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A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness

A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing:... Hindawi Journal of Healthcare Engineering Volume 2020, Article ID 2036842, 14 pages https://doi.org/10.1155/2020/2036842 Review Article A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness 1,2 1 2 3 Francisco Ibarra , Marcos Baez , Luca Cernuzzi , and Fabio Casati Department of Information Engineering and Computer Science, University of Trento, Trento 38123, Italy Department of Electronics and Informatics, Universidad Cato´lica “Nuestra Señora de la Asuncio´n”, Asuncio´n, Tte. Lidio Cantaluppi y Guillermo Molinas, Paraguay Tomsk Polytechnic University, Tomsk 634050, Russia Correspondence should be addressed to Francisco Ibarra; fj.ibarracaceres@unitn.it Received 18 September 2019; Revised 3 February 2020; Accepted 25 February 2020; Published 13 July 2020 Academic Editor: Kheng-Lim Goh Copyright © 2020 Francisco Ibarra et al. -is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. -is review studies technology-supported interventions to help older adults, living in situations of reduced mobility, overcome loneliness, and social isolation. -e 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. -e 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. roughly 30 percent for reported loneliness, social isolation, 1. Introduction and living alone, an effect comparable to those of smoking Social interactions significantly impact the quality of life of and obesity. adults in general and older adults in particular. Health risks Several studies report that both loneliness—a subjective have been associated with the characteristics of each indi- measure referring to the “unpleasant” lack of (quality of) social relationships [10]—and social isolation—an objective vidual’s social network, such as small size [1, 2], lack of diversity [3], infrequent contacts [4], and perceived social measure referring to the lack (absence or low number) of isolation [5]. Limited or poor social relationships have been social relationships [10]—increase as we age. Studies on shown to increase the risk of dementia by 60 percent [6]. different geographical and cultural regions report on varying Loneliness is a known risk factor for depression [7] and has levels of loneliness and social isolation depending on the been associated with increased risk of death and with country and the scale used. Older adults experiencing functional decline [8]. A meta-analytic review of 70 studies loneliness have been reported in the 20% to 30% range in [9] has shown that the likelihood of mortality increased by Europe [11], 19% to 32% in the United States [12, 13], and 2 Journal of Healthcare Engineering 29.6% and above in China [14]. -ese figures give us an older adults (older adult OR older people OR senior OR elder indication of the extent of the barriers and challenges to OR ageing OR aging), the target problems (loneliness OR social participation in older adults [15]. social isolation), means for interaction (technology OR In- Indeed, several risk factors such as sensory incapacity ternet OR ICT OR IT OR computer OR tablet OR mobile and reduced mobility, as well as reductions in the quality and OR smart phone), and focus on social (communication OR frequency of contact and requirements for long-term care or social interaction OR social network OR social networking additional support, are associated with loneliness in old age OR social participation OR social cognition OR community). [16]. Predictors of loneliness and isolation for older adults include health problems (such as chronic illness and cog- 2.2. Eligibility Criteria. We analyzed the title and abstract of nitive decline), widowhood, and living far from relatives or each of the 1178 search results and verified whether the alone [17]. Even when older adults engage in a conversation, publication targeted older adults. For the purpose of this interactions can be challenging. Williams and Nussbaum review, we adapted the definition of older adults by the [18] reported on the challenges of intergenerational con- WHO [28] and considered eligible studies reporting on versations, such as patronizing speech, painful disclosures, participants aged 65 and older, or with a mean participant and underutilization of topical resources. In particular, lack age above 65 years of age. In addition, we considered eligible of conversation topics can generate anxiety in intergener- papers that conformed to the following criteria: ational conversations [19]. -ese factors might affect older adults, but, more importantly, they are usually beyond the (i) -e work included an intervention (i.e., action taken affected person’s control [20]. to improve a situation) Technological innovations, along with social and eco- (ii) -e interactions with people were long-distance nomic changes, have made interconnected devices a com- (iii) -e intervention supported mainly technology- monplace, thus creating opportunities for interaction mediated communication [21, 22]. Nonetheless, few reviews have focused on tech- (iv) -e impact on loneliness or social isolation was nology-supported interventions aiming at reducing loneli- evaluated ness and social isolation for older adults. Choi et al. [23] conducted a meta-analysis on computer and Internet Despite our focus on loneliness and social isolation, we training interventions, but did not cover newer devices. considered social connectedness, the experience of be- More recent reviews have analyzed assistive technologies longing and relatedness among people, as a valid outcome and ICT interventions, but these have included interventions because it is related to the (dis)satisfaction with contact for general age-related problems, such as falls and medi- quantity and quality [29]. cation management [24], or considered interventions that required colocated participation, such as playing video 2.3. Study Selection. After the identification and screening games [25]. phases, 190 publications were left (see Figure 1). -ese In this systematic review, we focus instead on inter- publications were read fully and again discarded if not ventions enabling long-distance interactions through tech- nology-mediated communication, targeting loneliness and conforming to our inclusion criteria. An additional exclu- sion criterion for full paper screening was insufficient detail social isolation in old age. Our objective is to identify the in reporting interventions, which would prevent a mean- findings and limits of the knowledge acquired so far and to ingful analysis. After a detailed inspection, 25 publications emphasize areas where further research is needed. More were left for full analysis. specifically, for the interventions analyzed, we investigate the following research questions: RQ1. What challenges of long-distance interactions are 2.4. Analysis and Synthesis. -e review follows a narrative addressed and how? approach to the synthesis of results, given the heterogeneity of the studies included. In order to answer our research RQ2. Which technologies are used by interventions and questions, how? (i) On the challenges of long-distance interactions RQ3. What are the social interactions facilitated by interventions and with whom? addressed by interventions (RQ1), we analyze in- tervention strategies and outcomes used to ac- In the following, we discuss our investigation methods complish the study goals and results. (ii) On the technology used to support interventions (RQ2), we account for the technology and devices, 2. Methods as well as the use of the technology by older adults (iii) On the social interactions enabled (RQ3), we de- 2.1. Search and Information Sources. We conducted a sys- scribe the different contexts of interaction and the tematic review [26], reported here following the PRISMA contacts reached by participants statement guidelines [27], searching Elsevier’s Scopus da- tabase for related work published in English until January, Some authors were contacted to clarify the devices used 2020. -e search query was constructed using keywords for in their interventions and the strategies that participants Journal of Healthcare Engineering 3 Records identified through database searching (n = 1178) Records aer d ft uplicated removed (n = 1170) Records excluded by reading Records screened (n = 1170) title and abstract (n = 980) Full-text articles excluded (n =165) • 1 duplicated • 1 unable to get full paper Full text-articles assessed • 3 study protocols for eligibility (n = 190) • 25 not related to older adults • 26 not related to technology • 7 too short to be subjected to analysis • 24 surveys • 87 interactions were not remote Studies included • 116 not an intervention in analysis (n = 25) • 94 no outcomes in loneliness / social isolation Figure 1: -e full selection process, following the PRISMA statement guidelines. used to meet new people online. For two studies [30, 31], we isolated was a requirement for inclusion but without were able to contact and get a reply from the authors. reporting how this condition was determined [41, 43]. Two studies included participants that perceived themselves as lonely [30, 32], while most interventions measured baseline 3. Results conditions with some form or variant of the UCLA (n � 13) or De Jong Gierveld (n � 4) loneliness scales. 3.1. Study Characteristics and Outcomes. We start by sum- Finally, we mention the lack of agreement on the ef- marizing the interventions analyzed. -ere were 13 inter- fectiveness of video chat and social networks. Széman [41] ventions that considered loneliness as a primary outcome reported that Skype (video chat) helped to strengthen family [30–42], one of which also considered social isolation [34]. ties and expand interpersonal connections, as well as to Another 12 had loneliness and/or social connectedness as encourage learning on how to use other tools such as e-mail secondary outcomes (see Table 1, Outcomes). and chat. However, a computer training intervention by Six interventions conducted qualitative studies, relying Blazun et al. [32] found that levels of loneliness for those who on direct or indirect (e.g., reports by staff) observation, used Skype did not change, while those less lonely after the questionnaires, and interviews (see Table 1, Study methods). training used mainly e-mail, not Skype. Also, regarding All qualitative studies had positive outcomes, reporting mainly a social networking sites, Ballantyne et al. [30] reported a decrease in loneliness [30, 32, 40, 43] (see Table 1, Conclusion). decrease in loneliness as a result of using a social network for We must note, however, that some interventions described their older adults. -ese sites gave more control for users to results as “perceptions” or “being anecdotal” [40], and not manage their loneliness by giving access to contacts at any resulting from “standardized measurement tools” [32]. time and with no need to leave home. On the other hand, -e other 19 interventions conducted quantitative Széman [41] noted that Skype was preferred to Facebook studies, although only five were randomized controlled trials because it was simpler to use even after participants had (RCTs) [35, 36, 42, 50, 44] and one was a group randomized become familiar with Facebook and its functionalities. It is trial [33]. -e remaining interventions all relied on stan- interesting to note that all the aforementioned interventions dardized tools to measure loneliness or social isolation or were supported by desktop/laptop computers and offered some quantifiable variable such as the volume of incoming off-the-shelf solutions. No other conflicting results were and outgoing interactions [36] or the size of the social found. network [47]. Seven studies reported no significant differ- ences, but the majority reported positive outcomes such as decreased loneliness (n = 9) and increased network size 3.2. Challenges and Intervention Strategies. With respect to (n = 2; see Table 1, Conclusion). our first research question, we found that the lack of social All but two interventions had measured participants’ conditions at baseline, indicating that being lonely or relationships and infrequent contacts have been the most Included Eligibility Identification Screening 4 Journal of Healthcare Engineering Table 1: Summary of the interventions analyzed. a b Technology/ Study : length/ Study settings/ Outcomes: primary/ Measurements / Intervention Strategies device participants/age methods secondary Conclusion Social network Internet and Ballantyne 3 months/4/ Home/pilot study, Interview/decreased (About my computer Loneliness et al. [30] 69–85 prepost interviews loneliness age)/computer training Home in Finland, E-mail, residence in 3 weeks/45/66 in Internet and Loneliness, ICT Blazun ˇ et al. Internet, and Slovenia/prepost Questionnaire/ Finland, 77 in computer knowledge, and [32] Skype/ test no control; no decreased loneliness Slovenia training experience computer standard tool for assessment Questionnaire and Familiar, simple interview/decreased Cattan et al. Phone calls/ >3 months/34/ technology; Home/mixed Health and wellbeing/ feelings of loneliness, [43] telephone 55–95 ensure methods loneliness increased interactions socialization Hughes 3-items LS E-mail, Loneliness and social Internet and (UCLA-based) and Cotten et al. Internet, and 1–2 weeks/205 Facility/cross isolation/quantity and computer questionnaire/ [34] Facebook/ (79; 126)/82.8 sectional analysis quality of training decreased loneliness, computer communications not social isolation Familiar, simple technology; Video chat/ ensure Facility/ Hughes 3-items LS Dodge et al. 6 weeks/83 (41; Cognitive function/ touch-screen interactions; randomized (UCLA-based)/no [44] 42)/80.5 loneliness computer provide controlled trial difference conversation topics Home/interrupted Fokkema 3 years/26 (12; E-mail and Internet and time series, DeJong 11-items LS and 14)/66 in Internet/ computer nonequivalent Loneliness and questionnaire/ Knipscheer intervention, 68 computer training control group decreased loneliness [31] in control prepost test Broadcast, DeJong 6-items LS, Familiar, simple messages, and log, interview, technology; Home/mixed Garattini calls/touch- 10 weeks/19/ Feasibility/social questionnaire/helped provide methods, et al. [45] screen 65–84 connectedness social connection conversation exploratory study computer- and created topics phone hybrid interactions UCLA LS/decreased E-mail, loneliness Internet and Loneliness/satisfaction Larsson et al. Internet, Skype, 3 months/30/ Home/randomized (significant in both computer with social contacts [39] and Facebook/ 61–89 crossover study groups); satisfaction training online and offline computer with social contacts inconclusive Familiar, simple Virtual Machesney technology; Home/one group UCLA LS/decreased companion/ 1 week/13/65–93 Loneliness et al. [40] ensure observational study loneliness tablet interactions E-mail, >6 months/15 Internet and Observation/ Szeman ´ et al. Internet, Skype, (program), 25 computer Home/case study Loneliness increased size of [41] and Facebook/ (pilot)/>75 training social network computer UCLA LS (modified 5 months/93 (48; E-mail, Internet and Facility/ anchors)/decreased White et al. 45)/71 in Internet/ computer randomized Loneliness loneliness [42] interventions, 72 computer training controlled trial (nonstatistically in control significant) Journal of Healthcare Engineering 5 Table 1: Continued. a b Technology/ Study : length/ Study settings/ Outcomes: primary/ Measurements / Intervention Strategies device participants/age methods secondary Conclusion Internet and Virtual computer classroom, training; Training adherence/ Hughes 3-items LS Baez et al. 10 weeks/40 (20; Home/randomized messages, and familiar, simple loneliness and social (UCLA-based)/no [46] 20)/71.5 pilot trial predefined technology; wellbeing significant difference messages/tablet ensure interactions Hawthorne Internet and friendship scale, computer E-mail, Cohen perceived training; Loneliness and social Internet, virtual social support scale, Czaja et al. 12 months/300 familiar, simple Home/randomized isolation/attitude classroom, and Lubben social [35] (150; 150)/76.15 technology; controlled trial towards technology messages/ network size, UCLA provide and proficiency computer LS v3/decreased conversation loneliness and social topics isolation Familiar, simple technology; Social (egocentric) Home/ ensure network analysis Banbury nonrandomized Educational goals/ Skype/tablet 44 weeks/52/73.0 interactions; interviews, focus et al. [47] noncontrolled social support provide groups/increased prepost test conversation network size topics Hughes 3-items LS (UCLA-based), Messages Familiar, simple Abbrev. Duke social (video, photos, Barbosa et al. 3 months/12/ technology; Facility/feasibility Feasibility/social support index/ audio, [48] 82.5 ensure study connectedness increased social predefined)/ interactions interactions, high tablet perceived social connectedness CES-D Chinese Internet and version, Taiwanese Cognitive, physical Line computer inventory of social functioning and Chiu and (messaging 5 months/54 (19; training; Facility/group supportive behavior/ psychological Wu [33] service), 18; 17)/73.0 provide randomized trial increased social wellbeing/quality of YouTube/tablet conversation support and life topics satisfaction with contacts Familiar, simple Video chat, One-way repeated Gutierrez technology; Home/empirical in- Frequency of social messages, and 9 weeks/9/69–81 ANOVA/increased et al. [36] ensure the-wild study interactions photos/tablet social interactions interactions Virtual UCLA LS v3, Lubben classroom, Familiar, simple social network scale/ Isaacson video chat, 4-5 weeks/40/ technology; Technology adoption/ decreased loneliness, Home/pilot study et al. [49] photos/TV, 85.86 ensure emotional wellbeing increased social remote, and interactions wellbeing and social webcam network size WhatsApp Internet and (messaging Facility/ Loneliness and social YSQ short form, Jarvis et al. 3 months/29 (13; computer service)/mobile randomized cognition/use of DeJong 6-items LS/ [37] 16)/74.93 training; ensure phone controlled study technology decreased loneliness interactions (smartphone) 6 Journal of Healthcare Engineering Table 1: Continued. a b Technology/ Study : length/ Study settings/ Outcomes: primary/ Measurements / Intervention Strategies device participants/age methods secondary Conclusion WhatsApp Facility/ (messaging Internet and DeJong 6-items LS, Jarvis et al. 3 months/32 (15; experimental service)/mobile computer Loneliness focus groups/ [38] 17)/70.42 randomized phone (smart training decreased loneliness comparative study phone) Social network E-mail, Some at home, Cognitive and mental activity index, UCLA Internet and Morton et al. Internet, 4 months/76 (44; some at facility/ health/social network LS v3/no difference computer [50] Facebook, and 32)/80.71 randomized activity and in loneliness, training Skype 2 × 2 × 2 study satisfaction, loneliness increased social network activity 8 weeks/41 (14; UCLA LS v3, MOS 13; 14)/80.0 Internet and social support Some at home, Neuropsychological Myhre et al. Facebook, 73.38 computer survey, Lubben social Facebook some at facility/3- tests/social [51] online diary, training; ensure network 18-i scale/ arm study engagement 79.29 Waiting interactions; no significant list difference Video chat, Hughes 3-items LS photos, audio Feasibility and (UCLA-based), Barbosa et al. Familiar, simple Facility/embedded recording, 2 months/5/87.2 adoption/social Abbrev. Duke social [52] technology case study predefined connectedness support index/no messages significant difference E-mail, Self-reported Internet and Home/prepost, Physical activity/ Pauly et al. Internet, social >6 months/92/ questionnaires, R- computer repeated measures loneliness and [53] network, and 67.7 UCLA LS/no training study executive functioning messages significant difference Internet and computer PROMIS social Virtual training; ensure Depression, tech use Tomasino isolation 6-i, social classroom and 8 weeks/47/69.6 interactions; Home/pilot study and usability/social et al. [54] Provisions scale/no messages provide support and isolation significant difference conversation topics -e number of participants in controlled studies is shown in parentheses (intervention; control); participants’ age is indicated as mean, age range, or as reported in the study. LS stands for Loneliness Scale. commonly addressed challenges to overcome loneliness and Usability and acceptance of the technology by older social isolation. One prominent strategy has been to train adults were also challenges taken into account. Here, older adults to use computers and Internet (n � 16) strategies have been to employ familiar devices, such as the [30–35, 37–39, 41, 42, 46, 50, 51, 53], although few tech- telephone [43] or television [49]; devices that researchers nologies built specifically for older adults implemented this regarded as more accessible and friendly, such as tablets strategy [35, 46, 54]. After an initial training period, older [36, 40, 46, 48, 52]; or devices that researchers considered adults in these studies were left to put in practice the skills simple enough to require minimal [35, 47] to no training, learned to get in touch with others, with the exception of a such as touch-screen computers [44, 45]. Finally, some single intervention where participants received continuous interventions specifically aimed at solving conversational training [39]. Another strategy has been to ensure that the problems, such as the lack of conversation topics. One participants had someone to interact with (n � 10). -ese strategy was to provide context with educational content in virtual groups or classrooms (e.g., about health), which would usually be health professionals responding or con- tacting participants with some frequency for checks or to allowed participants to discuss and share personal experi- facilitate the intervention [37, 46, 47, 54] or other partici- ences [35, 45, 47, 49, 54]. An intervention reported that the pants such as relatives who agreed to contact and support shared experience provided topics of conversation for the older adults during the study period [36, 48]. Other inter- less active participants [45]. Other interventions prepared ventions had volunteers making phone calls [43], trained conversation around topics such as the childhood and interviewers having video chat conversations [44], and hobbies of participants [44] or implemented buddy systems trained helpers linked to a virtual companion [40]. One based on common interests [35]. Although not designed as intervention ensured interactions by design, requesting a part of the intervention, participants who received weekly participants to post and comment on Facebook daily [51]. phone calls [43] also reported shared interests as a way to Journal of Healthcare Engineering 7 old interests, explore content, or participate in online com- break the ice as well as to establish a “meaningful reciprocal relationship” and mentioned the importance of knowing munities [30–32, 39, 41], sometimes achieving a notorious improvement, even allowing to overcome depression [41]. about others’ lives and events and wanting to talk about ordinary, everyday topics. Pictures as prompt for con- In terms of understanding the human factors in the versation was also common, retrieving relatives’ pictures interventions and the relation between users and technology, from social media [36], using pictures during videochats we found that all interventions required older adults to use [44], or enabling sharing with family and friends the technology on their own, although some studies reported [33, 48, 49, 52]. that assistance was necessary for a long period [48, 52]. Aside for the telephone befriending service, all provided some kind of training or support (see Table 2, Training or support). 3.3. Technology Supporting Interventions. In answer to our Nonetheless, some interventions did require participants not second research question, we found that Internet access was to be proficient with technology on which they would receive fundamental to support long-distance interactions in all training, for instance, having none to limited experience interventions, except for the telephone befriending service with social networks [51] or no computer experience [43]. On top of Internet, different combinations of tech- [30–32, 39, 41]. Interestingly, two tablet-based interventions nologies were incorporated, including general Internet use reported requiring no computer experience [36, 47]. -e for interaction (e.g., discussions in forums) and e-mail remaining interventions did not required lack of experience (n � 10; see Table 2, Technology), video chat (n � 10), social to participate. networks (n � 8), virtual spaces or classrooms with mes- With respect to the difficulties in interacting with saging capabilities (n � 5), messaging services (n � 3), virtual technology, White et al. [42] reported on computer users companions (n � 1), and phone calls (n � 1). having problems with vision, colors on the screen, the Off-the-shelf solutions were favored (n � 15; see Table 2), mouse, and remembering how to use e-mail and Internet. including the social networks Facebook and About my age (a Other computer users withdrew from their studies because social network for older adults), Skype (video chat), learning how to use the computer was too difficult [30, 31] or WhatsApp, and Line (messaging services), a landline tele- they had found a better alternative [31]. In touch-screen phone service, as well as standard applications to use e-mail computer interventions, participants reported difficulties to and Internet. Tailored solutions, designed specifically for join into group conversations and limited privacy settings interventions (n � 10) include systems that facilitated virtual and amount of characters per message, as well as frustration spaces and messaging capabilities [35, 45, 47, 49, 54], sys- on the disengagement of others [45]. -e lack of partici- tems that enabled different interaction channels via sim- pation of others is echoed by more recent studies, men- plified interfaces [36, 48, 52], a custom video chat system tioning that relatives did not respond often due to using that allowed calling by simply touching the screen [44], and a WhatsApp (not supported in the study) more than e-mail virtual companion controlled remotely by a trained helper [52] and that not receiving responses could increase the [40]. perception of loneliness [48]. Computers, along with the mouse and keyboard as input Tablet users reported feeling silly talking to a virtual pet, devices, were preferred for supporting interventions (n � 10; problems with audio, and delay in messages [40]. A number see Table 2), closely followed by tablets (n � 9) which seem to of studies also reported that reduced dexterity could lead to be most popular among more recent studies. Other inter- difficulties with texting and typing [33], with gestures such as ventions employed mobile phones (n � 3), traditional tele- tapping and swiping [48, 52], and coordination issues such phones (n � 1), customized TV sets (n � 1), and touch-screen as requiring to hold voice icon to record audio messages computers (n � 3), one of which had a telephone handset [37]. attached to the screen so that users could get calls as they Usability, although not formally an outcome, was ana- would on a regular telephone [45]. lyzed by some interventions. In a computer training course While interventions clearly report on the technology and by Blazun ˇ et al. [32], which included e-mail, Internet, and devices used, features and channels used for communication Skype, participants self-reported on satisfaction (64% were are less discussed. -is information is useful to gain insight very satisfied or satisfied) and ease of use (74% reported it into participants’ preferences and adoption, and it is usually was easy). On the other hand, some interventions using reported in terms of “most used” features. Some interventions computers [32, 41] and tablets [40] reported initial feelings report that comments and likes are preferred over pre- of uncertainty and fear regarding use and adoption of determined messages [54]; the latter are usually not used much technology. -ese interventions also reported that such [46, 48] although reported to be useful when starting to use feelings were overcome in time, as participants gained systems [48]. Other interventions [49, 53] indicate that in- confidence and familiarity, thanks to both training and use. teraction features are used as much as content consumption One computer-supported study indicates that 80% of par- features (e.g., messaging and reading news). Studies with more ticipants reported that it was easy to become skilled at using qualitative insights praised video chat for allowing users to see the system. Studies with touch-screen computers [50] and people on the other side, which was particularly important tablets [48, 52] also reported increased confidence. Tablet with grandchildren [41]. One intervention even delivered fully studies, in particular, reported positive results with ease of remote training using Skype [39]. Interventions also reported use of the system [53] or interface [48] albeit some adap- that participants used Internet and computers to reengage in tation time required for gestures [52]. 8 Journal of Healthcare Engineering Table 2: Technology used in interventions. Custom or Technology ownership/ Intervention Technology Devices Training or support off-the-shelf experience Ballantyne et al. Social network (About Off-the- Initial training Computer Nonproficiency required [30] my age) shelf sessions E-mail, Internet, and Off-the- Initial training Blazun ˇ et al. [32] Computer Nonproficiency required Skype shelf sessions Off-the- Cattan et al. [43] Phone calls Telephone N/A N/A shelf E-mail, Internet, and Off-the- Initial training Cotten et al. [34] Computer Did not report Facebook shelf sessions Touch-screen Visits for setup; no Dodge et al. [44] Video chat Custom No previous use of PC (15%) computer training Fokkema and Off-the- Initial training E-mail and Internet Computer Nonproficiency required Knipscheer [31] shelf sessions Virtual room, calls, Touch-screen Garattini et al. Visits for training messages, and Custom computer with No computer ownership (68%) [45] and support broadcasts phone handset Visits for training Larsson et al. E-mail, Internet, Off-the- Computer ownership and Computer and support; remote [39] Facebook, and Skype shelf nonproficiency required training Machesney et al. Virtual companion (pet Continuous visits; Custom Tablet Did not report [40] avatar) remote support Szeman ´ et al. E-mail, Internet, Off-the- Initial training Computer Nonproficiency required [41] Facebook, and Skype shelf sessions Off-the- Owned a PC (9%); no previous Continuous visits; White et al. [42] E-mail and Internet Computer shelf experience (60%) remote support Virtual classroom, Initial training; Baez et al. [46] messages, and Custom Tablet Did not report remote support predefined messages Participants had minimal E-mail, Internet, virtual Initial training; check Czaja et al. [35] Custom Computer computer or Internet use classroom, and messages visits; remote support experience Banbury et al. Off-the- Most had no previous video Skype Tablet Visit for setup [47] shelf conference experience Initial training; Barbosa et al. Messages (video, photos, Moderate (5), basic (3), or no Custom Tablet weekly visits for [48] audio, and predefined) experience (4) support Chiu and Wu Line (messaging service) Off-the- No computer learning Training sessions Tablet [33] and YouTube shelf experience (82%) (long period) Gutierrez et al. Video chat, messages, First-time as computer user Provided by family Custom Tablet [36] and photos required member Isaacson et al. Virtual classroom, video TV, remote, and Many not proficient with smart Visit for setup and Custom [49] chat, and photos webcam phones/computers training Used mobile to contact family Initial training; WhatsApp (messaging Off-the- Mobile phone Jarvis et al. [37] and friends (55%), none had weekly visits for service) shelf (smart phone) used WhatsApp support Initial training; WhatsApp (messaging Off-the- Mobile phone N/A weekly visits for Jarvis et al. [38] service) shelf (smart phone) support Morton et al. E-mail, Internet, Off-the- Touch-screen Required no current access to Continuous visits; [50] Facebook, and Skype shelf computer Internet remote support No social network or minimal Off-the- Computer and Myhre et al. [51] Facebook use required, tablet/computer Initial training shelf tablet ownership required Video chat, photos, Initial training; Barbosa et al. All participants inexperienced audio recording, and Custom Tablet weekly visits for [52] with tech, save one predefined messages support None or very little experience Initial training; E-mail, Internet, social Off-the- Pauly et al. [53] Tablet with portable electronic devices workshop during network, and messages shelf (67%) intervention Tomasino et al. Virtual classroom, Computer, tablet, Required Internet access and Custom Remote support [54] messages mobile phones basic Internet skills Journal of Healthcare Engineering 9 Interactions in person also occurred. Sometimes, 3.4. Social Interaction and Contacts. In relation to our third research question, out of the 25 interventions, 20 involved participants met during the interventions and formed groups: a computer interest group [42] (which got to online groups (see Table 3), while in the remaining five, participants could only contact one other person (one-to- publish a newsletter for the community), group work- one interventions). shops [53] and training [37], and discussion and support -e majority of interventions (n � 19; see Table 3, groups [30], for example, to watch and discuss YouTube Contacts) focused on interactions between older adults and videos [33]. -ree interventions included support or their family and friends. Eight interventions had explicitly teaching imparted in person by relatives or volunteers planned for contact with family and friends: Gutierrez et al. [32, 36, 41]. Sometimes, participants also wanted to meet in person as a result of the interventions. Myhre et al. [51] [36], Garattini et al. [45], and Neves et al. [48, 52] asked participants to choose relatives and friends to be added to reported that participants used Facebook to arrange face- to-face meetings, after forming and maintaining rela- their contact list, while Larsson et al. [39] had “searching for relatives” as a task on their program. -e other three taught tionship during the study period. Banbury et al. [47] also reported that six participants met after talking via participants to communicate with family and friends via Internet [31, 34] or Skype [41]. videoconference. Interestingly, Széman [41] reported that participants In addition, visits were made in order to provide as- wanted to contact only their families in the beginning, but sistance or to make sure that systems were working properly later asked to expand their network to include old friends, (see Table 3, Contact with research staff). Especially, in acquaintances, new people, and finally other participants. interventions that provided education for computer and Initial apprehension to contact new people is also reported Internet use, visits were more or less frequent after the training period [30–32, 34, 39, 41, 42]. Few interventions did by [47]. Eleven interventions reported interactions between older adult study participants, with one even designed to not report visits to participants: one-to-one interventions including video chat with the trained interviewer [44] (one “encourage social interaction among strangers” [45]. Among studies comparing frequency of contact, Fokkema visit for setup only) and the telephone befriending service [43], as well as studies that relied on the family to support the and Knipscheer [31] reported that, out of 12 participants, ten had contact with family and acquaintances and three older adults [36] or reported offering remote support with other study participants. Baez et al. [46] report that throughout [54]. Since our focus is on loneliness and iso- group messages between participants was used more than lation, it is worth noting that, in a large part of the inter- one-to-one private messages, suggesting that more time ventions, there were visits to participants, which may have might be needed before developing meaningful had an effect on the results. relationships. One-to-one interventions limited contacts to family, 4. Discussion friends, and acquaintances [48, 52], as well as trained in- terviewers [44], trained helpers [40], or volunteers [43], put In the following, we analyze the findings from our research in place for the interventions. However, interventions that questions. In terms of challenges addressed by interventions, included general Internet use and social networks allowed the strategies applied, and the intervention outcomes (RQ1), participants to meet new people. Larsson et al. [39] even had we observed that most interventions have dealt with the lack “finding a new friend with the same interests” as a program of social relationships and infrequent contacts by training goal and contacting an unknown person through Internet as participants in the use of computers and Internet. While a task. Authors who replied to our inquiry on how new results have been positive, and it is true that training par- people were met said that most new contacts were other ticipants or providing simple technology might solve the participants reached through forums [31] or that partici- digital divide, such strategies do not guarantee access to pants met others in social network pages about shared in- contacts or frequent interactions. We argue that it is im- terests and during online activities offered by the site, such as portant to address the barriers directly, targeting challenges “quiz night online” [30]. with technology that incorporates strategies by design. In- Intergenerational relationships were also indicated as terventions providing simple technology also ensured in- important. -ree computer training interventions explicitly teraction as a strategy, and most of these interventions have mention interactions with young people. Blazun ˇ et al. [32] reported positive outcomes. More studies taking this reported benefits for both parties, with younger volunteers strategy would contribute evidence allowing for comparison teaching elders new ICTskills, and at the same time, learning with studies that train participants. Also, some studies have by themselves from the life stories of the older adults. White tried to improve conversations, by providing some con- et al. [42] reported that “some participants agreed to be textual information and conversation topics. -is area seems e-mail pals with middle school students”, and Széman [41] promising, especially in light of the surge of artificial in- reported that opportunities to contact grandchildren was the telligence and conversational agents. As fully automated “biggest motivation” for participants. Studies by Barbosa conversational agents were successful on interventions for et al. [48, 52] also report that some participants were more young adults with symptoms of depression and anxiety [55], engaged with their grandchildren, communicating with such agents could be designed to target loneliness and social them especially, and being happy about having the chance to isolation and adapted to help guide conversations and see them grow through video. provide conversational cues. 10 Journal of Healthcare Engineering Table 3: Social interactions and contacts. Online group Intervention Contacts Contact with research staff or one-to-one Ballantyne et al. Online group Family and friends, new people Weekly visits first, then fewer; phone calls at most 1 h/week [30] Blazun ˇ et al. [32] Online group Family and friends, new people Training once a week; 4 h in Finland and 3 h in Slovenia Cattan et al. [43] One-to-one Volunteers (predefined) Variable number of weekly calls Cotten et al. [34] Online group Family and friends, new people Eight-week training (data from first 2 weeks) Dodge et al. [44] One-to-one Predefined (trained interviewers) Video chat 30–35 min/day; 5 days/week Fokkema and Family and friends, new people, Online group 5 × 2 h lessons; visits every 2–3 weeks Knipscheer [41] other participants, acquaintances Family and friends, other 4 ×1 h visits; messages via app; weekly calls (extra calls for Garattini et al. [45] Online group participants technical issues) Family and friends, new people, Individual meeting offered weekly, group meeting every 2 Larsson et al. [39] Online group and other participants weeks Machesney et al. One-to-one Predefined (trained helpers) Visits and phone calls, available 24/7 [40] Family and friends, new people, Szeman et al. [41] Online group 1 × 1.5 h lesson; 1 h visits twice a week and acquaintances White et al. [42] Online group Family and friends, new people 3 × 2 h lessons, three 1 h lessons; trainer visits 2 h/week Other participants, predefined Baez et al. [46] Online group 1.5 h training model before baseline; support messages/calls (coach) Family and friends, other Czaja et al. [35] Online group Initial setup, 3x check visits, calls at week 1, months 3 and 9 participants Family and friends, predefined Banbury et al. [47] Online group Minimal training (facilitator), and other participants Barbosa et al. [48] One-to-one Family and friends, acquaintances Individual training at before deployment; weekly support visits Chiu and Wu [33] Online group Family and friends 90-min ICT training sessions weekly for 12 weeks Gutierrez et al. [36] Online group Family and friends Unaccounted frequency, support provided by family member Family and friends, other Isaacson et al. [49] Online group Visit for setup and training and after 4–5 weeks participants Family and friends, predefined 8x 90-min training session (during first 4 weeks), then weekly Jarvis et al. [37] Online group (facilitator) support visits Family and friends, other 2x 90-min training session/week over 15 days, then weekly Jarvis et al. [38] Online group participants support visits 3x 90-min training/week (month 1); session every 2 weeks, 1 h Family and friends, other Morton et al. [50] Online group remote support alternate weeks (month 2), then 1 month of participants, and acquaintances remote support and no visits Myhre et al. [51] Online group Other participants 3 × 2 h training session for a week Barbosa et al. [52] One-to-one Family and friends 1x individual training session, then weekly visits 2x training sessions before intervention, 3 h customized Pauly et al. [53] Online group Family and friends workshop during intervention Other participants, predefined Tomasino et al. [54] Online group Remote support throughout the study (coach) We also note that future studies should look into pro- be abandoned in favor of quantitative ones. Qualitative viding stronger evidence on the impact of the interventions studies are indeed useful to provide insight, especially on the conducted. Despite a majority of interventions reporting motives behind behaviors. In this review, we have found positive outcomes, and relying on quantitative methods, studies reporting on the reasons for technologies not being only five were RCTs. Studies disagree on the effectiveness of adopted or reasons for people to interact more (or less) with the technologies used (e.g., video chat and social networks), others, uncovered through qualitative methods. In this and some qualitative studies reports were obtained without sense, a methodological guide to designing studies in this standard measurement tools [32] or based on perceptions area would greatly benefit researchers, especially those from [40], making results hard to interpret and analyze. -ese the IT field, who might be less familiar with user studies with findings are in line with previous reviews which have already vulnerable subjects. highlighted weak methodologies [24] and noted that the With respect to the technology used in interventions and quality of studies does not allow establishing conclusive how this technology was used by older adults (RQ2), we remarks on effectiveness [25]. found that desktop/laptops make for a big part of the devices While we are advocating for more rigorous methodol- used to support interventions. Considering how common- ogies, we are not suggesting that qualitative outcomes should place long-distance interactions are nowadays and the Journal of Healthcare Engineering 11 groups. For example, Széman [41] reports that older adults availability of devices (e.g., mobile phones), we were sur- prised to find that studies based on desktop computers were enjoyed seeing their grandchildren through video chat. Future studies should consider analyzing the impact on so common, especially, since age-related limitations expe- rienced by older adult computer users [56] might hinder the effectiveness of the contacts enabled and the channels used interactions enabled, thus leading to poor intervention for interactions, as well as quantifying interactions and the outcomes. However, we have spotted a trend in recent contacts reached. -is would allow to better understand the studies to favor tablets, and there are a few studies based on motivations and opportunities that exist for conversation mobile and smart phones. between older adults and others. We also found less solutions designed specifically for Furthermore, despite assessing the effect of long-dis- tance interactions, many studies reported interactions in older adults than studies relying on off-the-shelf technolo- gies. -is might be due to the higher investment that de- person during the intervention (e.g., with other participants, with researchers). If interactions were frequent, the effect on signing tailored technologies requires. Nonetheless, previous research shows that tailored tools could increase adoption intervention outcomes should be considered. [57] while more general solutions (e.g., Facebook) could pose challenges for older adults [58] and present asym- 5. Conclusions metries in the interactions (especially for intergenerational communications [59]). -is presents a great opportunity for For interventions, technology had the fundamental role of human computer interaction researchers to collaborate with enabling long-distance interactions and was used for sup- technology-supported interventions to facilitate long-dis- port in different ways. By facilitating more channels for tance interactions for older adults. interaction and providing access to larger audiences, it -e prevailing technologies were e-mail and general allowed participants to expand social networks, strengthen Internet use for interaction (e.g., discussions in forums), existing ties, providing social support, or build community closely followed by social networks and video chat. We must rapport. However, since existing interventions are few, they note, however, that while we have identified some studies tell us about the feasibility of using technology for long- using more recent technologies such as messaging services distance interactions, but it is still unclear how technology is (e.g., WhatsApp) that allow for picture sharing and reaching actually used, what limitations and opportunities exist, and relatives more conveniently, we still observe a disconnect how these affect the success of the intervention. between the latest technologies available and those used to -erefore, we highlight some recommendations for re- conduct formal studies. searchers approaching this field of study. First, on the study Many interventions enabled a combination of features methods, it is important to (1) design studies as RCTs, (2) and channels for interaction; however, few reported on how leverage standard instruments for measuring loneliness and and how frequently these were used. Since such reports are social isolation, and (3) consider the potential impact of scant, we cannot assess technology adoption or effectiveness. continued (and in person) contact with participants on -erefore, we recommend future interventions to add for- measurements. -is may seem obvious, but we found few mal reports on usability (e.g., the System Usability Scale studies with these characteristics. We also recommend to [60]) and to quantify features and interaction channels used report and discuss separately the results for each interaction by participants. -e adoption of technology by older adults channel and by the type of relationship (e.g., with friends, largely depends on learnability and perceived difficulty of children, and grandchildren), since without this information, use [61]. Using standard instruments to measure usability is it is hard to infer what worked. Second, in terms of challenges, key to explain the success of technology-supported inter- open opportunities lie in studying how technologies can ventions, while failing to address usability might raise facilitate and improve conversation (e.g., by presenting shared concerns about the validity of the intervention. interests as topics), as opposed to enabling them. Finally, a Finally, with respect to the social interactions enabled (RQ3), vast majority of current research has focused on training for we found that most interventions enabled interaction with using a specific technology. To date, little attention has been online groups, rather than with one person put in place spe- paid to (1) designing interventions that enable or encourage cifically for the intervention. Family and friends were the contact usage of technology in specific ways (e.g., organizing and group reported by a majority of the interventions, some encouraging access to chat rooms with specific topics) and on highlighting intergenerational relationships as particularly im- (2) using persuasive technologies that introduce motivational portant for older adults. Nonetheless, here, we also lack elements and help users initiate and sustain conversations on quantitative information on the frequency of contact. Since all shared interests. We feel that addressing these gaps in current interventions with online groups included at least two different research can lead to a better understanding of the role groups of people (e.g., family and friends and other participants), technology can play in tackling loneliness, helping to alleviate we cannot tell whether older adults prefer to contact certain one of the modern ailments of our society. groups nor assess the impact the type of relationship has on the effectiveness of interventions. Friendship relationships, for in- stance, have been associated with stronger effects for subjective Disclosure wellbeing [62] as compared with familial relationships. Part of this work has been included and published as part of -e need for quantitative information also applies to the the doctoral dissertation entitled “-e Connective Power of channels used to interact with people from particular 12 Journal of Healthcare Engineering [13] C. Wilson and B. Moulton, Loneliness Among Older Adults: A Reminiscence: Designing a Reminiscence-based Tool to National Survey of Adults 45+, AARP, Washington, DC, USA, Increase Social Interactions in Residential Care” [63]. [14] K. Yang and C. R. Victor, “-e prevalence of and risk factors Conflicts of Interest for loneliness among older people in China,” Ageing and Society, vol. 28, no. 3, pp. 305–327, 2008. -e authors declare that there are no conflicts of interest [15] M. Baez, R. Nielek, F. Casati, and A. Wierzbicki, “Technologies regarding the publication of this paper. for promoting social participation in later life,” in Ageing and Digital Technology, pp. 285–306, Springer, Singapore, 2019. Acknowledgments [16] M. Pinquart and S. Sorensen, “Influences on loneliness in older adults: a meta-analysis,” Basic and Applied Social Psy- -is work was supported by the Russian Science Foundation chology, vol. 23, no. 4, pp. 245–266, 2001. (project no. 19-18-00282). -e authors would like to express [17] B. Havens, M. Hall, G. Sylvestre, and T. Jivan, “Social isolation their gratitude to the authors of the papers listed in this and loneliness: differences between older rural and urban Manitobans,” Canadian Journal on Aging, vol. 23, no. 2, review who replied to their inquiry for further details. -eir pp. 129–140, 2004. help has made this review work more thorough. [18] A. Williams and J. F. Nussbaum, Intergenerational Communi- cation Across the Life Span, Routledge, Mahwah, NJ, USA, 2001. References [19] M.-C. Lin, J. Harwood, and J. L. Bonnesen, “Conversation topics and communication satisfaction in grandparent- [1] L. F. Berkman and S. L. Syme, “Social networks, host resis- grandchild relationships,” Journal of Language and Social tance, and mortality: a nine-year follow-up study of alameda Psychology, vol. 21, no. 3, pp. 302–323, 2002. county residents,” American Journal of Epidemiology, vol. 109, [20] G. C. Wenger, R. Davies, S. Shahtahmasebi, and A. Scott, no. 2, pp. 186–204, 1979. “Social isolation and loneliness in old age: review and model [2] T. E. Seeman, L. F. Berkman, D. Blazer, and J. W. Rowe, refinement,” Ageing and Society, vol. 16, no. 3, pp. 333–358, “Social ties and support and neuroendocrine function: the MacArthur studies of successful aging,” Annals of Behavioral [21] P. DiMaggio, E. Hargittai, W. R. Neuman, and J. P. Robinson, Medicine, vol. 16, no. 2, pp. 95–106, 1994. “Social implications of the Internet,” Annual Review of So- [3] J. C. Barefoot, M. Grønbæk, G. Jensen, P. Schnohr, and ciology, vol. 27, no. 1, pp. 307–336, 2001. E. Prescott, “Social network diversity and risks of ischemic [22] C. Haythornthwaite, “Social networks and internet connec- heart disease and total mortality: findings from the Copen- tivity effects,” Information, Communication & Society, vol. 8, hagen city heart study,” American Journal of Epidemiology, no. 2, pp. 125–147, 2005. vol. 161, no. 10, pp. 960–967, 2005. [23] M. Choi, S. Kong, and D. Jung, “Computer and internet [4] B. H. Brummett, J. C. Barefoot, I. C. Siegler et al., “Charac- interventions for loneliness and depression in older adults: a teristics of socially isolated patients with coronary artery meta-analysis,” Healthcare Informatics Research, vol. 18, no. 3, disease who are at elevated risk for mortality,” Psychosomatic pp. 191–198, 2012. Medicine, vol. 63, no. 2, pp. 267–272, 2001. [24] P. Khosravi and A. H. Ghapanchi, “Investigating the effec- [5] E. Y. Cornwell and L. J. Waite, “Social disconnectedness, tiveness of technologies applied to assist seniors: a systematic perceived isolation, and health among older adults,” Journal of literature review,” International Journal of Medical Infor- Health and Social Behavior, vol. 50, no. 1, pp. 31–48, 2009. matics, vol. 85, no. 1, pp. 17–26, 2016. [6] L. Fratiglioni, H.-X. Wang, K. Ericsson, M. Maytan, and [25] Y.-R. R. Chen and P. J. Schulz, “-e effect of information B. Winblad, “Influence of social network on occurrence of communication technology interventions on reducing social dementia: a community-based longitudinal study,” ;e isolation in the elderly: a systematic review,” Journal of Lancet, vol. 355, no. 9212, pp. 1315–1319, 2000. Medical Internet Research, vol. 18, no. 1, p. e18, 2016. [7] J. T. Cacioppo, M. E. Hughes, L. J. Waite, L. C. Hawkley, and [26] M. J. Grant and A. Booth, “A typology of reviews: an analysis R. A. -isted, “Loneliness as a specific risk factor for de- of 14 review types and associated methodologies,” Health pressive symptoms: cross-sectional and longitudinal ana- Information & Libraries Journal, vol. 26, no. 2, pp. 91–108, lyses,” Psychology and Aging, vol. 21, no. 1, pp. 140–151, 2006. [8] C. M. Perissinotto, I. Stijacic Cenzer, and E. C. Kenneth, [27] D. Moher, A. Liberati, J. Tetzlaff, D. G. Altman, and “Loneliness in older persons: a predictor of functional decline T. P. Group, “Preferred reporting items for systematic reviews and death,” Archives of Internal Medicine, vol. 172, no. 14, and meta-analyses: the Prisma statement,” PLoS Medicine, pp. 1078–1084, 2012. vol. 6, no. 7, pp. 1–6, 2009. [9] J. Holt-Lunstad, T. B. Smith, M. Baker, T. Harris, and [28] World Health Organization, Definition of an Older or Elderly D. Stephenson, “Loneliness and social isolation as risk factors Person: Proposed Working Definition of an Older Person in for mortality,” Perspectives on Psychological Science, vol. 10, Africa for the MDS Project, WHO, Geneva, Switzerland, 2002, no. 2, pp. 227–237, 2015. [10] J. de Jong Gierveld, T. van Tilburg, and P. A. Dykstra, http://www.who.int/healthinfo/survey/ageingdefnolder/en/. [29] D. T. van Bel, K. C. H. J. Smolders, W. A. IJsselsteijn, and “Loneliness and social isolation,” Cambridge Handbooks in Psychology, pp. 485–500, Cambridge University Press, Y. de Kort, “Social connectedness: concept and measure- ment,” in Proceedings of the 5th International Conference on Cambridge, UK, 2006. [11] P. A. Dykstra, “Older adult loneliness: myths and realities,” Intelligent Environments, Barcelona, Spain, 2009. [30] A. Ballantyne, L. Trenwith, S. Zubrinich, and M. Corlis, ““I European Journal of Ageing, vol. 6, no. 2, pp. 91–100, 2009. [12] L. A. -eeke, “Predictors of loneliness in U.S. adults over age feel less lonely”: what older people say about participating in a social networking website,” Quality in Ageing and Older sixty-five,” Archives of Psychiatric Nursing, vol. 23, no. 5, pp. 387–396, 2009. Adults, vol. 11, no. 3, pp. 25–35, 2010. Journal of Healthcare Engineering 13 [31] T. Fokkema and K. Knipscheer, “Escape loneliness by going designed to support social interaction among older adults,” digital: a quantitative and qualitative evaluation of a Dutch Universal Access in the Information Society, vol. 11, no. 2, experiment in using ECT to overcome loneliness among older pp. 211–222, 2012. adults,” Aging & Mental Health, vol. 11, no. 5, pp. 496–504, [46] M. Baez, I. K. Far, F. Ibarra, M. Ferron, D. Didino, and F. Casati, “Effects of online group exercises for older adults on [32] H. Blazun, ˇ K. Saranto, and S. Rissanen, “Impact of computer physical, psychological and social wellbeing: a randomized training courses on reduction of loneliness of older people in pilot trial,” PeerJ, vol. 5, p. e3150, 2017. Finland and Slovenia,” Computers in Human Behavior, [47] A. Banbury, D. Chamberlain, S. Nancarrow, J. Dart, L. Gray, vol. 28, no. 4, pp. 1202–1212, 2012. and L. Parkinson, “Can videoconferencing affect older peo- [33] C.-J. Chiu and C. H. Wu, “Information and communications ple’s engagement and perception of their social support in technology as a health promotion method for older adults in long-term conditions management: a social network analysis assisted-living facilities: three-arm group-randomized trial,” from the Telehealth Literacy Project,” Health & Social Care in JMIR Aging, vol. 2, Article ID e12633, 2019. the Community, vol. 25, no. 3, pp. 938–950, 2017. [34] S. R. Cotten, W. A. Anderson, and B. M. McCullough, [48] B. B. Neves, R. Franz, R. Judges, C. Beermann, and R. Baecker, “Impact of internet use on loneliness and contact with others “Can digital technology enhance social connectedness among among older adults: cross-sectional analysis,” Journal of older adults? A feasibility study,” Journal of Applied Geron- Medical Internet Research, vol. 15, no. 2, p. e39, 2013. tology, vol. 38, no. 1, pp. 49–72, 2019. [35] S. J. Czaja, W. R. Boot, N. Charness, W. A. Rogers, and [49] M. Isaacson, I. Cohen, and C. N. Shpigelman, “Leveraging J. Sharit, “Improving social support for older adults through emotional wellbeing and social engagement of the oldest old by technology: findings from the PRISM randomized controlled using advanced communication technologies: a pilot study using trial,” ;e Gerontologist, vol. 58, no. 3, pp. 467–477, 2018. Uniper-Care’s technology,” in Proceedings of the 3rd IET In- [36] F. J. Gutierrez, S. F. Ochoa, and J. Vassileva, “Mediating ternational Conference on Technologies for Active and Assisted intergenerational family communication with computer- Living (TechAAL 2019), p. 5, London, UK, March 2019. supported domestic technology,” in Proceedings of the [50] T. A. Morton, N. Wilson, C. Haslam, M. Birney, R. Kingston, CYTED-RITOS International Workshop on Groupware, and L.-G. McCloskey, “Activating and guiding the engage- Springer, Cham, Switzerland, 2017. ment of seniors with online social networking: experimental [37] M. A. Jarvis, A. Padmanabhanunni, and J. Chipps, “An findings from the AGES 2.0 project,” Journal of Aging and evaluation of a low-intensity cognitive behavioral therapy Health, vol. 30, no. 1, pp. 27–51, 2018. mHealth-supported intervention to reduce loneliness in older [51] J. W. Myhre, M. R. Mehl, and E. L. Glisky, “Cognitive benefits people,” International Journal of Environmental Research and of online social networking for healthy older adults,” ;e Public Health, vol. 16, no. 7, p. 1305, 2019. Journals of Gerontology: Series B, vol. 72, no. 5, pp. 752–760, [38] M. A. Jarvis, J. Chipps, and A. Padmanabhanunni, ““-is phone saved my life”: older persons’ experiences and ap- [52] B. B. Neves, R. L. Franz, C. Munteanu, and R. Baecker, praisals of an mHealth intervention aimed at addressing “Adoption and feasibility of a communication app to enhance loneliness,” Journal of Psychology in Africa, vol. 29, no. 2, social connectedness amongst frail institutionalized oldest pp. 159–166, 2019. old: an embedded case study,” Information, Communication [39] E. Larsson, M. Padyab, M. Larsson-Lund, and I. Nilsson, & Society, vol. 21, no. 11, pp. 1681–1699, 2018. “Effects of a social Internet-based intervention programme for [53] T. Pauly, J. C. Lay, P. Kozik, P. Graf, A. Mahmood, and older adults: an explorative randomised crossover study,” C. A. Hoppmann, “Technology, physical activity, loneliness, British Journal of Occupational ;erapy, vol. 79, no. 10, and cognitive functioning in old age,” GeroPsych, vol. 32, pp. 629–636, 2016. no. 3, pp. 111–123, 2019. [40] D. Machesney, S. S. Wexler, T. Chen, and J. F. Coppola, [54] K. N. Tomasino, E. G. Lattie, J. Ho, H. L. Palac, S. M. Kaiser, “Gerontechnology companion: virtual pets for dementia and D. C. Mohr, “Harnessing peer support in an online in- patients,” in Proceedings of the IEEE Long Island Systems, tervention for older adults with depression,” ;e American Applications and Technology (LISAT) Conference 2014, Journal of Geriatric Psychiatry, vol. 25, no. 10, pp. 1109–1119, pp. 1–3, Farmingdale, NY, USA, May 2014. [41] Z. Széman, “A new pattern in long term care in Hungary: [55] K. K. Fitzpatrick, A. Darcy, and M. Vierhile, “Delivering Skype and youth volunteers,” Anthropological Notebooks, cognitive behavior therapy to young adults with symptoms of vol. 20, pp. 105–117, 2014. depression and anxiety using a fully automated conversational [42] H. White, E. McConnell, E. Clipp et al., “A randomized agent (Woebot): a randomized controlled trial,” JMIR Mental controlled trial of the psychosocial impact of providing In- Health, vol. 4, no. 2, p. e19, 2017. ternet training and access to older adults,” Aging & Mental [56] C. B. Mayhorn, A. J. Stronge, A. C. McLaughlin, and Health, vol. 6, no. 3, pp. 213–221, 2002. W. A. Rogers, “Older adults, computer training, and the [43] M. Cattan, N. Kime, and A.-M. Bagnall, “-e use of telephone systems approach: a formula for success,” Educational Ger- befriending in low level support for socially isolated older ontology, vol. 30, no. 3, pp. 185–203, 2004. people—an evaluation,” Health & Social Care in the Com- [57] K. Boyd, C. Nugent, M. Donnelly et al., “Easisocial: an in- munity, vol. 19, no. 2, pp. 198–206, 2011. novative way of increasing adoption of social media in older [44] H. H. Dodge, J. Zhu, N. C. Mattek et al., “Web-enabled people,” in Smart Homes and Health Telematics, C. Bodine, conversational interactions as a method to improve cognitive S. Helal, T. Gu, and M. Mokhtari, Eds., pp. 21–28, Springer functions: results of a 6-week randomized controlled trial,” Alzheimer’s & Dementia: Translational Research & Clinical International Publishing, Cham, Switzerland, 2015. [58] J. Coelho and C. Duarte, “Socially networked or isolated? Interventions, vol. 1, no. 1, pp. 1–12, 2015. [45] C. Garattini, J. Wherton, and D. Prendergast, “Linking the differentiating older adults and the role of tablets and tele- lonely: an exploration of a communication technology vision,” in In Human-Computer Interaction—INTERACT 14 Journal of Healthcare Engineering 2015, J. Abascal, S. Barbosa, M. Fetter et al., Eds., pp. 129–146, Springer International Publishing, Cham, Switzerland, 2015. [59] F. J. Gutierrez, S. F. Ochoa, and J. Vassileva, “Mediating asymmetries in family communication: supporting the eIn- clusion of older adults,” in In Universal Access in Human- Computer Interaction, M. Antona and C. Stephanidis, Eds., pp. 438–448, Springer International Publishing, Cham, Switzerland, 2015. [60] J. Brooke, “SUS-a quick and dirty usability scale,” Usability Evaluation in Industry, vol. 189, p. 194, 1996. [61] Y. Barnard, M. D. Bradley, F. Hodgson, and A. D. Lloyd, “Learning to use new technologies by older adults: perceived difficulties, experimentation behaviour and usability,” Com- puters in Human Behavior, vol. 29, no. 4, pp. 1715–1724, 2013. [62] M. Pinquart and S. Sorensen, “Influences of socioeconomic status, social network, and competence on subjective well- being in later life: a meta-analysis,” Psychology and Aging, vol. 15, no. 2, pp. 187–224, 2000. [63] F. Ibarra, ;e connective power of reminiscence—designing a reminiscence-based tool to increase social interactions in res- idential care, University of Trento, Trento, Italy, Ph.D. dis- sertation, 2018. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Healthcare Engineering Hindawi Publishing Corporation

A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness

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Copyright © 2020 Francisco Ibarra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Journal of Healthcare Engineering Volume 2020, Article ID 2036842, 14 pages https://doi.org/10.1155/2020/2036842 Review Article A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness 1,2 1 2 3 Francisco Ibarra , Marcos Baez , Luca Cernuzzi , and Fabio Casati Department of Information Engineering and Computer Science, University of Trento, Trento 38123, Italy Department of Electronics and Informatics, Universidad Cato´lica “Nuestra Señora de la Asuncio´n”, Asuncio´n, Tte. Lidio Cantaluppi y Guillermo Molinas, Paraguay Tomsk Polytechnic University, Tomsk 634050, Russia Correspondence should be addressed to Francisco Ibarra; fj.ibarracaceres@unitn.it Received 18 September 2019; Revised 3 February 2020; Accepted 25 February 2020; Published 13 July 2020 Academic Editor: Kheng-Lim Goh Copyright © 2020 Francisco Ibarra et al. -is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. -is review studies technology-supported interventions to help older adults, living in situations of reduced mobility, overcome loneliness, and social isolation. -e 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. -e 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. roughly 30 percent for reported loneliness, social isolation, 1. Introduction and living alone, an effect comparable to those of smoking Social interactions significantly impact the quality of life of and obesity. adults in general and older adults in particular. Health risks Several studies report that both loneliness—a subjective have been associated with the characteristics of each indi- measure referring to the “unpleasant” lack of (quality of) social relationships [10]—and social isolation—an objective vidual’s social network, such as small size [1, 2], lack of diversity [3], infrequent contacts [4], and perceived social measure referring to the lack (absence or low number) of isolation [5]. Limited or poor social relationships have been social relationships [10]—increase as we age. Studies on shown to increase the risk of dementia by 60 percent [6]. different geographical and cultural regions report on varying Loneliness is a known risk factor for depression [7] and has levels of loneliness and social isolation depending on the been associated with increased risk of death and with country and the scale used. Older adults experiencing functional decline [8]. A meta-analytic review of 70 studies loneliness have been reported in the 20% to 30% range in [9] has shown that the likelihood of mortality increased by Europe [11], 19% to 32% in the United States [12, 13], and 2 Journal of Healthcare Engineering 29.6% and above in China [14]. -ese figures give us an older adults (older adult OR older people OR senior OR elder indication of the extent of the barriers and challenges to OR ageing OR aging), the target problems (loneliness OR social participation in older adults [15]. social isolation), means for interaction (technology OR In- Indeed, several risk factors such as sensory incapacity ternet OR ICT OR IT OR computer OR tablet OR mobile and reduced mobility, as well as reductions in the quality and OR smart phone), and focus on social (communication OR frequency of contact and requirements for long-term care or social interaction OR social network OR social networking additional support, are associated with loneliness in old age OR social participation OR social cognition OR community). [16]. Predictors of loneliness and isolation for older adults include health problems (such as chronic illness and cog- 2.2. Eligibility Criteria. We analyzed the title and abstract of nitive decline), widowhood, and living far from relatives or each of the 1178 search results and verified whether the alone [17]. Even when older adults engage in a conversation, publication targeted older adults. For the purpose of this interactions can be challenging. Williams and Nussbaum review, we adapted the definition of older adults by the [18] reported on the challenges of intergenerational con- WHO [28] and considered eligible studies reporting on versations, such as patronizing speech, painful disclosures, participants aged 65 and older, or with a mean participant and underutilization of topical resources. In particular, lack age above 65 years of age. In addition, we considered eligible of conversation topics can generate anxiety in intergener- papers that conformed to the following criteria: ational conversations [19]. -ese factors might affect older adults, but, more importantly, they are usually beyond the (i) -e work included an intervention (i.e., action taken affected person’s control [20]. to improve a situation) Technological innovations, along with social and eco- (ii) -e interactions with people were long-distance nomic changes, have made interconnected devices a com- (iii) -e intervention supported mainly technology- monplace, thus creating opportunities for interaction mediated communication [21, 22]. Nonetheless, few reviews have focused on tech- (iv) -e impact on loneliness or social isolation was nology-supported interventions aiming at reducing loneli- evaluated ness and social isolation for older adults. Choi et al. [23] conducted a meta-analysis on computer and Internet Despite our focus on loneliness and social isolation, we training interventions, but did not cover newer devices. considered social connectedness, the experience of be- More recent reviews have analyzed assistive technologies longing and relatedness among people, as a valid outcome and ICT interventions, but these have included interventions because it is related to the (dis)satisfaction with contact for general age-related problems, such as falls and medi- quantity and quality [29]. cation management [24], or considered interventions that required colocated participation, such as playing video 2.3. Study Selection. After the identification and screening games [25]. phases, 190 publications were left (see Figure 1). -ese In this systematic review, we focus instead on inter- publications were read fully and again discarded if not ventions enabling long-distance interactions through tech- nology-mediated communication, targeting loneliness and conforming to our inclusion criteria. An additional exclu- sion criterion for full paper screening was insufficient detail social isolation in old age. Our objective is to identify the in reporting interventions, which would prevent a mean- findings and limits of the knowledge acquired so far and to ingful analysis. After a detailed inspection, 25 publications emphasize areas where further research is needed. More were left for full analysis. specifically, for the interventions analyzed, we investigate the following research questions: RQ1. What challenges of long-distance interactions are 2.4. Analysis and Synthesis. -e review follows a narrative addressed and how? approach to the synthesis of results, given the heterogeneity of the studies included. In order to answer our research RQ2. Which technologies are used by interventions and questions, how? (i) On the challenges of long-distance interactions RQ3. What are the social interactions facilitated by interventions and with whom? addressed by interventions (RQ1), we analyze in- tervention strategies and outcomes used to ac- In the following, we discuss our investigation methods complish the study goals and results. (ii) On the technology used to support interventions (RQ2), we account for the technology and devices, 2. Methods as well as the use of the technology by older adults (iii) On the social interactions enabled (RQ3), we de- 2.1. Search and Information Sources. We conducted a sys- scribe the different contexts of interaction and the tematic review [26], reported here following the PRISMA contacts reached by participants statement guidelines [27], searching Elsevier’s Scopus da- tabase for related work published in English until January, Some authors were contacted to clarify the devices used 2020. -e search query was constructed using keywords for in their interventions and the strategies that participants Journal of Healthcare Engineering 3 Records identified through database searching (n = 1178) Records aer d ft uplicated removed (n = 1170) Records excluded by reading Records screened (n = 1170) title and abstract (n = 980) Full-text articles excluded (n =165) • 1 duplicated • 1 unable to get full paper Full text-articles assessed • 3 study protocols for eligibility (n = 190) • 25 not related to older adults • 26 not related to technology • 7 too short to be subjected to analysis • 24 surveys • 87 interactions were not remote Studies included • 116 not an intervention in analysis (n = 25) • 94 no outcomes in loneliness / social isolation Figure 1: -e full selection process, following the PRISMA statement guidelines. used to meet new people online. For two studies [30, 31], we isolated was a requirement for inclusion but without were able to contact and get a reply from the authors. reporting how this condition was determined [41, 43]. Two studies included participants that perceived themselves as lonely [30, 32], while most interventions measured baseline 3. Results conditions with some form or variant of the UCLA (n � 13) or De Jong Gierveld (n � 4) loneliness scales. 3.1. Study Characteristics and Outcomes. We start by sum- Finally, we mention the lack of agreement on the ef- marizing the interventions analyzed. -ere were 13 inter- fectiveness of video chat and social networks. Széman [41] ventions that considered loneliness as a primary outcome reported that Skype (video chat) helped to strengthen family [30–42], one of which also considered social isolation [34]. ties and expand interpersonal connections, as well as to Another 12 had loneliness and/or social connectedness as encourage learning on how to use other tools such as e-mail secondary outcomes (see Table 1, Outcomes). and chat. However, a computer training intervention by Six interventions conducted qualitative studies, relying Blazun et al. [32] found that levels of loneliness for those who on direct or indirect (e.g., reports by staff) observation, used Skype did not change, while those less lonely after the questionnaires, and interviews (see Table 1, Study methods). training used mainly e-mail, not Skype. Also, regarding All qualitative studies had positive outcomes, reporting mainly a social networking sites, Ballantyne et al. [30] reported a decrease in loneliness [30, 32, 40, 43] (see Table 1, Conclusion). decrease in loneliness as a result of using a social network for We must note, however, that some interventions described their older adults. -ese sites gave more control for users to results as “perceptions” or “being anecdotal” [40], and not manage their loneliness by giving access to contacts at any resulting from “standardized measurement tools” [32]. time and with no need to leave home. On the other hand, -e other 19 interventions conducted quantitative Széman [41] noted that Skype was preferred to Facebook studies, although only five were randomized controlled trials because it was simpler to use even after participants had (RCTs) [35, 36, 42, 50, 44] and one was a group randomized become familiar with Facebook and its functionalities. It is trial [33]. -e remaining interventions all relied on stan- interesting to note that all the aforementioned interventions dardized tools to measure loneliness or social isolation or were supported by desktop/laptop computers and offered some quantifiable variable such as the volume of incoming off-the-shelf solutions. No other conflicting results were and outgoing interactions [36] or the size of the social found. network [47]. Seven studies reported no significant differ- ences, but the majority reported positive outcomes such as decreased loneliness (n = 9) and increased network size 3.2. Challenges and Intervention Strategies. With respect to (n = 2; see Table 1, Conclusion). our first research question, we found that the lack of social All but two interventions had measured participants’ conditions at baseline, indicating that being lonely or relationships and infrequent contacts have been the most Included Eligibility Identification Screening 4 Journal of Healthcare Engineering Table 1: Summary of the interventions analyzed. a b Technology/ Study : length/ Study settings/ Outcomes: primary/ Measurements / Intervention Strategies device participants/age methods secondary Conclusion Social network Internet and Ballantyne 3 months/4/ Home/pilot study, Interview/decreased (About my computer Loneliness et al. [30] 69–85 prepost interviews loneliness age)/computer training Home in Finland, E-mail, residence in 3 weeks/45/66 in Internet and Loneliness, ICT Blazun ˇ et al. Internet, and Slovenia/prepost Questionnaire/ Finland, 77 in computer knowledge, and [32] Skype/ test no control; no decreased loneliness Slovenia training experience computer standard tool for assessment Questionnaire and Familiar, simple interview/decreased Cattan et al. Phone calls/ >3 months/34/ technology; Home/mixed Health and wellbeing/ feelings of loneliness, [43] telephone 55–95 ensure methods loneliness increased interactions socialization Hughes 3-items LS E-mail, Loneliness and social Internet and (UCLA-based) and Cotten et al. Internet, and 1–2 weeks/205 Facility/cross isolation/quantity and computer questionnaire/ [34] Facebook/ (79; 126)/82.8 sectional analysis quality of training decreased loneliness, computer communications not social isolation Familiar, simple technology; Video chat/ ensure Facility/ Hughes 3-items LS Dodge et al. 6 weeks/83 (41; Cognitive function/ touch-screen interactions; randomized (UCLA-based)/no [44] 42)/80.5 loneliness computer provide controlled trial difference conversation topics Home/interrupted Fokkema 3 years/26 (12; E-mail and Internet and time series, DeJong 11-items LS and 14)/66 in Internet/ computer nonequivalent Loneliness and questionnaire/ Knipscheer intervention, 68 computer training control group decreased loneliness [31] in control prepost test Broadcast, DeJong 6-items LS, Familiar, simple messages, and log, interview, technology; Home/mixed Garattini calls/touch- 10 weeks/19/ Feasibility/social questionnaire/helped provide methods, et al. [45] screen 65–84 connectedness social connection conversation exploratory study computer- and created topics phone hybrid interactions UCLA LS/decreased E-mail, loneliness Internet and Loneliness/satisfaction Larsson et al. Internet, Skype, 3 months/30/ Home/randomized (significant in both computer with social contacts [39] and Facebook/ 61–89 crossover study groups); satisfaction training online and offline computer with social contacts inconclusive Familiar, simple Virtual Machesney technology; Home/one group UCLA LS/decreased companion/ 1 week/13/65–93 Loneliness et al. [40] ensure observational study loneliness tablet interactions E-mail, >6 months/15 Internet and Observation/ Szeman ´ et al. Internet, Skype, (program), 25 computer Home/case study Loneliness increased size of [41] and Facebook/ (pilot)/>75 training social network computer UCLA LS (modified 5 months/93 (48; E-mail, Internet and Facility/ anchors)/decreased White et al. 45)/71 in Internet/ computer randomized Loneliness loneliness [42] interventions, 72 computer training controlled trial (nonstatistically in control significant) Journal of Healthcare Engineering 5 Table 1: Continued. a b Technology/ Study : length/ Study settings/ Outcomes: primary/ Measurements / Intervention Strategies device participants/age methods secondary Conclusion Internet and Virtual computer classroom, training; Training adherence/ Hughes 3-items LS Baez et al. 10 weeks/40 (20; Home/randomized messages, and familiar, simple loneliness and social (UCLA-based)/no [46] 20)/71.5 pilot trial predefined technology; wellbeing significant difference messages/tablet ensure interactions Hawthorne Internet and friendship scale, computer E-mail, Cohen perceived training; Loneliness and social Internet, virtual social support scale, Czaja et al. 12 months/300 familiar, simple Home/randomized isolation/attitude classroom, and Lubben social [35] (150; 150)/76.15 technology; controlled trial towards technology messages/ network size, UCLA provide and proficiency computer LS v3/decreased conversation loneliness and social topics isolation Familiar, simple technology; Social (egocentric) Home/ ensure network analysis Banbury nonrandomized Educational goals/ Skype/tablet 44 weeks/52/73.0 interactions; interviews, focus et al. [47] noncontrolled social support provide groups/increased prepost test conversation network size topics Hughes 3-items LS (UCLA-based), Messages Familiar, simple Abbrev. Duke social (video, photos, Barbosa et al. 3 months/12/ technology; Facility/feasibility Feasibility/social support index/ audio, [48] 82.5 ensure study connectedness increased social predefined)/ interactions interactions, high tablet perceived social connectedness CES-D Chinese Internet and version, Taiwanese Cognitive, physical Line computer inventory of social functioning and Chiu and (messaging 5 months/54 (19; training; Facility/group supportive behavior/ psychological Wu [33] service), 18; 17)/73.0 provide randomized trial increased social wellbeing/quality of YouTube/tablet conversation support and life topics satisfaction with contacts Familiar, simple Video chat, One-way repeated Gutierrez technology; Home/empirical in- Frequency of social messages, and 9 weeks/9/69–81 ANOVA/increased et al. [36] ensure the-wild study interactions photos/tablet social interactions interactions Virtual UCLA LS v3, Lubben classroom, Familiar, simple social network scale/ Isaacson video chat, 4-5 weeks/40/ technology; Technology adoption/ decreased loneliness, Home/pilot study et al. [49] photos/TV, 85.86 ensure emotional wellbeing increased social remote, and interactions wellbeing and social webcam network size WhatsApp Internet and (messaging Facility/ Loneliness and social YSQ short form, Jarvis et al. 3 months/29 (13; computer service)/mobile randomized cognition/use of DeJong 6-items LS/ [37] 16)/74.93 training; ensure phone controlled study technology decreased loneliness interactions (smartphone) 6 Journal of Healthcare Engineering Table 1: Continued. a b Technology/ Study : length/ Study settings/ Outcomes: primary/ Measurements / Intervention Strategies device participants/age methods secondary Conclusion WhatsApp Facility/ (messaging Internet and DeJong 6-items LS, Jarvis et al. 3 months/32 (15; experimental service)/mobile computer Loneliness focus groups/ [38] 17)/70.42 randomized phone (smart training decreased loneliness comparative study phone) Social network E-mail, Some at home, Cognitive and mental activity index, UCLA Internet and Morton et al. Internet, 4 months/76 (44; some at facility/ health/social network LS v3/no difference computer [50] Facebook, and 32)/80.71 randomized activity and in loneliness, training Skype 2 × 2 × 2 study satisfaction, loneliness increased social network activity 8 weeks/41 (14; UCLA LS v3, MOS 13; 14)/80.0 Internet and social support Some at home, Neuropsychological Myhre et al. Facebook, 73.38 computer survey, Lubben social Facebook some at facility/3- tests/social [51] online diary, training; ensure network 18-i scale/ arm study engagement 79.29 Waiting interactions; no significant list difference Video chat, Hughes 3-items LS photos, audio Feasibility and (UCLA-based), Barbosa et al. Familiar, simple Facility/embedded recording, 2 months/5/87.2 adoption/social Abbrev. Duke social [52] technology case study predefined connectedness support index/no messages significant difference E-mail, Self-reported Internet and Home/prepost, Physical activity/ Pauly et al. Internet, social >6 months/92/ questionnaires, R- computer repeated measures loneliness and [53] network, and 67.7 UCLA LS/no training study executive functioning messages significant difference Internet and computer PROMIS social Virtual training; ensure Depression, tech use Tomasino isolation 6-i, social classroom and 8 weeks/47/69.6 interactions; Home/pilot study and usability/social et al. [54] Provisions scale/no messages provide support and isolation significant difference conversation topics -e number of participants in controlled studies is shown in parentheses (intervention; control); participants’ age is indicated as mean, age range, or as reported in the study. LS stands for Loneliness Scale. commonly addressed challenges to overcome loneliness and Usability and acceptance of the technology by older social isolation. One prominent strategy has been to train adults were also challenges taken into account. Here, older adults to use computers and Internet (n � 16) strategies have been to employ familiar devices, such as the [30–35, 37–39, 41, 42, 46, 50, 51, 53], although few tech- telephone [43] or television [49]; devices that researchers nologies built specifically for older adults implemented this regarded as more accessible and friendly, such as tablets strategy [35, 46, 54]. After an initial training period, older [36, 40, 46, 48, 52]; or devices that researchers considered adults in these studies were left to put in practice the skills simple enough to require minimal [35, 47] to no training, learned to get in touch with others, with the exception of a such as touch-screen computers [44, 45]. Finally, some single intervention where participants received continuous interventions specifically aimed at solving conversational training [39]. Another strategy has been to ensure that the problems, such as the lack of conversation topics. One participants had someone to interact with (n � 10). -ese strategy was to provide context with educational content in virtual groups or classrooms (e.g., about health), which would usually be health professionals responding or con- tacting participants with some frequency for checks or to allowed participants to discuss and share personal experi- facilitate the intervention [37, 46, 47, 54] or other partici- ences [35, 45, 47, 49, 54]. An intervention reported that the pants such as relatives who agreed to contact and support shared experience provided topics of conversation for the older adults during the study period [36, 48]. Other inter- less active participants [45]. Other interventions prepared ventions had volunteers making phone calls [43], trained conversation around topics such as the childhood and interviewers having video chat conversations [44], and hobbies of participants [44] or implemented buddy systems trained helpers linked to a virtual companion [40]. One based on common interests [35]. Although not designed as intervention ensured interactions by design, requesting a part of the intervention, participants who received weekly participants to post and comment on Facebook daily [51]. phone calls [43] also reported shared interests as a way to Journal of Healthcare Engineering 7 old interests, explore content, or participate in online com- break the ice as well as to establish a “meaningful reciprocal relationship” and mentioned the importance of knowing munities [30–32, 39, 41], sometimes achieving a notorious improvement, even allowing to overcome depression [41]. about others’ lives and events and wanting to talk about ordinary, everyday topics. Pictures as prompt for con- In terms of understanding the human factors in the versation was also common, retrieving relatives’ pictures interventions and the relation between users and technology, from social media [36], using pictures during videochats we found that all interventions required older adults to use [44], or enabling sharing with family and friends the technology on their own, although some studies reported [33, 48, 49, 52]. that assistance was necessary for a long period [48, 52]. Aside for the telephone befriending service, all provided some kind of training or support (see Table 2, Training or support). 3.3. Technology Supporting Interventions. In answer to our Nonetheless, some interventions did require participants not second research question, we found that Internet access was to be proficient with technology on which they would receive fundamental to support long-distance interactions in all training, for instance, having none to limited experience interventions, except for the telephone befriending service with social networks [51] or no computer experience [43]. On top of Internet, different combinations of tech- [30–32, 39, 41]. Interestingly, two tablet-based interventions nologies were incorporated, including general Internet use reported requiring no computer experience [36, 47]. -e for interaction (e.g., discussions in forums) and e-mail remaining interventions did not required lack of experience (n � 10; see Table 2, Technology), video chat (n � 10), social to participate. networks (n � 8), virtual spaces or classrooms with mes- With respect to the difficulties in interacting with saging capabilities (n � 5), messaging services (n � 3), virtual technology, White et al. [42] reported on computer users companions (n � 1), and phone calls (n � 1). having problems with vision, colors on the screen, the Off-the-shelf solutions were favored (n � 15; see Table 2), mouse, and remembering how to use e-mail and Internet. including the social networks Facebook and About my age (a Other computer users withdrew from their studies because social network for older adults), Skype (video chat), learning how to use the computer was too difficult [30, 31] or WhatsApp, and Line (messaging services), a landline tele- they had found a better alternative [31]. In touch-screen phone service, as well as standard applications to use e-mail computer interventions, participants reported difficulties to and Internet. Tailored solutions, designed specifically for join into group conversations and limited privacy settings interventions (n � 10) include systems that facilitated virtual and amount of characters per message, as well as frustration spaces and messaging capabilities [35, 45, 47, 49, 54], sys- on the disengagement of others [45]. -e lack of partici- tems that enabled different interaction channels via sim- pation of others is echoed by more recent studies, men- plified interfaces [36, 48, 52], a custom video chat system tioning that relatives did not respond often due to using that allowed calling by simply touching the screen [44], and a WhatsApp (not supported in the study) more than e-mail virtual companion controlled remotely by a trained helper [52] and that not receiving responses could increase the [40]. perception of loneliness [48]. Computers, along with the mouse and keyboard as input Tablet users reported feeling silly talking to a virtual pet, devices, were preferred for supporting interventions (n � 10; problems with audio, and delay in messages [40]. A number see Table 2), closely followed by tablets (n � 9) which seem to of studies also reported that reduced dexterity could lead to be most popular among more recent studies. Other inter- difficulties with texting and typing [33], with gestures such as ventions employed mobile phones (n � 3), traditional tele- tapping and swiping [48, 52], and coordination issues such phones (n � 1), customized TV sets (n � 1), and touch-screen as requiring to hold voice icon to record audio messages computers (n � 3), one of which had a telephone handset [37]. attached to the screen so that users could get calls as they Usability, although not formally an outcome, was ana- would on a regular telephone [45]. lyzed by some interventions. In a computer training course While interventions clearly report on the technology and by Blazun ˇ et al. [32], which included e-mail, Internet, and devices used, features and channels used for communication Skype, participants self-reported on satisfaction (64% were are less discussed. -is information is useful to gain insight very satisfied or satisfied) and ease of use (74% reported it into participants’ preferences and adoption, and it is usually was easy). On the other hand, some interventions using reported in terms of “most used” features. Some interventions computers [32, 41] and tablets [40] reported initial feelings report that comments and likes are preferred over pre- of uncertainty and fear regarding use and adoption of determined messages [54]; the latter are usually not used much technology. -ese interventions also reported that such [46, 48] although reported to be useful when starting to use feelings were overcome in time, as participants gained systems [48]. Other interventions [49, 53] indicate that in- confidence and familiarity, thanks to both training and use. teraction features are used as much as content consumption One computer-supported study indicates that 80% of par- features (e.g., messaging and reading news). Studies with more ticipants reported that it was easy to become skilled at using qualitative insights praised video chat for allowing users to see the system. Studies with touch-screen computers [50] and people on the other side, which was particularly important tablets [48, 52] also reported increased confidence. Tablet with grandchildren [41]. One intervention even delivered fully studies, in particular, reported positive results with ease of remote training using Skype [39]. Interventions also reported use of the system [53] or interface [48] albeit some adap- that participants used Internet and computers to reengage in tation time required for gestures [52]. 8 Journal of Healthcare Engineering Table 2: Technology used in interventions. Custom or Technology ownership/ Intervention Technology Devices Training or support off-the-shelf experience Ballantyne et al. Social network (About Off-the- Initial training Computer Nonproficiency required [30] my age) shelf sessions E-mail, Internet, and Off-the- Initial training Blazun ˇ et al. [32] Computer Nonproficiency required Skype shelf sessions Off-the- Cattan et al. [43] Phone calls Telephone N/A N/A shelf E-mail, Internet, and Off-the- Initial training Cotten et al. [34] Computer Did not report Facebook shelf sessions Touch-screen Visits for setup; no Dodge et al. [44] Video chat Custom No previous use of PC (15%) computer training Fokkema and Off-the- Initial training E-mail and Internet Computer Nonproficiency required Knipscheer [31] shelf sessions Virtual room, calls, Touch-screen Garattini et al. Visits for training messages, and Custom computer with No computer ownership (68%) [45] and support broadcasts phone handset Visits for training Larsson et al. E-mail, Internet, Off-the- Computer ownership and Computer and support; remote [39] Facebook, and Skype shelf nonproficiency required training Machesney et al. Virtual companion (pet Continuous visits; Custom Tablet Did not report [40] avatar) remote support Szeman ´ et al. E-mail, Internet, Off-the- Initial training Computer Nonproficiency required [41] Facebook, and Skype shelf sessions Off-the- Owned a PC (9%); no previous Continuous visits; White et al. [42] E-mail and Internet Computer shelf experience (60%) remote support Virtual classroom, Initial training; Baez et al. [46] messages, and Custom Tablet Did not report remote support predefined messages Participants had minimal E-mail, Internet, virtual Initial training; check Czaja et al. [35] Custom Computer computer or Internet use classroom, and messages visits; remote support experience Banbury et al. Off-the- Most had no previous video Skype Tablet Visit for setup [47] shelf conference experience Initial training; Barbosa et al. Messages (video, photos, Moderate (5), basic (3), or no Custom Tablet weekly visits for [48] audio, and predefined) experience (4) support Chiu and Wu Line (messaging service) Off-the- No computer learning Training sessions Tablet [33] and YouTube shelf experience (82%) (long period) Gutierrez et al. Video chat, messages, First-time as computer user Provided by family Custom Tablet [36] and photos required member Isaacson et al. Virtual classroom, video TV, remote, and Many not proficient with smart Visit for setup and Custom [49] chat, and photos webcam phones/computers training Used mobile to contact family Initial training; WhatsApp (messaging Off-the- Mobile phone Jarvis et al. [37] and friends (55%), none had weekly visits for service) shelf (smart phone) used WhatsApp support Initial training; WhatsApp (messaging Off-the- Mobile phone N/A weekly visits for Jarvis et al. [38] service) shelf (smart phone) support Morton et al. E-mail, Internet, Off-the- Touch-screen Required no current access to Continuous visits; [50] Facebook, and Skype shelf computer Internet remote support No social network or minimal Off-the- Computer and Myhre et al. [51] Facebook use required, tablet/computer Initial training shelf tablet ownership required Video chat, photos, Initial training; Barbosa et al. All participants inexperienced audio recording, and Custom Tablet weekly visits for [52] with tech, save one predefined messages support None or very little experience Initial training; E-mail, Internet, social Off-the- Pauly et al. [53] Tablet with portable electronic devices workshop during network, and messages shelf (67%) intervention Tomasino et al. Virtual classroom, Computer, tablet, Required Internet access and Custom Remote support [54] messages mobile phones basic Internet skills Journal of Healthcare Engineering 9 Interactions in person also occurred. Sometimes, 3.4. Social Interaction and Contacts. In relation to our third research question, out of the 25 interventions, 20 involved participants met during the interventions and formed groups: a computer interest group [42] (which got to online groups (see Table 3), while in the remaining five, participants could only contact one other person (one-to- publish a newsletter for the community), group work- one interventions). shops [53] and training [37], and discussion and support -e majority of interventions (n � 19; see Table 3, groups [30], for example, to watch and discuss YouTube Contacts) focused on interactions between older adults and videos [33]. -ree interventions included support or their family and friends. Eight interventions had explicitly teaching imparted in person by relatives or volunteers planned for contact with family and friends: Gutierrez et al. [32, 36, 41]. Sometimes, participants also wanted to meet in person as a result of the interventions. Myhre et al. [51] [36], Garattini et al. [45], and Neves et al. [48, 52] asked participants to choose relatives and friends to be added to reported that participants used Facebook to arrange face- to-face meetings, after forming and maintaining rela- their contact list, while Larsson et al. [39] had “searching for relatives” as a task on their program. -e other three taught tionship during the study period. Banbury et al. [47] also reported that six participants met after talking via participants to communicate with family and friends via Internet [31, 34] or Skype [41]. videoconference. Interestingly, Széman [41] reported that participants In addition, visits were made in order to provide as- wanted to contact only their families in the beginning, but sistance or to make sure that systems were working properly later asked to expand their network to include old friends, (see Table 3, Contact with research staff). Especially, in acquaintances, new people, and finally other participants. interventions that provided education for computer and Initial apprehension to contact new people is also reported Internet use, visits were more or less frequent after the training period [30–32, 34, 39, 41, 42]. Few interventions did by [47]. Eleven interventions reported interactions between older adult study participants, with one even designed to not report visits to participants: one-to-one interventions including video chat with the trained interviewer [44] (one “encourage social interaction among strangers” [45]. Among studies comparing frequency of contact, Fokkema visit for setup only) and the telephone befriending service [43], as well as studies that relied on the family to support the and Knipscheer [31] reported that, out of 12 participants, ten had contact with family and acquaintances and three older adults [36] or reported offering remote support with other study participants. Baez et al. [46] report that throughout [54]. Since our focus is on loneliness and iso- group messages between participants was used more than lation, it is worth noting that, in a large part of the inter- one-to-one private messages, suggesting that more time ventions, there were visits to participants, which may have might be needed before developing meaningful had an effect on the results. relationships. One-to-one interventions limited contacts to family, 4. Discussion friends, and acquaintances [48, 52], as well as trained in- terviewers [44], trained helpers [40], or volunteers [43], put In the following, we analyze the findings from our research in place for the interventions. However, interventions that questions. In terms of challenges addressed by interventions, included general Internet use and social networks allowed the strategies applied, and the intervention outcomes (RQ1), participants to meet new people. Larsson et al. [39] even had we observed that most interventions have dealt with the lack “finding a new friend with the same interests” as a program of social relationships and infrequent contacts by training goal and contacting an unknown person through Internet as participants in the use of computers and Internet. While a task. Authors who replied to our inquiry on how new results have been positive, and it is true that training par- people were met said that most new contacts were other ticipants or providing simple technology might solve the participants reached through forums [31] or that partici- digital divide, such strategies do not guarantee access to pants met others in social network pages about shared in- contacts or frequent interactions. We argue that it is im- terests and during online activities offered by the site, such as portant to address the barriers directly, targeting challenges “quiz night online” [30]. with technology that incorporates strategies by design. In- Intergenerational relationships were also indicated as terventions providing simple technology also ensured in- important. -ree computer training interventions explicitly teraction as a strategy, and most of these interventions have mention interactions with young people. Blazun ˇ et al. [32] reported positive outcomes. More studies taking this reported benefits for both parties, with younger volunteers strategy would contribute evidence allowing for comparison teaching elders new ICTskills, and at the same time, learning with studies that train participants. Also, some studies have by themselves from the life stories of the older adults. White tried to improve conversations, by providing some con- et al. [42] reported that “some participants agreed to be textual information and conversation topics. -is area seems e-mail pals with middle school students”, and Széman [41] promising, especially in light of the surge of artificial in- reported that opportunities to contact grandchildren was the telligence and conversational agents. As fully automated “biggest motivation” for participants. Studies by Barbosa conversational agents were successful on interventions for et al. [48, 52] also report that some participants were more young adults with symptoms of depression and anxiety [55], engaged with their grandchildren, communicating with such agents could be designed to target loneliness and social them especially, and being happy about having the chance to isolation and adapted to help guide conversations and see them grow through video. provide conversational cues. 10 Journal of Healthcare Engineering Table 3: Social interactions and contacts. Online group Intervention Contacts Contact with research staff or one-to-one Ballantyne et al. Online group Family and friends, new people Weekly visits first, then fewer; phone calls at most 1 h/week [30] Blazun ˇ et al. [32] Online group Family and friends, new people Training once a week; 4 h in Finland and 3 h in Slovenia Cattan et al. [43] One-to-one Volunteers (predefined) Variable number of weekly calls Cotten et al. [34] Online group Family and friends, new people Eight-week training (data from first 2 weeks) Dodge et al. [44] One-to-one Predefined (trained interviewers) Video chat 30–35 min/day; 5 days/week Fokkema and Family and friends, new people, Online group 5 × 2 h lessons; visits every 2–3 weeks Knipscheer [41] other participants, acquaintances Family and friends, other 4 ×1 h visits; messages via app; weekly calls (extra calls for Garattini et al. [45] Online group participants technical issues) Family and friends, new people, Individual meeting offered weekly, group meeting every 2 Larsson et al. [39] Online group and other participants weeks Machesney et al. One-to-one Predefined (trained helpers) Visits and phone calls, available 24/7 [40] Family and friends, new people, Szeman et al. [41] Online group 1 × 1.5 h lesson; 1 h visits twice a week and acquaintances White et al. [42] Online group Family and friends, new people 3 × 2 h lessons, three 1 h lessons; trainer visits 2 h/week Other participants, predefined Baez et al. [46] Online group 1.5 h training model before baseline; support messages/calls (coach) Family and friends, other Czaja et al. [35] Online group Initial setup, 3x check visits, calls at week 1, months 3 and 9 participants Family and friends, predefined Banbury et al. [47] Online group Minimal training (facilitator), and other participants Barbosa et al. [48] One-to-one Family and friends, acquaintances Individual training at before deployment; weekly support visits Chiu and Wu [33] Online group Family and friends 90-min ICT training sessions weekly for 12 weeks Gutierrez et al. [36] Online group Family and friends Unaccounted frequency, support provided by family member Family and friends, other Isaacson et al. [49] Online group Visit for setup and training and after 4–5 weeks participants Family and friends, predefined 8x 90-min training session (during first 4 weeks), then weekly Jarvis et al. [37] Online group (facilitator) support visits Family and friends, other 2x 90-min training session/week over 15 days, then weekly Jarvis et al. [38] Online group participants support visits 3x 90-min training/week (month 1); session every 2 weeks, 1 h Family and friends, other Morton et al. [50] Online group remote support alternate weeks (month 2), then 1 month of participants, and acquaintances remote support and no visits Myhre et al. [51] Online group Other participants 3 × 2 h training session for a week Barbosa et al. [52] One-to-one Family and friends 1x individual training session, then weekly visits 2x training sessions before intervention, 3 h customized Pauly et al. [53] Online group Family and friends workshop during intervention Other participants, predefined Tomasino et al. [54] Online group Remote support throughout the study (coach) We also note that future studies should look into pro- be abandoned in favor of quantitative ones. Qualitative viding stronger evidence on the impact of the interventions studies are indeed useful to provide insight, especially on the conducted. Despite a majority of interventions reporting motives behind behaviors. In this review, we have found positive outcomes, and relying on quantitative methods, studies reporting on the reasons for technologies not being only five were RCTs. Studies disagree on the effectiveness of adopted or reasons for people to interact more (or less) with the technologies used (e.g., video chat and social networks), others, uncovered through qualitative methods. In this and some qualitative studies reports were obtained without sense, a methodological guide to designing studies in this standard measurement tools [32] or based on perceptions area would greatly benefit researchers, especially those from [40], making results hard to interpret and analyze. -ese the IT field, who might be less familiar with user studies with findings are in line with previous reviews which have already vulnerable subjects. highlighted weak methodologies [24] and noted that the With respect to the technology used in interventions and quality of studies does not allow establishing conclusive how this technology was used by older adults (RQ2), we remarks on effectiveness [25]. found that desktop/laptops make for a big part of the devices While we are advocating for more rigorous methodol- used to support interventions. Considering how common- ogies, we are not suggesting that qualitative outcomes should place long-distance interactions are nowadays and the Journal of Healthcare Engineering 11 groups. For example, Széman [41] reports that older adults availability of devices (e.g., mobile phones), we were sur- prised to find that studies based on desktop computers were enjoyed seeing their grandchildren through video chat. Future studies should consider analyzing the impact on so common, especially, since age-related limitations expe- rienced by older adult computer users [56] might hinder the effectiveness of the contacts enabled and the channels used interactions enabled, thus leading to poor intervention for interactions, as well as quantifying interactions and the outcomes. However, we have spotted a trend in recent contacts reached. -is would allow to better understand the studies to favor tablets, and there are a few studies based on motivations and opportunities that exist for conversation mobile and smart phones. between older adults and others. We also found less solutions designed specifically for Furthermore, despite assessing the effect of long-dis- tance interactions, many studies reported interactions in older adults than studies relying on off-the-shelf technolo- gies. -is might be due to the higher investment that de- person during the intervention (e.g., with other participants, with researchers). If interactions were frequent, the effect on signing tailored technologies requires. Nonetheless, previous research shows that tailored tools could increase adoption intervention outcomes should be considered. [57] while more general solutions (e.g., Facebook) could pose challenges for older adults [58] and present asym- 5. Conclusions metries in the interactions (especially for intergenerational communications [59]). -is presents a great opportunity for For interventions, technology had the fundamental role of human computer interaction researchers to collaborate with enabling long-distance interactions and was used for sup- technology-supported interventions to facilitate long-dis- port in different ways. By facilitating more channels for tance interactions for older adults. interaction and providing access to larger audiences, it -e prevailing technologies were e-mail and general allowed participants to expand social networks, strengthen Internet use for interaction (e.g., discussions in forums), existing ties, providing social support, or build community closely followed by social networks and video chat. We must rapport. However, since existing interventions are few, they note, however, that while we have identified some studies tell us about the feasibility of using technology for long- using more recent technologies such as messaging services distance interactions, but it is still unclear how technology is (e.g., WhatsApp) that allow for picture sharing and reaching actually used, what limitations and opportunities exist, and relatives more conveniently, we still observe a disconnect how these affect the success of the intervention. between the latest technologies available and those used to -erefore, we highlight some recommendations for re- conduct formal studies. searchers approaching this field of study. First, on the study Many interventions enabled a combination of features methods, it is important to (1) design studies as RCTs, (2) and channels for interaction; however, few reported on how leverage standard instruments for measuring loneliness and and how frequently these were used. Since such reports are social isolation, and (3) consider the potential impact of scant, we cannot assess technology adoption or effectiveness. continued (and in person) contact with participants on -erefore, we recommend future interventions to add for- measurements. -is may seem obvious, but we found few mal reports on usability (e.g., the System Usability Scale studies with these characteristics. We also recommend to [60]) and to quantify features and interaction channels used report and discuss separately the results for each interaction by participants. -e adoption of technology by older adults channel and by the type of relationship (e.g., with friends, largely depends on learnability and perceived difficulty of children, and grandchildren), since without this information, use [61]. Using standard instruments to measure usability is it is hard to infer what worked. Second, in terms of challenges, key to explain the success of technology-supported inter- open opportunities lie in studying how technologies can ventions, while failing to address usability might raise facilitate and improve conversation (e.g., by presenting shared concerns about the validity of the intervention. interests as topics), as opposed to enabling them. Finally, a Finally, with respect to the social interactions enabled (RQ3), vast majority of current research has focused on training for we found that most interventions enabled interaction with using a specific technology. To date, little attention has been online groups, rather than with one person put in place spe- paid to (1) designing interventions that enable or encourage cifically for the intervention. Family and friends were the contact usage of technology in specific ways (e.g., organizing and group reported by a majority of the interventions, some encouraging access to chat rooms with specific topics) and on highlighting intergenerational relationships as particularly im- (2) using persuasive technologies that introduce motivational portant for older adults. Nonetheless, here, we also lack elements and help users initiate and sustain conversations on quantitative information on the frequency of contact. Since all shared interests. We feel that addressing these gaps in current interventions with online groups included at least two different research can lead to a better understanding of the role groups of people (e.g., family and friends and other participants), technology can play in tackling loneliness, helping to alleviate we cannot tell whether older adults prefer to contact certain one of the modern ailments of our society. groups nor assess the impact the type of relationship has on the effectiveness of interventions. Friendship relationships, for in- stance, have been associated with stronger effects for subjective Disclosure wellbeing [62] as compared with familial relationships. Part of this work has been included and published as part of -e need for quantitative information also applies to the the doctoral dissertation entitled “-e Connective Power of channels used to interact with people from particular 12 Journal of Healthcare Engineering [13] C. Wilson and B. Moulton, Loneliness Among Older Adults: A Reminiscence: Designing a Reminiscence-based Tool to National Survey of Adults 45+, AARP, Washington, DC, USA, Increase Social Interactions in Residential Care” [63]. [14] K. Yang and C. R. Victor, “-e prevalence of and risk factors Conflicts of Interest for loneliness among older people in China,” Ageing and Society, vol. 28, no. 3, pp. 305–327, 2008. -e authors declare that there are no conflicts of interest [15] M. Baez, R. Nielek, F. Casati, and A. Wierzbicki, “Technologies regarding the publication of this paper. for promoting social participation in later life,” in Ageing and Digital Technology, pp. 285–306, Springer, Singapore, 2019. Acknowledgments [16] M. Pinquart and S. Sorensen, “Influences on loneliness in older adults: a meta-analysis,” Basic and Applied Social Psy- -is work was supported by the Russian Science Foundation chology, vol. 23, no. 4, pp. 245–266, 2001. (project no. 19-18-00282). -e authors would like to express [17] B. Havens, M. Hall, G. Sylvestre, and T. Jivan, “Social isolation their gratitude to the authors of the papers listed in this and loneliness: differences between older rural and urban Manitobans,” Canadian Journal on Aging, vol. 23, no. 2, review who replied to their inquiry for further details. -eir pp. 129–140, 2004. help has made this review work more thorough. [18] A. Williams and J. F. Nussbaum, Intergenerational Communi- cation Across the Life Span, Routledge, Mahwah, NJ, USA, 2001. References [19] M.-C. Lin, J. Harwood, and J. L. Bonnesen, “Conversation topics and communication satisfaction in grandparent- [1] L. F. Berkman and S. L. Syme, “Social networks, host resis- grandchild relationships,” Journal of Language and Social tance, and mortality: a nine-year follow-up study of alameda Psychology, vol. 21, no. 3, pp. 302–323, 2002. county residents,” American Journal of Epidemiology, vol. 109, [20] G. C. Wenger, R. Davies, S. Shahtahmasebi, and A. Scott, no. 2, pp. 186–204, 1979. “Social isolation and loneliness in old age: review and model [2] T. E. Seeman, L. F. Berkman, D. Blazer, and J. W. Rowe, refinement,” Ageing and Society, vol. 16, no. 3, pp. 333–358, “Social ties and support and neuroendocrine function: the MacArthur studies of successful aging,” Annals of Behavioral [21] P. DiMaggio, E. Hargittai, W. R. Neuman, and J. P. Robinson, Medicine, vol. 16, no. 2, pp. 95–106, 1994. “Social implications of the Internet,” Annual Review of So- [3] J. C. Barefoot, M. Grønbæk, G. Jensen, P. Schnohr, and ciology, vol. 27, no. 1, pp. 307–336, 2001. E. Prescott, “Social network diversity and risks of ischemic [22] C. Haythornthwaite, “Social networks and internet connec- heart disease and total mortality: findings from the Copen- tivity effects,” Information, Communication & Society, vol. 8, hagen city heart study,” American Journal of Epidemiology, no. 2, pp. 125–147, 2005. vol. 161, no. 10, pp. 960–967, 2005. [23] M. Choi, S. Kong, and D. Jung, “Computer and internet [4] B. H. Brummett, J. C. Barefoot, I. C. Siegler et al., “Charac- interventions for loneliness and depression in older adults: a teristics of socially isolated patients with coronary artery meta-analysis,” Healthcare Informatics Research, vol. 18, no. 3, disease who are at elevated risk for mortality,” Psychosomatic pp. 191–198, 2012. Medicine, vol. 63, no. 2, pp. 267–272, 2001. [24] P. Khosravi and A. H. Ghapanchi, “Investigating the effec- [5] E. Y. Cornwell and L. J. Waite, “Social disconnectedness, tiveness of technologies applied to assist seniors: a systematic perceived isolation, and health among older adults,” Journal of literature review,” International Journal of Medical Infor- Health and Social Behavior, vol. 50, no. 1, pp. 31–48, 2009. matics, vol. 85, no. 1, pp. 17–26, 2016. [6] L. Fratiglioni, H.-X. Wang, K. Ericsson, M. Maytan, and [25] Y.-R. R. Chen and P. J. Schulz, “-e effect of information B. Winblad, “Influence of social network on occurrence of communication technology interventions on reducing social dementia: a community-based longitudinal study,” ;e isolation in the elderly: a systematic review,” Journal of Lancet, vol. 355, no. 9212, pp. 1315–1319, 2000. Medical Internet Research, vol. 18, no. 1, p. e18, 2016. [7] J. T. Cacioppo, M. E. Hughes, L. J. Waite, L. C. Hawkley, and [26] M. J. Grant and A. Booth, “A typology of reviews: an analysis R. A. -isted, “Loneliness as a specific risk factor for de- of 14 review types and associated methodologies,” Health pressive symptoms: cross-sectional and longitudinal ana- Information & Libraries Journal, vol. 26, no. 2, pp. 91–108, lyses,” Psychology and Aging, vol. 21, no. 1, pp. 140–151, 2006. [8] C. M. Perissinotto, I. Stijacic Cenzer, and E. C. Kenneth, [27] D. Moher, A. Liberati, J. Tetzlaff, D. G. Altman, and “Loneliness in older persons: a predictor of functional decline T. P. Group, “Preferred reporting items for systematic reviews and death,” Archives of Internal Medicine, vol. 172, no. 14, and meta-analyses: the Prisma statement,” PLoS Medicine, pp. 1078–1084, 2012. vol. 6, no. 7, pp. 1–6, 2009. [9] J. Holt-Lunstad, T. B. Smith, M. Baker, T. Harris, and [28] World Health Organization, Definition of an Older or Elderly D. Stephenson, “Loneliness and social isolation as risk factors Person: Proposed Working Definition of an Older Person in for mortality,” Perspectives on Psychological Science, vol. 10, Africa for the MDS Project, WHO, Geneva, Switzerland, 2002, no. 2, pp. 227–237, 2015. [10] J. de Jong Gierveld, T. van Tilburg, and P. A. Dykstra, http://www.who.int/healthinfo/survey/ageingdefnolder/en/. [29] D. T. van Bel, K. C. H. J. Smolders, W. A. IJsselsteijn, and “Loneliness and social isolation,” Cambridge Handbooks in Psychology, pp. 485–500, Cambridge University Press, Y. de Kort, “Social connectedness: concept and measure- ment,” in Proceedings of the 5th International Conference on Cambridge, UK, 2006. [11] P. A. Dykstra, “Older adult loneliness: myths and realities,” Intelligent Environments, Barcelona, Spain, 2009. [30] A. Ballantyne, L. Trenwith, S. Zubrinich, and M. Corlis, ““I European Journal of Ageing, vol. 6, no. 2, pp. 91–100, 2009. [12] L. A. -eeke, “Predictors of loneliness in U.S. adults over age feel less lonely”: what older people say about participating in a social networking website,” Quality in Ageing and Older sixty-five,” Archives of Psychiatric Nursing, vol. 23, no. 5, pp. 387–396, 2009. Adults, vol. 11, no. 3, pp. 25–35, 2010. Journal of Healthcare Engineering 13 [31] T. Fokkema and K. Knipscheer, “Escape loneliness by going designed to support social interaction among older adults,” digital: a quantitative and qualitative evaluation of a Dutch Universal Access in the Information Society, vol. 11, no. 2, experiment in using ECT to overcome loneliness among older pp. 211–222, 2012. adults,” Aging & Mental Health, vol. 11, no. 5, pp. 496–504, [46] M. Baez, I. K. Far, F. Ibarra, M. Ferron, D. Didino, and F. Casati, “Effects of online group exercises for older adults on [32] H. Blazun, ˇ K. Saranto, and S. Rissanen, “Impact of computer physical, psychological and social wellbeing: a randomized training courses on reduction of loneliness of older people in pilot trial,” PeerJ, vol. 5, p. e3150, 2017. Finland and Slovenia,” Computers in Human Behavior, [47] A. Banbury, D. Chamberlain, S. Nancarrow, J. Dart, L. Gray, vol. 28, no. 4, pp. 1202–1212, 2012. and L. Parkinson, “Can videoconferencing affect older peo- [33] C.-J. Chiu and C. H. Wu, “Information and communications ple’s engagement and perception of their social support in technology as a health promotion method for older adults in long-term conditions management: a social network analysis assisted-living facilities: three-arm group-randomized trial,” from the Telehealth Literacy Project,” Health & Social Care in JMIR Aging, vol. 2, Article ID e12633, 2019. the Community, vol. 25, no. 3, pp. 938–950, 2017. [34] S. R. Cotten, W. A. Anderson, and B. M. McCullough, [48] B. B. Neves, R. Franz, R. Judges, C. Beermann, and R. Baecker, “Impact of internet use on loneliness and contact with others “Can digital technology enhance social connectedness among among older adults: cross-sectional analysis,” Journal of older adults? A feasibility study,” Journal of Applied Geron- Medical Internet Research, vol. 15, no. 2, p. e39, 2013. tology, vol. 38, no. 1, pp. 49–72, 2019. [35] S. J. Czaja, W. R. Boot, N. Charness, W. A. Rogers, and [49] M. Isaacson, I. Cohen, and C. N. Shpigelman, “Leveraging J. Sharit, “Improving social support for older adults through emotional wellbeing and social engagement of the oldest old by technology: findings from the PRISM randomized controlled using advanced communication technologies: a pilot study using trial,” ;e Gerontologist, vol. 58, no. 3, pp. 467–477, 2018. Uniper-Care’s technology,” in Proceedings of the 3rd IET In- [36] F. J. Gutierrez, S. F. Ochoa, and J. Vassileva, “Mediating ternational Conference on Technologies for Active and Assisted intergenerational family communication with computer- Living (TechAAL 2019), p. 5, London, UK, March 2019. supported domestic technology,” in Proceedings of the [50] T. A. Morton, N. Wilson, C. Haslam, M. Birney, R. Kingston, CYTED-RITOS International Workshop on Groupware, and L.-G. McCloskey, “Activating and guiding the engage- Springer, Cham, Switzerland, 2017. ment of seniors with online social networking: experimental [37] M. A. Jarvis, A. Padmanabhanunni, and J. Chipps, “An findings from the AGES 2.0 project,” Journal of Aging and evaluation of a low-intensity cognitive behavioral therapy Health, vol. 30, no. 1, pp. 27–51, 2018. mHealth-supported intervention to reduce loneliness in older [51] J. W. Myhre, M. R. Mehl, and E. L. Glisky, “Cognitive benefits people,” International Journal of Environmental Research and of online social networking for healthy older adults,” ;e Public Health, vol. 16, no. 7, p. 1305, 2019. Journals of Gerontology: Series B, vol. 72, no. 5, pp. 752–760, [38] M. A. Jarvis, J. Chipps, and A. Padmanabhanunni, ““-is phone saved my life”: older persons’ experiences and ap- [52] B. B. Neves, R. L. Franz, C. Munteanu, and R. Baecker, praisals of an mHealth intervention aimed at addressing “Adoption and feasibility of a communication app to enhance loneliness,” Journal of Psychology in Africa, vol. 29, no. 2, social connectedness amongst frail institutionalized oldest pp. 159–166, 2019. old: an embedded case study,” Information, Communication [39] E. Larsson, M. Padyab, M. Larsson-Lund, and I. Nilsson, & Society, vol. 21, no. 11, pp. 1681–1699, 2018. “Effects of a social Internet-based intervention programme for [53] T. Pauly, J. C. Lay, P. Kozik, P. Graf, A. Mahmood, and older adults: an explorative randomised crossover study,” C. A. Hoppmann, “Technology, physical activity, loneliness, British Journal of Occupational ;erapy, vol. 79, no. 10, and cognitive functioning in old age,” GeroPsych, vol. 32, pp. 629–636, 2016. no. 3, pp. 111–123, 2019. [40] D. Machesney, S. S. Wexler, T. Chen, and J. F. Coppola, [54] K. N. Tomasino, E. G. Lattie, J. Ho, H. L. Palac, S. M. Kaiser, “Gerontechnology companion: virtual pets for dementia and D. C. Mohr, “Harnessing peer support in an online in- patients,” in Proceedings of the IEEE Long Island Systems, tervention for older adults with depression,” ;e American Applications and Technology (LISAT) Conference 2014, Journal of Geriatric Psychiatry, vol. 25, no. 10, pp. 1109–1119, pp. 1–3, Farmingdale, NY, USA, May 2014. [41] Z. Széman, “A new pattern in long term care in Hungary: [55] K. K. Fitzpatrick, A. Darcy, and M. Vierhile, “Delivering Skype and youth volunteers,” Anthropological Notebooks, cognitive behavior therapy to young adults with symptoms of vol. 20, pp. 105–117, 2014. depression and anxiety using a fully automated conversational [42] H. White, E. McConnell, E. Clipp et al., “A randomized agent (Woebot): a randomized controlled trial,” JMIR Mental controlled trial of the psychosocial impact of providing In- Health, vol. 4, no. 2, p. e19, 2017. ternet training and access to older adults,” Aging & Mental [56] C. B. Mayhorn, A. J. Stronge, A. C. McLaughlin, and Health, vol. 6, no. 3, pp. 213–221, 2002. W. A. Rogers, “Older adults, computer training, and the [43] M. Cattan, N. Kime, and A.-M. Bagnall, “-e use of telephone systems approach: a formula for success,” Educational Ger- befriending in low level support for socially isolated older ontology, vol. 30, no. 3, pp. 185–203, 2004. people—an evaluation,” Health & Social Care in the Com- [57] K. Boyd, C. Nugent, M. Donnelly et al., “Easisocial: an in- munity, vol. 19, no. 2, pp. 198–206, 2011. novative way of increasing adoption of social media in older [44] H. H. Dodge, J. Zhu, N. C. Mattek et al., “Web-enabled people,” in Smart Homes and Health Telematics, C. Bodine, conversational interactions as a method to improve cognitive S. Helal, T. Gu, and M. Mokhtari, Eds., pp. 21–28, Springer functions: results of a 6-week randomized controlled trial,” Alzheimer’s & Dementia: Translational Research & Clinical International Publishing, Cham, Switzerland, 2015. [58] J. Coelho and C. Duarte, “Socially networked or isolated? Interventions, vol. 1, no. 1, pp. 1–12, 2015. [45] C. Garattini, J. Wherton, and D. Prendergast, “Linking the differentiating older adults and the role of tablets and tele- lonely: an exploration of a communication technology vision,” in In Human-Computer Interaction—INTERACT 14 Journal of Healthcare Engineering 2015, J. Abascal, S. Barbosa, M. Fetter et al., Eds., pp. 129–146, Springer International Publishing, Cham, Switzerland, 2015. [59] F. J. Gutierrez, S. F. Ochoa, and J. Vassileva, “Mediating asymmetries in family communication: supporting the eIn- clusion of older adults,” in In Universal Access in Human- Computer Interaction, M. Antona and C. Stephanidis, Eds., pp. 438–448, Springer International Publishing, Cham, Switzerland, 2015. [60] J. Brooke, “SUS-a quick and dirty usability scale,” Usability Evaluation in Industry, vol. 189, p. 194, 1996. [61] Y. Barnard, M. D. Bradley, F. Hodgson, and A. D. Lloyd, “Learning to use new technologies by older adults: perceived difficulties, experimentation behaviour and usability,” Com- puters in Human Behavior, vol. 29, no. 4, pp. 1715–1724, 2013. [62] M. Pinquart and S. Sorensen, “Influences of socioeconomic status, social network, and competence on subjective well- being in later life: a meta-analysis,” Psychology and Aging, vol. 15, no. 2, pp. 187–224, 2000. [63] F. Ibarra, ;e connective power of reminiscence—designing a reminiscence-based tool to increase social interactions in res- idential care, University of Trento, Trento, Italy, Ph.D. dis- sertation, 2018.

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Published: Jul 13, 2020

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