Elisabeth Boulton*, Dylan Kneale*, Claire Stansfield, Paul Heron, Katy Sutcliffe, Brenda Hayanga, Alex Hall, Peter Bower, Dympna Casey, Laura Jeerson, Dawn Craig, Simon Gilbody, Barbara Hanratty, Dean McMillan, James Thomas, Chris Todd
*Joint first authors
Rapid review of reviews: what remotely delivered interventions can reduce social isolation and loneliness among older adults?
During the 2020 coronavirus (COVID-19) crisis, millions of older adults (70+) across the UK (and elsewhere) are being advised to be particularly stringent about social distancing, and to avoid contact with those outside their household. Older adults are already more likely to have long-term illness or disability, to live alone and to be widowed, all of which are risk factors for loneliness. Social distancing places them at even higher risk than normal of social isolation and loneliness, which can adversely affect quality of life, wellbeing and mental health, and are associated with physical ill health and mortality. However, what works to prevent or mitigate loneliness is less clear. The requirement for older adults to restrict their activities during the COVID-19 pandemic has put a spotlight on the need to understand how to minimise the impact of loneliness and isolation.
In the voluntary and community sector, many existing social care services are no longer operating as conventionally commissioned and there is a shift to providing remote support instead, often via the telephone. The call for NHS Volunteer Responders includes roles to make ‘regular phone calls to check on people isolating at home’, which means that there is a need to ensure that the programmes and interventions that will be staffed by these volunteers are effective and have minimal adverse consequences for older people; and that the volunteers are adequately trained and supported to fulfil these roles.
Our interest here, against a backdrop of mandatory social distancing, is to understand how remote interventions may be effectively delivered. The question of whether remotely delivered interventions can be as effective as face-to-face interventions is not considered in this report.
We followed a ‘review of reviews’ methodology to synthesise evidence from related (but differing) remote interventions for social isolation and loneliness, to help inform decisions about different approaches. In this rapid review of reviews, we find that:
- Supported video-communication interventions are regarded positively by older adults and have positive effects on loneliness and social support.
- Telephone befriending has not been widely researched, but qualitative studies suggest improvements in loneliness and social isolation.
- Online discussion groups and forums are less clear with mixed results, with increases in social support, but less evidence for improvements in loneliness.
- The evidence for social networking sites is weak.
- Multi-tool interventions (PC, training, messaging, chat groups) show decreases in loneliness, but not always increases in social support. Interventions vary greatly, making it difficult to isolate the effective elements.
- Concepts of loneliness and social isolation vary, making comparisons and conclusions challenging.
- Detailed analysis of the intervention components, which focussed mainly on social support (an indicator of social isolation), shows that following characteristics are present in effective interventions:
- Supporting development of close relationships
- Supporting interactions through ensuring participants share experiences/characteristics
- Support interactions through pastoral guidance
The findings from this review do not lead us to recommend particular modes of delivering befriending, social support, or low intensity psychological interventions (e.g. videoconferencing, telephone calls, chat rooms or forums), but they do suggest that the characteristics identified through the detailed analysis of components should be incorporated into the delivery of an intervention.