What you need to know
Similar to other public health crises, the pandemic is having short- and long-term adverse mental health consequences among the general population, including increases in loneliness, anxiety and depression. Older adults are at increased risk of being socially isolated. The evidence suggests that physical distancing measures implemented worldwide have significantly affected the psychological well-being of individuals and how mental health care services are delivered to older adults.
Overall, the researchers provide a summary of the literature on remotely delivered interventions for older adults that target loneliness and/or psychological distress (e.g., depression and anxiety).
What is this research about?
Evidence shows that social isolation and loneliness are associated with increased reactivity to stressors, anxiety, depression, cognitive decline, negative health outcomes and mortality risk. In order to reduce the negative effects of the pandemic, interventions focusing on isolation and loneliness are important. There are a range of benefits when interventions are designed to reduce social isolation and loneliness, but these interventions, although highly needed for older adults, are often lacking.
The researchers conducted a narrative review and provided a summary of the literature on remotely delivered interventions for older adults that target loneliness and/or psychological distress (e.g., depression and anxiety). In their review, the researchers:
- identified remotely delivered evidence-based interventions for social isolation and psychological distress
- provided a comprehensive overview of interventions appropriate for implementation by individuals with differing education and training
- identified barriers to remote delivery of reviewed interventions for older adults
- provided recommendations that acknowledge unique considerations among the aging population and the COVID-19 pandemic.
What did the researchers do?
The researchers conducted a narrative literature review. The narrative review focused on remotely delivered interventions for older adults that target loneliness and/or psychological distress (e.g., depression and anxiety).
What did the researchers find?
From the narrative review, the researchers identified two types of remotely delivered interventions:
- Social isolation and loneliness interventions: These interventions help to reduce social disengagement and loneliness. Communication occurs with older adults and others through telephone or video conversation, or online social media platforms.
- Psychological interventions: These interventions typically target symptoms of depression and anxiety. The most common therapeutic method used in these interventions is cognitive-behavioural therapy (CBT).
The researchers also identified several barriers in implementing remotely delivered interventions, including:
- older adults’ attitudes toward required technologies: Older adults may not want to learn how to use new technologies such as computers, tablets, applications for video calls or the Internet.
- ability to access technology required: Older adults may not be able to access required technology based on their geographical location or socioeconomic status.
- limited experience and skills in technology use: Older adults may not know how to use the technology, which could lead to a decrease in uptake and adherence to treatment.
- the requirement for the involvement of others: Older adults may not have the support from family members or staff needed to participate in the intervention.
The researchers further went on to provide general considerations and recommendations to address social isolation and distress in older adults during the COVID-19 pandemic.
Evaluating the barriers to technology use
- using technology the individuals are already familiar with to deliver the intervention (e.g., telephone)
- providing directions/training for use over the phone
- providing print materials with instructions, reminders and tips for use of technology and troubleshooting
- involving a live-in family member or caretaker to help set up or troubleshoot issues with technology.
The researchers recommend that staff or family should support older adults with setting up technology but let them have privacy during their personal conversations.
Keeping up to date on psychological practice guidelines
The researchers recommend that psychologists should consult the relevant practice guidelines for the practice of telepsychology.
Assessing for need and increasing awareness of treatment availability
The researchers recommend that older adults should be made aware (e.g., through print media, telephone referrals, e-mail, websites, social media, etc.) of the available programs that they can access.
Checking in with older adults
Older adults living in self-isolation will significantly reduce the contact they have with their communities and families due to the pandemic. It is important that older adults maintain regular contact with their families, friends and health care workers who can assess their mental health and well-being.
In this review, the researchers also described the type of intervention to implement and the delivery of interventions based on the living setting. They found that video calls worked for psychological interventions and communication between family and care recipients in long-term care (LTC) settings. They recommended telephone-based interventions for individuals without access to computer or Internet technologies. Furthermore, in LTC settings, video calls set up by staff reduced loneliness and depression. The researchers also found that telephone interactions reduced loneliness among older adults through community volunteer programs (e.g., befriending programs).
Limitations of the research
The researchers noted several limitations regarding the available evidence on this topic, including the following:
- evaluation and publication of remotely delivered COVID-19 specific interventions
- research on comparing the treatment outcomes between participants who receive varying levels of clinician contact
- evaluation of comparisons between methods of remote delivery
- research on the effectiveness of reviewed interventions among older adults with cognitive impairment and barriers to engagement, both in the community and in LTC settings
- evaluation of safety monitoring and risk-assessment methods
- evaluation or translation of psychological interventions for social/interpersonal problems to remote delivery.
How can you use this research?
The researchers suggest that these approaches be translated to community and LTC settings while promoting uptake by considering the individual’s preference for delivery method and technological literacy. However, there is still a need for more research on evaluating and implementing remotely delivered interventions and the effects they have on individuals from diverse socioeconomic backgrounds and living settings.
About the researchers
Julie A. Gorenko1, Chelsea Moran1, Michelle Flynn1, Keith Dobson1, Candace Konnert1
- University of Calgary, Calgary, AB, Canada