Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.

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A Meta-Analysis of Interventions to Reduce Loneliness:

Preventing and alleviating social isolation and loneliness among older people is an important area for policy and practice, but the effectiveness of many interventions has been questioned because of the lack of evidence. A systematic review was conducted to determine the effectiveness of health promotion interventions that target social isolation and loneliness among older people. Quantitative outcome studies between 1970 and 2002 in any language were included. Articles were identified by searching electronic databases, journals and abstracts, and contacting key informants. Information was extracted and synthesised using a standard form. Thirty studies were identified and categorised as ‘group’ (n=17); ‘one-to-one’ (n=10); ‘service provision’ (n=3); and ‘community development’ (n=1). Most were conducted in the USA and Canada, and their design, methods, quality and transferability varied considerably. Nine of the 10 effective interventions were group activities with an educational or support input. Six of the eight ineffective interventions provided one-to-one social support, advice and information, or health-needs assessment. The review suggests that educational and social activity group interventions that target specific groups can alleviate social isolation and loneliness among older people. The effectiveness of home visiting and befriending schemes remains unclear.

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Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions

Review: Computer use by older adults: A multi-disciplinary review

Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people. Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data. Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting. More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.

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Interventions targeting social isolation in older people: a systematic review.

Social commentators are beginning to recognise that encouraging older adults’ use of information and communication technologies (ICTs) is an essential prerequisite for (over)developed countries such as the United Kingdom becoming bone fide information societies. To date, however, few studies have examined older adults’ access to and use of ICTs in detail. This important aspect of the interaction between population ageing and societal change is more complex than the existing literature’s portrayal of a dichotomy between ‘successful users’ and ‘unsuccessful non-users’. We still know little, for example, about the reasons and motivations underlying older adults’ adoption or non-adoption of ICTs. We also know little about the nature of this use and the support which older adults draw upon regarding ICTs. Finally, and perhaps most importantly, we know little about the outcomes and ‘life-fit’ of older adults’ (non)use of ICTs. The paper examines the extent and nature of ICT access and use by older adults in their everyday lives through two sources of data: (i) information collected from a sub-sample of 352 adults aged over sixty years taken from a large household survey of ICT use in England and Wales among 1,001 people, and; (ii) follow-up interview data from thirty-five of these individuals. The findings suggest that using a computer is not only a minority activity amongst older adults but also highly stratified activity by gender, age, marital status and educational background. Conversely, non-use of computers can be attributed to the low relevance and ‘relative advantage’ to older adults’ lives. From this analysis the paper highlights the key issue of many older adults’ ambivalence towards ICT in light of the limited relevance of new technologies to their day-to-day lives. The paper concludes by considering what steps can be taken to facilitate wider use of ICT by older adults; in particular how political and academic assumptions about older people and ICTs might be refocused, away from trying to ‘change’ older adults, and towards involving older adults in changing ICT.

The information aged: older adults’ use of information and communications technology in everyday life

The Internet offers new opportunities for communication that can help older adults avoid social isolation. Although elders may need more time and assistance in learning computer systems, many are embracing this new technology. There is growing potential not only for recreation and communication through the Internet but also the delivery of services. This study examines the feasibility of providing Internet and electronic mail access to older adults in a retirement community and the extent to which this improves psychosocial well-being. In contrast to members of a comparison group, a trend toward decreased loneliness was observed among participants. In addition, the number of computer-related problems decreased and use of the applications increased throughout the study. These preliminary results support the feasibility of implementing computer-based interventions with the potential of improving psychosocial well-being among older adults.

Surfing the Net in Later Life: A Review of the Literature and Pilot Study of Computer Use and Quality of Life

Children with chronic kidney disease (CKD) are at risk for neurocognitive deficits while simultaneously being at risk for chronic school absenteeism (≥ 18 school days per school year). Chronic school absenteeism compounds the negative impacts of CKD on academic achievement. In this study, we examined patient- and caregiver-reported factors associated with school absenteeism in children with non-dialysis- or transplant-dependent CKD in order to help identify which factors could be modifiable and ultimately improve school attendance.We utilized a combination of chart review and questionnaires distributed in person to patients and caregivers at a pediatric nephrology clinic between November 2018 and August 2019 to gather data. We used descriptive statistics to illustrate clinical characteristics of the children included in the study, caregiver characteristics, and examined reported reasons for missing school.Twenty-one percent of participants (10/48) missed 18 full days of school or more, categorizing them as chronically absent. The top three reasons for missing school were doctor appointments, feeling sick, and being bullied. More specific sequelae of CKD were not highly reported as reasons for missing school.Chronic absenteeism is a highly reported phenomenon among children with pediatric CKD. Given that missing school for doctor appointments was a top reason for absenteeism, this data suggests alternative appointment hours and virtual appointments may reduce chronic school absenteeism in children, and by extension improve their health, behavioral, and academic outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information. 

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Sara Craven

Papers

Surfing the Net in Later Life: A Review of the Literature and Pilot Study of Computer Use and Quality of Life

Patient- and caregiver-reported factors associated with school absenteeism in children with chronic kidney disease