Exercise, Technological Interventions Have Little Effect on Social Isolation

Several interventions are associated with a reduction in loneliness in older adults, though these results should be interpreted cautiously.

Exercise and technological interventions in the community had little practical significance (small effect sizes [ESs]) in older adults with loneliness and social isolation. Animal therapy and technology in long-term care had the largest ESs among numerous interventions, but high heterogeneity attenuates interpretation of the magnitude of ESs.  These are among the study findings published recently in the Journal of the American Medical Association Network Open.

Researchers conducted a systematic review and meta-analysis of the CENTRAL, CINAHL, OVID, Web of Science, PsychINFO, and Scopus databases from inception until March 2020 of randomized clinical trials that measured loneliness and social isolation or social support in adults aged 65 years and older. Loneliness and low social support, which was defined as the perception of accessible and quality social ties with social needs met, were both associated with poorer quality of life.

The researchers included 44 studies (range, 8-741 participants, ages 55-100 years, predominantly women) in the current loneliness meta-analysis (11 in long-term care n=1057; 33 in the community n=3535). Loneliness was measured using the UCLA Loneliness scale and the De Jong Gierveld Loneliness Scale. Social isolation was measured primarily using the Lubben Social Network Scale.

The interventions included in the meta-analysis comprised technological interventions (9 studies), animal therapy (6 studies), reminiscence therapy (2 studies), occupational therapy (2 studies), music therapy (1 studies), psychotherapy or cognitive behavioral therapy (4 studies), multicomponent therapy (5 studies), counseling (6 studies), exercise (8 studies), and social interventions (5 studies).

[A]nimal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size’s magnitude should be interpreted with caution.

The largest ES on loneliness reduction in long-term care was animal therapy (ES -1.86; 95% CI, -3.14 to -0.59; I2 =86%) and technological interventions (ie, videoconferencing) (-1.40; 95% CI, -2.37 to -0.44; I2 =70%) when accounting for studies with no active controls.

Counseling among community-dwelling participants included bereavement counseling and group support programs (ES -0.80; 95% CI, -1.96 to 0.36;  I2 =97%; P <.001). Excluding 1 of 6 studies reduced ES to -0.19 with no heterogeneity.

Exercise, which was performed in a group setting in 7 of 8 studies, showed ES -0.15 with low heterogeneity (I2 =35%) in community and ES -0.53 with I2 =57% in long-term care.

Limitations of study include the underpowered sample size of some included studies, a lack of active controls, and the inclusion of English-only studies.

Researchers conclude, “[A]nimal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size’s magnitude should be interpreted with caution.” They add, “[E]xercise and technological interventions in the community had the highest precision with small ESs.”

References:

Hoang P, King JA, Moore S, et al. Interventions associated with reduced loneliness and social isolation in older adults: a systematic review and meta-analysis. JAMA Netw Open. Published online October 3, 2022. doi:10.1001/jamanetworkopen.2022.36676