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In the last decades, the relationship between social networking sites (SNSs) and older people’s loneliness is gaining specific relevance. Studies in this field are often based on qualitative methods to study in-depth self-perceived issues, including loneliness and well-being, or quantitative surveys to report the links between information and communication technologies (ICTs) and older people’s well-being or loneliness. However, these nonexperimental methods are unable to deeply analyze the causal relationship. Moreover, the research on older people’s SNS use is still scant, especially regarding its impact on health and well-being. In recent years, the existing review studies have separately focused their attention on loneliness and social isolation of older people or on the use of ICTs and SNSs in elderly populations without addressing the relationship between the former and the latter. This thorough qualitative review provides an analysis of research performed using an experimental or quasi-experimental design that investigates the causal effect of ICT and SNS use on elderly people’s well-being related to loneliness.
The aims of this review are to contrast and compare research designs (sampling and recruitment, evaluation tools, interventions) and the findings of these studies and highlight their limitations.
Using an approach that integrates the methodological framework for scoping studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews, we identified 11 articles that met our inclusion criteria. A thematic and content analysis was performed based on the ex post categorization of the data on the selected studies, and the data were summarized in tables.
The analysis of the selected articles showed that: (1) ICT use is positively but weakly related to the different measures of older people’s well-being and loneliness, (2) overall, the studies under review lack a sound experimental design, (3) the main limitations of these studies lie in the lack of rigor in the sampling method and in the recruitment strategy.
The analysis of the reviewed studies confirms the existence of a beneficial effect of ICT use on the well-being of older people in terms of reduced loneliness. However, the causal relationship is often found to be weak. This review highlights the need to study these issues further with adequate methodological rigor.
The percentage of people aged 65 years and older in the world will rise to 24% in 2030 [
In recent years, review studies have focused on loneliness and social isolation of older people [
The purpose of this review is to contribute to the literature debate on the effect of SNS use on older people’s well-being with specific attention on loneliness, focusing on experimental and quasi-experimental studies. The main aims are to examine and compare the selected studies, analyzing their protocols (sampling, evaluation tools, and treatments) and their findings to identify strengths and limitations and support the development of further similar studies. According to the aims, we present a thorough qualitative review of experimental studies in this field.
To ensure a high quality of reporting, this study used the 5 stages for reviews proposed by Arksey and O’Malley [
Flowchart of scoping review: methods and procedure.
In the first stage, we identified 3 research questions: (1) What are the main methodological characteristics of the study designs? (2) What causal evidence exists on the relationships between ICTs, SNSs, and well-being in older people, particularly as regards loneliness? (3) What are the main studies’ declared limitations?
In March 2020 for stages 2 and 3, we performed a comprehensive literature search in the main search engines used in health and social sciences: Scopus, PubMed, Web of Science, and Sociological Abstracts. The search was based on a set of keywords (“older people,” “elderly,” “loneliness,” “well-being,” “information and communication technologies,” “social networks,” and “Facebook”) clustered in the search process to enhance the relationship between web-based communication technologies, isolation, and loneliness conditions of older people, as detailed in
In stage 4, we organized the materials to be analyzed. First, we ordered the collected papers by date from the oldest to the newest [
Frameworks of analysis: general items, main questions, and detected items by analysis macro areas.
Categories and general items | Main questions | Detected items | |
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Keywords |
What are the items of study declared by authors? |
List of keywords |
|
Methods |
Is the study experimental? |
Presence of randomized trial study |
|
Sample |
What is the dimension of the sample? |
Number of participants in assessments |
|
Population |
What are the age characteristics of population? |
Range of age group Mean age |
|
Selection criteria |
What are the applied selection criteria? |
Place of living Previous experience with ICTa use Healthy conditions Level of social engagement |
|
Recruitment |
What is the recruitment strategy? |
Place of recruitment |
|
Control group |
How many control groups are included in the protocol? |
Presence of control group Typologies of control groups |
|
Assessments |
How many assessments are included? |
Number and timing of follow-up evaluations |
|
Intervention |
How long is the intervention? What activities are performed in the intervention? |
Number of intervention weeks or years Presence of training course and training size |
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|||
|
Study issues |
Is the study focused on SNSb use? |
Presence of SNS focus |
|
Outcomes |
What are the outcomes included in the study? Is loneliness one of them? |
List of outcomes Presence of loneliness as an outcome |
|
Evaluation tools |
What are the evaluation tools used in the study? Which validated scales have been used? |
Presence of validated scales Presence of self-made instruments List of validated scales |
|
Main results |
What are the main results of study? |
Summarize the results |
|
Declared limitations |
What are the main limitations of study? |
Summarize the limitation |
aICT: information and communication technology.
bSNS: social networking site.
Keywords and protocol characteristics.
Author name and year | Keywords | Randomized trial | Sample size, baseline (f/ua) | Age range (mean) | Recruitment in care home | Control group | >1 f/u | Length of training (intervention) |
White et al (2002) [ |
Older people; social isolation; internet; psychosocial impact | *b | 100 (84) | 59-83 (71.5) | * | Pc | no | 9 h (20 w) |
Fokkema & Knipscheer (2007) [ |
N/Ad | no | 21 (12) | 66+ (N/A) | no | Ve | * | 10 h (3 yrs) |
Shapira et al (2007) [ |
Internet; senior well-being; personal sense of empowerment; Israel | no | 46 (39) | 70-93 (81.2) | * | Af | no | 20 h (15 w) |
Siegers et al (2008) [ |
Computer use; internet; well-being | * | 236 (211) | 64-75 (N/A) | no | P,P | * | 4 h (54 w) |
Woodward et al (2010) [ |
Gerontology; information and communication technologies; older adults; computer training; social support; mental health | * | 83 (83) | 60-89 (71.8) | no | P | * | 24 h (24 w) |
Blažun et al (2012) [ |
Older people; loneliness; computer training course; socialization; health; well-being | no | 58 (45) | 58-93 (72.9) | * | no | no | 4 h (3 w) |
Cotten et al (2012) [ |
Computers; internet; loneliness; social isolation; older adults; independent living; assistant living facilities | * | 205 (205) | N/A (82.7) | * | A,P | * | N/A (8 w) |
Myhre et al (2017) [ |
Executive functions; social interaction; social media; technology; training; working memory | * | 43 (41) | 75-86 (81.7 / 75.7?) | * | A,P | no | 6 h (8 w) |
Larsson et al (2016) [ |
Loneliness; social activities; social contact | * | 30 (30) | 61-89 (71.2) | no | P | * | N/A |
Quinn (2018) [ |
Older adults; executive functions; social media training; experiment | * | 34 | N/A (76.5) | no | P | * | 8 h (4 w) |
Morton et al (2018) [ |
computers; internet; social connections; cognitive capacity; well-being | * | 97 (76) | 60-95 (80.7) | * not exclusive | P,Dg | no | 18 h (12 w) |
af/u: follow-up.
a*: yes, not available, or not declared in paper.
aP: passive control group or waiting list.
aN/A: not applicable.
aV: virtual control group by online survey.
aA: active control group.
aD: double intervention with different place of living and two control groups.
Contents of studies: focus on social networking sites, outcomes, and tools.
Author name and year | Focus on SNSa | Loneliness | Beneficial effects on loneliness | Other outcomes | Specific questionnaire | Validated scales |
White et al (2002) [ |
no | *b | no | Psychological and social well-being | no | UCLA Loneliness Scale, UCLASc, CES-Depressiond, PCLSe, CASf |
Fokkema and Knipscheer (2007) [ |
no | * | * | Distinction between social loneliness and emotional loneliness | noh | SJGLS-6g |
Shapira et al (2007) [ |
no | * | * | Psychological well-being | no | UCLAS, DPFSh, DACLi, SASj, PCSk, LSSl |
Siegers et al (2008) [ |
no | * | no | Physical, social, and emotional well-being | no | SJGLS-6, SF-36m, SCL-90n, IADL scaleo, EPQ-Rp, ECSq |
Woodward et al (2010) [ |
no | * | no | Mental health | * | Antonucci’s HMTr, Gagnè-MNSSs, CSE-16t |
Blažun et al (2012) [ |
no | * | * | no | * | no |
Cotten et al (2012) [ |
* | * | * weakly | Social well-being | * | RTLS-34u |
Myhre et al (2017) [ |
* | * | no | Cognitive functions | no | UCLA Loneliness Scale, LSNS-18v, SPS-10w, RAVLTx, ReyCFTy, DSSTz, DFRTTaa, TMTbb, COWATcc, Miyake EFsTdd |
Larsson et al (2016) [ |
* | * | * | no | no | UCLA Loneliness Scale, ESIee, VASff |
Quinn (2018) [ |
* | no | no | Cognitive functions | no | MMSEgg, COASThh, SDMTii, WAISjj |
Morton et al (2018) [ |
* | * | no | Computer attitude; sense of self-worth (competence, autonomy, and personal identity); cognitive and mental health | no | UCLA Loneliness Scale, SNAIkk, ACE-Rll, CES-D Depressionmm, GAI-SFnn, GHQ-12oo, SWLpp, SWLSqq, CAS |
aSNS: social networking site.
b*yes or not available.
cUCLAS: Revised UCLA Loneliness Scale.
dCES-Depression: CES-Depression Scale.
ePCLS: Perceived Control Life Situation.
fCAS: Computer Attitude Scale.
gSJGLS-6: 6-Item De Jong Gierveld Loneliness Scales.
hDPFS: Difficulties in Physical Functioning Scale.
iDACL: Depressive Adjective Checklist.
jSAS: Self-Anchoring Scale.
kPCS: Perceived Control scale.
lLSS: Life Satisfaction Scale.
mSF-36: 36-item Short Form Health Survey.
nSCL-90: 90-item Symptom Check List.
oIADL scale: Specific Questionnaire to Measure Daily Activities.
pEPQ-R: Subscales of the Eysenck Personality Questionnaire.
qECS: External Control Scale.
rAntonucci’s HMT: Antonucci’s Hierarchical Mapping Technique.
sGagnè-MNSS: Gagnè Motivation and Need Satisfaction Scale.
tCSE-16: Computer Self-Efficacy 16-item Scales.
uRTLS-34: Rasch Type Loneliness Scale 34-item.
vLSNS-18: Lubben Social Network Scale 18-item version.
wSPS-10: Social Provision Scale.
xRAVLT: Rey Auditory Verbal Learning test.
yReyCFT: Rey Complex Figure Test.
zDSST: Digit Symbol Substitution Test.
aaDFRTT: Deary-Liewald Reaction Time Test.
bbTMT: Trail Making Test.
ccCOWAT: Controlled Oral Word Association Test and Category Fluency Test.
ddMiyake EFsT: Miyake Executive Function Test.
eeESI: Evaluation of Social Interaction.
ffVAS: visual analog scale.
ggMMSE: Mini-Mental State Examination.
hhCOAST: California Older Adults Stroop Test.
iiSDMT: Symbol Digit Modalities Test.
jjWAIS: Wechsler Digit Span Forward and Backward subtest.
kkSNAI: Social Networking Activity Index.
llACE-R: Addenbrooke’s Cognitive Examination–Revised.
mmCES-D Depression: CES-D Depression Scale.
nnGAI-SF: Geriatric Anxiety Inventory Short Form.
ooGHQ-12: General Health Questionnaire.
ppSWL: 5-Item Satisfaction With Life Scale.
qqSWLS: The Satisfaction With Life Scale.
Contents of studies: findings and limitations.
Author name and year | Results | Limitations |
White et al (2002) [ |
Successful intervention. Improvement of PC use by all participants No significant correlation between self-reported health, activity limitations, and internet use |
Short follow-up time to evaluate intervention effect in terms of loneliness Need for more intensive intervention Use of self-reported condition of PC use for selection criteria |
Fokkema and Knipscheer (2007) [ |
Feeling of loneliness significantly decreased in both follow-ups (2 and 3 years after baseline) Greatest reduction took place in the first step (T0 to T1) Difference of reduction of loneliness between intervention group and control group is significant Emotional loneliness reduction is significant, unlike the results on social loneliness Qualitative findings confirm results that the internet helps to maintain contact with family or friends and it is a meaningful way to pass time |
Social contacts of participants increased due to classes and tutoring included in the intervention. These could influence effects of loneliness Experiment was only performed once, and results should then be checked by repeat study Suboptimal matching of intervention and control groups created a problem with identifying the intervention as the reason for the reduction of loneliness |
Shapira et al (2007) [ |
Positive effects on loneliness, less depression, more satisfaction with life, and more control and pleasure with their current quality of life |
Short and simple intervention to analyze a complex phenomenon Language barrier in PC use Lack of analysis of secondary effects (eg, social environment and activism) |
Siegers et al (2008) [ |
No significant differences (including for loneliness) were observed between groups and between times of follow-ups |
Lack of analysis of changes in lifestyles Self-report measures of aspects of well-being Exposure time bias: 1 year too short to make structural changes but too long to measure small daily changes in attitude |
Woodward et al (2010) [ |
No significant effect on loneliness and depressive symptoms between groups and between times Experimental group reported a significantly higher quality of life compared with control group No significant effect on social support outcome Significantly greater computer self-efficacy and use of ICTsa for both groups |
Randomization on people who agreed to participate made a self-selected sample not corresponding to a real population |
Blažun et al (2012) [ |
Loneliness reduction was statistically significant, detected in pre-post analysis related to gender (female), living alone, living in town Improvement in independence of people living alone in town and their perception of safety |
Different trials in country cases Data collection bias; questionnaire translation |
Cotten et al (2012) [ |
Weak and negative correlation between going online and loneliness Moderate correlation between internet outcome variables and quality of communication Mean social relation network: 11.2 members—friends and family |
Small sample Lack of analysis of detailed information on participants |
Myhre et al (2017) [ |
Social outcome measured no significant change between pre- and posttimes |
Small sample Randomization sample had been adapted by availability of individuals Socialization in group should have had an effect on results |
Larsson et al (2013) [ |
Significant effect on satisfaction loneliness Online contacts were significantly improved No changes in offline contacts satisfaction |
Lack of active control groups |
Quinn (2018) [ |
No significant differences pre-post No significant improvement on MMSEb |
Small sample Lack of detailed information on participants |
Morton et al (2018) [ |
Significant cognitive improvements across time in the training but not control group This effect was mediated through a combination of increased social activity, improved self-competence, and preserved personal identity strength Indirect effects on mental health outcomes via these processes were also observed Larger improvement was detected in the residential care group (more socially restricted at the outset) No significant effect on satisfaction loneliness |
Inability to disentangle the effects of training from the trainer visits High attrition rate Enduring relevance of the issues raised: importance of providing older adults with supportive training in the social use of internet technology might wane with current generations |
aICT: information and communication technology.
bMMSE: Mini-Mental State Examination.
The main findings are summarized in
A total of 953 participants were recruited for these studies, and 860 of them took part in the postintervention assessment. Thus, around 10% of participants dropped out of the experimental studies before the follow-up. The age groups were different in each of the analyzed studies: from the largest, 58 to 93 years, in the Blažun et al [
Furthermore, the sample sizes were very heterogeneous among studies. Taking into consideration the follow-ups, most of the studies involved fewer than 50 participants [
The studies imposed a range of inclusion criteria (20 in total, see
The place of residence criteria were strongly related to the recruitment process. Five studies [
Social engagement criteria were adopted in 2 studies: Larsson et al [
All studies except for Blažun et al [
Five protocols were characterized by a single follow-up at the end of the intervention [
All experimental studies used training classes on PC or SNS as the main part of the intervention. In 4 studies, training did not last longer than 9 hours, and the intervention duration was often less than 8 weeks [
Papers published after 2013 considered SNS use an independent variable, while the previous ones focused their attention on PC use, including email activity (
International validated scales were the most commonly used measurement tools, but 2 studies included bespoke questionnaires created by the authors [
Three studies [
Clinical and physical well-being was investigated by Shapira et al [
Five studies highlight the positive effect of ICT use including SNS use on the social relationships of older people (
In addition to general results on the main declared outcomes, some papers reported the effects of treatment on secondary outcomes in terms of the success of training [
The authors highlighted how their study protocols presented limitations. In 2 cases, the intervention duration was considered too short to assess ICT effect on older people’s loneliness [
The analysis of the findings of the reviewed studies highlights the growing interest in assessing the impact of SNSs on the social well-being of elderly people. The existence of a positive effect of ICT use on older people’s loneliness seems to be confirmed, even if it is often a weak or not statistically significant effect. Moreover, the results underline how the use of ICTs has positive effects on the individual sense of self-worth, strength of personal identity, and self-esteem. The literature emphasizes the connection between these aspects of mental and psychological well-being and loneliness [
Despite the low level of attrition in the selected studies (always below 10%), long- and medium-term studies involving older people need to take it into account carefully, because it could occur nonrandomly, thus posing challenges in the accuracy of results [
In almost all of the reviewed studies, participants must have been early users of ICTs, but in some of them the availability of a PC is a fundamental participation criterion. This choice, although it alleviates the cost and management of the study, can represent a source of bias in the sampling process. Indeed, in almost all cases the ICT use is self-reported by participants and may correspond to a different level of actual knowledge and ability in using the PC.
This review stresses the strong impact of the chosen recruitment process on the target population and sampling design. In particular, recruitment by flyers mostly involves people living at home and with a high level of autonomy, while recruitment in residential homes could find less healthy people with some functional limitations (eg, hearing or walking) [
In the last 5 years, in line with the broader use of SNSs, the number of studies that have observed the socializing role of ICTs has grown. Loneliness is the primary measured outcome of individual social well-being and is often considered strongly related to other well-being aspects, such as personal life satisfaction, cognitive health conditions, and the ability to manage daily life events. The heterogeneity and number of measurement tools used confirm the theoretical and methodological debate on how complex phenomena (such as loneliness or social isolation) should be measured [
Some limitations need to be considered in this review. First, the small amount of experimental articles in this area and their heterogeneity make it hard to produce a meta-analysis of the results and draw generalized conclusions. The decision to limit the literature search to articles published in English might have led to selection bias, although English is by far the leading language in this field of research. Second, the complex nature of the outcomes compared with the small size of the study samples limits the generalizability of the conclusions.
This review aimed to clarify how experimental studies improve the understanding of the causal relationships between older people’s ICT use and their well-being concerning loneliness. Moreover, this review highlights the analysis of protocols applied to support the design of future research in this field. In particular, we compared 11 experimental and quasi-experimental studies published from 2002 to 2019. The characteristics of the analyzed study protocols (research questions, outcomes, evaluation tools, and treatments) highlighted difficulties in design, sampling, and management of the interventions. Nevertheless, despite the declared limitations, the overall findings are positive, highlighting the need for studying these issues with adequate methodological rigor. First, care is needed to discern the causal relationship between the dependent and independent variables from the effects of other intervening variables. Second, these difficulties affect the possibility of carrying out more than one follow-up—usually at the end of the intervention—and force the recruitment of small samples. The extensive use of the passive control group is an indirect effect of these difficulties. Moreover, this review underlines how the complex nature of loneliness and, even more, its relationship with ICT use, would require a complex and complete design of evidence-based studies, characterized by multivariable schemes and large sample sizes. On the other hand, randomized controlled studies allow the identification and analysis of causal relationships. The experimental studies included in the review show some difficulties and limitations in data collection due to the exclusive use of standardized tools to analyze the loneliness issue, in which individual feeling seems better detected by qualitative than quantitative methods.
The findings coming from the reviewed studies seem to confirm a beneficial effect—albeit weak—of ICT use on the well-being of older people in terms of reduced loneliness. The weakness of these results, along with the growing interest in the relationship between ICT use and loneliness in older age, draws attention to the need for development of further evidence-based studies. Future research in this field should take account of the need for studies with multidisciplinary design. The integration of clinical, psychological, and sociological research approaches would allow us to better verify primary and secondary outcomes of ICT use for older people’s well-being, including loneliness. Moreover, quantitative protocol studies could benefit from a larger randomized sampling—better if supported by power analysis—and by a short qualitative set of questions to improve the understanding and validity of the results.
Keywords and protocol characteristics.
Reference list of the international validated scales used in the reviewed studies.
information and communication technology
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
social networking site
University of California Los Angeles
This research was supported by Fondazione Cariplo under grant for “Bando 2017, ricerca scientifica: Ricerca sociale sull’invecchiamento: persone, luoghi e relazioni” (number 0946). This study was partially supported by Ricerca Corrente funding from the Italian Ministry of Health to Istituti di Ricovero e Cura a Carattere Scientifico—Istituto Nazionale di Ricovero e Cura degli Anziani.
None declared.