Abstract and Introduction
Abstract
Background: Social isolation is a key public health concern and has been associated with numerous negative health consequences. Technology is increasingly thought of as a solution to address social isolation. This study examines the longitudinal association between the access and use of technology and social isolation in older adults 65 and older, living in the United States.
Methods: This observational cohort study included community-dwelling older adults (N = 6704) who participated in the National Health and Aging Trends Study. Regression analyses were conducted using data from 2015 to 2019. Information about technology access and use was ascertained using self-reported questionnaires. The primary outcome was the risk of social isolation.
Results: At baseline, the majority of older adults that were not socially isolated had a working cell phone (88%) or computer (71%) and used email or text messaging (56%). Older adults that had access to (cell phone- incidence rate ratio [IRR] 0.62 [95% CI 0.48–0.81]; computer- IRR 0.63 [95% CI 0.51–0.78]), and used technology (email or text messaging- IRR 0.64 [95% CI 0.51–0.80]) in the year prior had a lower risk of social isolation than older adults who reported they did not access or use technology. Additionally, over four years, older adults who reported that they had access to a computer had a lower risk (0.69 [0.57, 0.84]) for social isolation than their counterparts.
Conclusion: In this cohort study, technology access was associated with a lower risk for social isolation among community-dwelling older adults. These findings suggest that technology has an important role in approaches that seek to prevent social isolation among older adults.
Introduction
Social isolation is an important and underrecognized public health risk. It is defined as a lack of social contact with others; it differs from loneliness, which is a subjective feeling of isolation.[1,2] Nearly 1 in 4 community-dwelling adults age 65 and older in the United States are socially isolated, indicating that social isolation impacts a considerable proportion of older adults.[3] Social isolation can influence health through several different pathways, including affecting behaviors, interpersonal relationships, and compliance with medical recommendations.[4] Furthermore, social isolation is associated with mortality and functional decline in older adults.[5–7] Risk factors for social isolation among older people include family dispersal, decreased mobility and income, and loss of loved ones.[1] Additionally, being unmarried, male, having lower education attainment, having a low income, living alone, lacking participation in social groups, having fewer friends, and strained relationships are each independently associated with social isolation.[3,4] Given the detrimental health effects associated with social isolation, and the many risks linked with this burdensome problem, there is a great need to better understand factors that may buffer or protect older adults against social isolation.
Social connection is informed by the structure, function, and quality of one's relationships or social network.[7] Increasingly, information and communication technologies including mobile phones, computers, and the internet influence the way in which individuals communicate and interact.[8] These technologies can serve a key role in facilitating communication (voice, video, text messaging) in a manner that is potentially more frequent than face-to-face, in-person opportunities. Technology can offer opportunities for connection with family, friends, or others that could mitigate one's risk for social isolation by supporting one's social networks. Additionally, technology can enable enliven the function of one's connection (i.e., reminders for a family or friend to visit or allowing someone to participate in a virtual group).[1,9]
Previous studies examining social isolation interventions in older adults mostly focus on interventions that approach this issue via one-on-one strategies, group services, or wider community engagements.[10] One review suggested that technological interventions were most promising for addressing social isolation among older adults.[11] However, there are large gaps in our understanding of how technology access and use can influence social isolation in older adults. The dearth of longitudinal studies in this area means that the directionality of the relationship between technology and social isolation in older adults has not been fully examined. Further, few investigations have examined the association between technology and loneliness (subjective assessment of social connection) through self-report survey measures (i.e., UCLA Loneliness scale) or other psychosocial factors, which differs from social isolation (objective assessment of social connection). One study found internet use was linked to an increased sense of well-being in a sample of older adults aged 80 and older.[12] Another found that internet use among adults over 65 years of age was associated with lower levels of loneliness.[13] Kim et al. used data from the 2011 National Health Aging Trends Study (NHATS) to examine how information and communication technologies (ICT) access and use were associated with social engagement. They found that men were more likely than women to access and use ICT, and there were differences in how each gender engaged with technology.[14] However, that study was unable to infer a causal relationship between ICT use and social engagement given the cross-sectional design. A study leveraging the 2012 wave of the Health and Retirement Study found social technology use was beneficial for older adults, and greater technology use was associated with better self-rated health, higher subjective well-being, and lower depression.[15] Yu et al. evaluated the longitudinal association of internet use and loneliness and found a mediating role of social contact using hierarchical linear modeling to determine how internet use impacts loneliness.[16] In a systematic review published in 2016 exploring the effects of ICT interventions on reducing social isolation in older adults, ICT was consistently found to positively affect social support, social connectedness, and social isolation. Notably, all of the studies that used survey data included in this systematic review were cross-sectional.[17] A focus group study completed in a small, continued care senior facility assessed the impact of the COVID-19 pandemic and "Stay-at-Home" order on the mental and physical health of older adults and found that technology access and connectivity are potential "game-changers" that should be prioritized for future research.[18]
A major limitation of cross-sectional studies is that they cannot exclude reverse causality. Examining the relationship between social isolation and technology longitudinally informs the creation of interventions targeting social isolation. This study leverages a nationally representative sample to determine the influence of technology access and use on social isolation risk among community-dwelling older adults over time.
J Am Geriatr Soc. 2023;71(4):1117-1123. © 2023 Blackwell Publishing
