Modelling the Economic Impact of Reducing Loneliness in Community Dwelling Older People in England

Efficacy of relational agents for loneliness across age groups: a systematic review and meta-analysis

BACKGROUND

Loneliness is a serious public health concern. Although previous interventions have had some success in mitigating loneliness, the field is in search of novel, more effective, and more scalable solutions. Here, we focus on "relational agents", a form of software agents that are increasingly powered by artificial intelligence and large language models (LLMs). We report on a systematic review and meta-analysis to investigate the impact of relational agents on loneliness across age groups.

METHODS

In this systematic review and meta-analysis, we searched 11 databases including Ovid MEDLINE and Embase from inception to Sep 16, 2022. We included randomised controlled trials and non-randomised studies of interventions published in English across all age groups. These loneliness interventions, typically attempt to improve social skills, social support, social interaction, and maladaptive cognitions. Peer-reviewed journal articles, books, book chapters, Master's and PhD theses, or conference papers were eligible for inclusion. Two reviewers independently screened studies, extracted data, and assessed risk of bias via the RoB 2 and ROBINS-I tools. We calculated pooled estimates of Hedge's g in a random-effects meta-analysis and conducted sensitivity and sub-group analyses. We evaluated publication bias via funnel plots, Egger's test, and a trim-and-fill algorithm.

FINDINGS

Our search identified 3,935 records of which 14 met eligibility criteria and were included in our meta-analysis. Included studies comprised 286 participants with individual study sample sizes ranging from 4 to 42 participants (x̄ = 20.43, s = 11.58, x̃ = 20). We used a Bonferroni correction with αBonferroni = 0.05 / 4 = 0.0125 and applied Knapp-Hartung adjustments. Relational agents reduced loneliness significantly at an adjusted αBonferroni (g = -0.552; 95% Knapp-Hartung CI, -0.877 to -0.226; P = 0.003), which corresponds to a moderate reduction in loneliness.

CONCLUSION

Our results are currently the most comprehensive of their kind and provide promising evidence for the efficacy of relational agents. Relational agents are a promising technology that can alleviate loneliness in a scalable way and that can be a meaningful complement to other approaches. The advent of LLMs should boost their efficacy, and further research is needed to explore the optimal design and use of relational agents. Future research could also address shortcomings of current results, such as small sample sizes and high risk of bias. Particularly young audiences have been overlooked in past research.

Loneliness impact on healthcare utilization in primary care: A retrospective study

BACKGROUND

An increased number of patients seek help for loneliness in primary care.

OBJECTIVE

To analyze whether loneliness was associated with a higher utilization of healthcare facilities.

METHODS

Observational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data.

RESULTS

A total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6-9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year.

CONCLUSION

Loneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.

Gender Differences in Correlates of Loneliness among Community-Dwelling Older Koreans

Background: Despite a relatively large number of studies exploring late-life loneliness, few studies have compared gender differences in the correlates of loneliness of older adults. Thus, we examined the gender differences in correlates of loneliness among community-dwelling older adults. Methods: This study was a secondary analysis of data from a parent study conducted among community-dwelling Koreans 65 years of age or older. Loneliness was measured by the 20-item Revised University of California Los Angeles Loneliness Scale. As potential correlates, demographic, health-related, and social variables were included. Multivariate hierarchical regression analyses were performed separately by gender. Results: Men were more likely to be lonely than women, after controlling for demographic, health-related, and social variables. A social network of family ties and being married were found to be inversely correlated with loneliness in men but not in women. A social network of friendship ties and participation in a variety of community activities were inversely correlated with loneliness in both men and women. Conclusions: A social network of family ties and being married may help reduce late-life loneliness, particularly among men. This study highlights the importance of considering gender differences in the design of strategies for preventing and alleviating late-life loneliness.

Understanding the Economic Value and Impacts on Informal Carers of People Living with Mental Health Conditions

Informal carers play a vital role in supporting people living with mental health conditions, but comparatively little is known about the economic value of caring. This study undertook an online survey of adult informal carers supporting adults with mental health conditions to better understand the impacts of caring on carer quality of life, levels of loneliness, finances and employment, as well as estimate the economic value of time spent caring. In total, 712 carers participated in the multi-national survey between August 2019 and April 2020. A total of 17% were male, with a mean age of 53, and 68% supported a child living with a mental health condition. A total of 56% of care recipients were male, with a mean age of 37. Adverse impacts on quality of life, loneliness and personal finances were greatest in carers living with care recipients. Overall mean weekly hours of care were 43.42, rising to 65.41 for carers living with care recipients. Mean weekly costs of care per carer ranged from €660 to €2223 depending on living arrangements. Annual costs ranged between €34,960 and €125,412, depending on living arrangements and valuation method. Informal care costs are substantial, and policy makers should consider investing more in carer support, especially for carers living with care recipients.