look AHEAD study, a diverse cohort of individuals (ages 61–92) with overweight or obesity and type 2 diabetes measured 5–6 years after a 10-year weight loss randomized, controlled trial. Results Loneliness scores were significantly associated with greater disability symptoms and slower 4-meter gait speed (ps < 0.01). Loneliness did not differ across treatment arms. Discussion. Overall, these results extend prior findings relating loneliness to disability and decreased mobility to older individuals with type 2 diabetes and overweight or obesity.
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39
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Aboody D, Siev J, Doron G. Building resilience to body image triggers using brief cognitive training on a mobile application: A randomized controlled trial. Behav Res Ther 2020; 134:103723. [PMID: 32920164 DOI: 10.1016/j.brat.2020.103723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Body image disturbance (BID) is common among women, characterized by persistent and distressing appearance dissatisfaction, and linked with eating disorders. Although effective, cognitive behavioral therapy (CBT) delivered by trained professionals is not easily accessible. This randomized trial evaluated the effects of a CBT-based mobile application designed to increase resilience to body image triggers and reduce BID symptoms. METHOD A non-clinical sample of women (N = 90; Mage = 23.52) was randomized to use the mobile application for approximately 4 min of daily exercises for two weeks or to a control condition. Body image was measured at baseline, immediately after two weeks of mobile application use, and at 1-month follow-up. To examine whether using the application was associated with increased resilience to common BID triggers, participants completed an Instagram exposure resilience task upon completion and at 1-month follow-up. RESULTS Relative to those in the control condition, participants who used the application demonstrated increased resiliency and reduced BID symptoms. Theses effects were medium-to-large and were maintained at 1-month follow-up. CONCLUSION These results underscore the potential usefulness of brief, low-intensity, portable interventions in reducing BID symptoms and in increasing resilience to thin-ideal body messages often portrayed on social media.
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Affiliation(s)
- Dinur Aboody
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, 8 Ha'universuta St. Herzliya, 46150, Israel.
| | - Jedidiah Siev
- Department of Psychology, Swarthmore College, 500 College Ave, Swarthmore, PA, 19081, United States.
| | - Guy Doron
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, 8 Ha'universuta St. Herzliya, 46150, Israel.
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40
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Cheng C, Beauchamp A, Elsworth GR, Osborne RH. Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups. J Med Internet Res 2020; 22:e18476. [PMID: 32788144 PMCID: PMC7453328 DOI: 10.2196/18476] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. OBJECTIVE This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. METHODS A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. RESULTS A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. CONCLUSIONS The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia.,Deakin University, School of Health and Social Development, Faculty of Health, Burwood, Australia
| | - Alison Beauchamp
- Department of Rural Health, Monash University, Melbourne, Australia.,Department of Medicine - Western Health, The University of Melbourne, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Sunshine Hospital, St Albans, Australia
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:2036842. [PMID: 32765823 PMCID: PMC7374226 DOI: 10.1155/2020/2036842] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
Abstract
Background This review studies technology-supported interventions to help older adults, living in situations of reduced mobility, overcome loneliness, and social isolation. The focus is on long-distance interactions, investigating the (i) challenges addressed and strategies applied; (ii) technology used in interventions; and (iii) social interactions enabled. Methods We conducted a search on Elsevier's Scopus database for related work published until January 2020, focusing on (i) intervention studies supported mainly by technology-mediated communication, (ii) aiming at supported virtual social interactions between people, and (iii) evaluating the impact of loneliness or social isolation. Results Of the 1178 papers screened, 25 met the inclusion criteria. Computer and Internet training was the dominant strategy, allowing access to communication technologies, while in recent years, we see more studies aiming to provide simple, easy-to-use technology. The technology used was mostly off-the-shelf, with fewer solutions tailored to older adults. Social interactions targeted mainly friends and family, and most interventions focused on more than one group of people. Discussion. All interventions reported positive results, suggesting feasibility. However, more research is needed on the topic (especially randomized controlled trials), as evidenced by the low number of interventions found. We recommend more rigorous methods, addressing human factors and reporting technology usage in future research.
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Akhter-Khan SC, Au R. Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2020; 2:e200016. [PMID: 36037052 PMCID: PMC9410567 DOI: 10.20900/agmr20200016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
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.
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Affiliation(s)
- Samia C. Akhter-Khan
- Department of Psychology, Humboldt University of Berlin, 10117 Berlin, Germany
- Department of Psychology & Neuroscience, Duke University Graduate School, NC 27705, USA
| | - Rhoda Au
- Departments of Anatomy & Neurobiology and Neurology, Boston University Alzheimer’s Disease Center, Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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Chambergo-Michilot D, Tellez WA, Becerra-Chauca N, Zafra-Tanaka JH, Taype-Rondan A. Text message reminders for improving sun protection habits: A systematic review. PLoS One 2020; 15:e0233220. [PMID: 32428021 PMCID: PMC7236986 DOI: 10.1371/journal.pone.0233220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background Excessive exposure to ultraviolet radiation increases the risk of skin cancer and other conditions. SMS text reminders may be a useful tool to improve sun protection habits due to its massive reach, low cost, and accessibility. Objective To perform a systematic review of randomized controlled trials (RCTs) that evaluated the effects of SMS text reminders in promoting sun protection habits. Methods We performed a systematic search in PubMed, Central Cochrane Library, and Scopus; following the PRISMA recommendations to perform systematic reviews. We included RCTs published up to December 2018, which evaluated the benefits and harms of SMS text reminders to improve sun protection habits. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed for RCTs estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42018091661). Results Five RCTs were included in this review. When pooled, the studies found no effect of SMS text reminders in “sunburn anytime during follow-up” (two studies, risk ratio: 0.93; 95% confidence interval: 0.83–1.05). Contradictory results were obtained for sunscreen use (three RCTs) and sun protection habits (two RCTs), however, they could not be meta-analyzed because outcomes were measured differently across studies. The certainty of the evidence was very low for these three outcomes according to GRADE methodology. Conclusions RCTs that assessed effects of SMS text reminders did not find a significant benefit on objective outcomes, such as having a sunburn, sunscreen use and composite score of sun protection habits. Since certainty of the evidence was very low, future high-quality studies are needed to reach a conclusion regarding the balance of desirable and undesirable outcomes. Protocol registration number PROSPERO (CRD42018091661).
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Affiliation(s)
| | | | - Naysha Becerra-Chauca
- Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima, Perú
| | | | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
- * E-mail:
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Tan SS, Fierloos IN, Zhang X, Koppelaar E, Alhambra-Borras T, Rentoumis T, Williams G, Rukavina T, van Staveren R, Garces-Ferrer J, Franse CB, Raat H. The Association between Loneliness and Health Related Quality of Life (HR-QoL) among Community-Dwelling Older Citizens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020600. [PMID: 31963427 PMCID: PMC7013468 DOI: 10.3390/ijerph17020600] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/06/2020] [Accepted: 01/15/2020] [Indexed: 11/16/2022]
Abstract
Background: This study aimed to assess the association between loneliness and Health-Related Quality of Life (HR-QoL) among community-dwelling older citizens in five European countries. We characterize loneliness broadly from an emotional and social perspective. Methods: This cross-sectional study measured loneliness with the 6-item De Jong Gierveld Loneliness Scale and HR-QoL with the 12-Item Short-Form Health Survey. The association between loneliness and HR-QoL was examined using multivariable linear regression models. Results: Data of 2169 citizens of at least 70 years of age and living independently (mean age = 79.6 ± 5.6; 61% females) were analyzed. Among the participants, 1007 (46%) were lonely; 627 (29%) were emotionally and 575 (27%) socially lonely. Participants who were lonely experienced a lower HR-QoL than participants who were not lonely (p ≤ 0.001). Emotional loneliness [std-β: -1.39; 95%-CI: -1.88 to -0.91] and social loneliness [-0.95; -1.44 to -0.45] were both associated with a lower physical HR-QoL. Emotional loneliness [-3.73; -4.16 to -3.31] and social loneliness [-1.84; -2.27 to -1.41] were also both associated with a lower mental HR-QoL. Conclusions: We found a negative association between loneliness and HR-QoL, especially between emotional loneliness and mental HR-QoL. This finding indicates that older citizens who miss an intimate or intense emotional relationship and interventions targeting mental HR-QoL deserve more attention in policy and practice than in the past.
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Affiliation(s)
- Siok Swan Tan
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (I.N.F.); (X.Z.); (C.B.F.); (H.R.)
- Correspondence: ; Tel.: +31-10-703-8460
| | - Irene N. Fierloos
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (I.N.F.); (X.Z.); (C.B.F.); (H.R.)
| | - Xuxi Zhang
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (I.N.F.); (X.Z.); (C.B.F.); (H.R.)
| | - Elin Koppelaar
- Research Centre Innovation in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands;
| | - Tamara Alhambra-Borras
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022 Valencia, Spain; (T.A.-B.); (J.G.-F.)
| | - Tasos Rentoumis
- Alliance for Integrated Care, Amfitritis 14, Palaio Faliro, 175 61 Athens, Greece;
| | - Greg Williams
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Road, Manchester M13 9PT, UK;
| | - Tomislav Rukavina
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Trg braće Mažuranića 10, 51000 Rijeka, Croatia;
| | - Rob van Staveren
- Zorg Op Noord, Cypresbaan 7, 2908 LT Capelle aan den IJssel, The Netherlands;
| | - Jordi Garces-Ferrer
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022 Valencia, Spain; (T.A.-B.); (J.G.-F.)
| | - Carmen B. Franse
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (I.N.F.); (X.Z.); (C.B.F.); (H.R.)
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (I.N.F.); (X.Z.); (C.B.F.); (H.R.)
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Chipps J. Psychological therapies for the management of chronic and recurrent pain in children and adolescents: A Cochrane review summary. Int J Nurs Stud 2019; 113:103393. [PMID: 31519334 DOI: 10.1016/j.ijnurstu.2019.103393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jennifer Chipps
- School of Nursing, University of the Western Cape, South Africa.
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