Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis

Abstract

Background: Loneliness is a serious public health issue, and its burden is increasing in many countries. Loneliness affects social, physical, and mental health, and it is associated with multimorbidity and premature mortality. In addition to social interventions, a range of digital technology interventions (DTIs) are being used to tackle loneliness. However, there is limited evidence on the effectiveness of DTIs in reducing loneliness, especially in adults. The effectiveness of DTIs in reducing loneliness needs to be systematically assessed.

Objective: The objective of this study is to assess the effectiveness of DTIs in reducing loneliness in older adults.

Methods: We conducted electronic searches in PubMed, MEDLINE, CINAHL, Embase, and Web of Science for empirical studies published in English from January 1, 2010, to July 31, 2019. The study selection criteria included interventional studies that used any type of DTIs to reduce loneliness in adults (aged ≥18 years) with a minimum intervention duration of 3 months and follow-up measurements at least 3 months after the intervention. Two researchers independently screened articles and extracted data using the PICO (participant, intervention, comparator, and outcome) framework. The primary outcome measure was loneliness. Loneliness scores in both the intervention and control groups at baseline and at follow-up at 3, 4, 6, and 12 months after the intervention were extracted. Data were analyzed via narrative synthesis and meta-analysis using RevMan (The Cochrane Collaboration) software.

Results: A total of 6 studies were selected from 4939 screened articles. These studies included 1 before and after study and 5 clinical trials (4 randomized clinical trials and 1 quasi-experimental study). All of these studies enrolled a total of 646 participants (men: n=154, 23.8%; women: n=427, 66.1%; no gender information: n=65, 10.1%) with an average age of 73-78 years (SD 6-11). Five clinical trials were included in the meta-analysis, and by using the random effects model, standardized mean differences (SMDs) were calculated for each trial and pooled across studies at the 3-, 4-, and 6-month follow-ups. The overall effect estimates showed no statistically significant difference in the effectiveness of DTIs compared with that of usual care or non-DTIs at follow-up at 3 months (SMD 0.02; 95% CI -0.36 to 0.40; P=.92), 4 months (SMD -1.11; 95% CI -2.60 to 0.38; P=.14), and 6 months (SMD -0.11; 95% CI -0.54 to 0.32; P=.61). The quality of evidence was very low to moderate in these trials.

Conclusions: Our meta-analysis shows no evidence supporting the effectiveness of DTIs in reducing loneliness in older adults. Future research may consider randomized controlled trials with larger sample sizes and longer durations for both the interventions and follow-ups.

International registered report identifier (irrid): RR2-10.1136/bmjopen-2019-032455.

Keywords: digital technology; effectiveness; efficacy; evidence; loneliness; meta-analysis; older people; systematic review.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study selection flow diagram.

Figure 2

Forest plot of standardized mean differences for loneliness at the 3-month follow-up (digital technology intervention vs control).

Figure 3

Forest plots of standardized mean differences for loneliness at the 4-month follow-up (digital technology intervention vs control).

Figure 4

Forest plots of standardized mean differences for loneliness at the 6-month follow-up (digital technology intervention vs control).

Figure 5

Risk of bias summary. Review authors’ judgments about risk of bias in included studies: Czaja et al, 2017 [45], Tsai et al 2010 [46], Larsson et al, 2016 [50], Morton et al, 2018 [53], and Jarvis et al, 2019 [54].

Figure 6

Risk of bias graph. Review authors’ judgments about each risk of bias item are presented as percentages across all included studies.

Figure 7

GRADE (Grading of Recommendations Assessment, Development and Evaluation) quality of evidence summary. DTI: digital technology intervention; RCT: randomized controlled trial; SMD: standardized mean difference.