Long-Term Effects on Loneliness of a Computer-Tailored Intervention for Older Adults With Chronic Diseases: A Randomized Controlled Trial

Janet M Boekhout, Esmee Volders, Catherine A W Bolman, Renate H M de Groot, Lilian Lechner, Janet M Boekhout, Esmee Volders, Catherine A W Bolman, Renate H M de Groot, Lilian Lechner

Abstract

Objectives: This study explores the effects of the Active Plus intervention aiming to decrease loneliness among older adults (>65 years) with chronic diseases. Methods: A randomized controlled trial (RCT) was performed (N = 585; age: M = 74.5 years, SD = 6.4), assessing loneliness at baseline, 6 months and 12 months. Outcome measures in the multilevel linear regression analyses were total, social and emotional loneliness. Results: At 12 months, significant decreases in total (B = -.37, p = .01) and social loneliness (B = -.24, p = .02) were found. Age was a significant moderator for total and social loneliness; however, the intervention was effective only for participants aged 80 years and older. Discussion: The Active Plus intervention showed a significant decrease in total and social loneliness and was especially beneficial for the vulnerable age group of 80 years and older. A more comprehensive tool for measuring social activity and mobility impairments, and using a longer time frame to detect loneliness changes, may form interesting future research.

Keywords: chronic diseases; loneliness; mobility impairments; older adults.

Conflict of interest statement

Declaration of Conflicting of Interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart of the study.

References

    1. Adams K. B., Sanders S., Auth E. A. (2004). Loneliness and depression in independent living retirement communities: Risk and resilience factors. Aging & Mental Health, 8(6), 475-485. doi:10.1080/13607860410001725054.
    1. Asante S., Castillo J. (2018). Social connectedness, perceived social support, and health among older adults. Innovation in Aging, 2(Suppl_1), 737. doi:10.1093/geroni/igy023.2719.
    1. Association of Dutch Municipalities (2020). Status of your municipality ("waar staat je gemeente"). Retrieved November 18, 2020, from .
    1. Barlow M. A., Liu S. Y., Wrosch C. (2015). Chronic illness and loneliness in older adulthood: The role of self-protective control strategies. Health Psychology, 34(8), 870-879. doi:10.1037/hea0000182.
    1. Boekhout J. M., Berendsen B. A. J., Peels D. A., Bolman C., Lechner L. (2019). Physical impairments disrupt the association between physical activity and loneliness: A longitudinal study. Journal of Ageing and Physical Activity, 27, 787-796. doi:10.1123/japa.2018-032510.1123/japa.2018-0325.
    1. Boekhout J. M., Peels D. A., Berendsen B. A., Bolman C. A., Lechner L. (2017). An eHealth intervention to promote physical activity and social network of single, chronically impaired older adults: Adaptation of an existing intervention using intervention mapping. JMIR Research Protocols, 6(11), e230. doi:10.2196/resprot.8093.
    1. Bruggencate T. T., Luijkx K. G., Sturm J. (2018). Social needs of older people: A systematic literature review. Ageing and Society, 38(9), 1745-1770. doi:10.1017/S0144686X17000150.
    1. Cacioppo J. T., Cacioppo S. (2014). Older adults reporting social isolation or loneliness show poorer cognitive function 4 years later. Evidence-based Nursing, 17(2), 59-60. doi:10.1136/eb-2013-101379.
    1. Cohen-Mansfield J., Hazan H., Lerman Y., Shalom V. (2016). Correlates and predictors of loneliness in older-adults: A review of quantitative results informed by qualitative insights. International Psychogeriatrics, 28(4), 557-576. doi:10.1017/S1041610215001532.
    1. Cohen-Mansfield J., Perach R. (2015). Interventions for alleviating loneliness among older persons: A critical review. American Journal of Health Promotion, 29(3), e109-e125. doi:10.4278/ajhp.130418-LIT-182.
    1. Courtin E., Knapp M. (2017). Social isolation, loneliness and health in old age: A scoping review. Health & Social Care in the Community, 25(3), 799-812. doi:10.1111/hsc.12311.
    1. Dahlberg L., Andersson L., McKee K. J., Lennartsson C. (2015). Predictors of loneliness among older women and men in Sweden: A national longitudinal study. Aging & Mental Health, 19(5), 409-417. doi:10.1080/13607863.2014.944091.
    1. Dahlberg L., McKee K. J. (2014). Correlates of social and emotional loneliness in older people: Evidence from an English community study. Aging & Mental Health, 18(4), 504-514. doi:10.1080/13607863.2013.856863.
    1. de Hond A., Bakx P., Versteegh M. (2019). Can time heal all wounds? An empirical assessment of adaptation to functional limitations in an older population. Social Science & Medicine, 222, 180-187. doi:10.1016/j.socscimed.2018.12.028.
    1. de Jong Gierveld J., van Tilburg T. (1999). Manual of the loneliness scale. Vrije Universiteit Amsterdam.
    1. de Jong-Gierveld J. (1998). A review of loneliness: Concept and definitions, determinants and consequences. Clinical Gerontology, 8, 73-80.
    1. Dickens A., Richards S., Greaves C., Campbell J. (2011). Interventions targeting social isolation in older people: A systematic review. BMC Public Health, 11(1), 647.
    1. Dutch Central Bureau of Statistics (2016). Loneliness in The Netherlands. Retrieved from .
    1. Dutch Central Bureau of Statistics (2018). Measuring loneliness. Retrieved from .
    1. Dutch Department of Health Wellbeing and Sports (2016. a). Chronic diseases and multimorbidity. Retrieved from .
    1. Dutch Department of Health Wellbeing and Sports (2016. b). Loneliness in The Netherlands by age. Retrieved from .
    1. Dutch Department of Health Wellbeing and Sports (2018). Public health status and foresight report 2018. Retrieved from .
    1. Dutch Department of Health Wellbeing and Sports (2020). Information on public health and care. Retrieved from .
    1. European Union (2015). Quality of life: Facts and views. European Union.
    1. Everard K. M., Lach H. W., Fisher E. B., Baum M. C. (2000). Relationship of activity and social support to the functional health of older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55(4), S208-S212. doi:10.1093/geronb/55.4.s208.
    1. Eysenbach G. (2005). The law of attrition. Journal of Medical Internet Research, 7(1), e11. doi:10.2196/jmir.7.1.e11.
    1. Fakoya O. A., McCorry N. K., Donnelly M. (2020). Loneliness and social isolation interventions for older adults: A scoping review of reviews. BMC Public Health, 20(1), 129. doi:10.1186/s12889-020-8251-6.
    1. Gardiner C., Geldenhuys G., Gott M. (2018). Interventions to reduce social isolation and loneliness among older people: An integrative review. Health & Social Care in the Community, 26(2), 147-157. doi:10.1111/hsc.12367.
    1. Gierveld D. J., Tilburg T. V. (2006). A 6-Item scale for overall, emotional, and social loneliness: Confirmatory tests on survey data. Research on Aging, 28(5), 582-598. doi:10.1177/0164027506289723.
    1. Global Council on Brain Health (2017). The brain and social connectedness: GCBH recommendations on social engagement and brain health. Retrieved from .
    1. Goodman R. A., Posner S. F., Huang E. S., Parekh A. K., Koh H. K. (2013). Defining and measuring chronic conditions: Imperatives for research, policy, program, and practice. Preventing Chronic Disease, 10, E66. doi:10.5888/pcd10.120239.
    1. Gouveia É. R. Q., Gouveia B. R., Ihle A., Kliegel M., Maia J. A., I Badia S. B., Freitas D. L. (2017). Correlates of health-related quality of life in young-old and old-old community-dwelling older adults. Quality of Life Research, 26(6), 1561-1569. doi:10.1007/s11136-017-1502-z.
    1. Green L. R., Richardson D. S., Lago T., Schatten-Jones E. C. (2001). Network correlates of social and emotional loneliness in young and older adults. Personality & Social Psychology Bulletin, 27(3), 281-288. doi:10.1177/0146167201273002.
    1. Griffith L. E., Raina P., Levasseur M., Sohel N., Payette H., Tuokko H., van den Heuvel E., Wister A., Gilsing A., Patterson C. (2017). Functional disability and social participation restriction associated with chronic conditions in middle-aged and older adults. Journal of Epidemiology and Community Health, 71(4), 381-389. doi:10.1136/jech-2016-207982.
    1. Haahr M. (2020). . Retrieved from .
    1. Hawkley L. C., Cacioppo J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine : A Publication of The Society of Behavioral Medicine, 40(2). doi:10.1007/s12160-12010-19210-12168.
    1. He W., Goodkind D., Kowal P. (2016). An aging world 2015: International population reports. United States Census Bureau. Retrieved from: .
    1. Heinrich L. M., Gullone E. (2006). The clinical significance of loneliness: A literature review. Clinical Psychology Review, 26(6), 695-718. doi:10.1016/j.cpr.2006.04.002.
    1. Holt-Lunstad J. (2018). The potential public health relevance of social isolation and loneliness: Prevalence, epidemiology, and risk factors. Public Policy & Aging Report, 27(4), 127-130. doi:10.1093/ppar/prx030.
    1. Holt-Lunstad J., Smith T. B., Baker M., Harris T., Stephenson D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237. doi:10.1177/1745691614568352.
    1. Jarvis M.-A., Padmanabhanunni A., Balakrishna Y., Chipps J. (2020). The effectiveness of interventions addressing loneliness in older persons: An umbrella review. International Journal of Africa Nursing Sciences, 12(1), 100177.
    1. Krosnick C. A., Presser S. (2010). Question and questionnaire design. Emereld Group Publishing Limited.
    1. Ku P.-W., Fox K. R., Liao Y., Sun W.-J., Chen L.-J. (2016). Prospective associations of objectively assessed physical activity at different intensities with subjective well-being in older adults. Quality of Life Research, 25(11), 2909-2919. doi:10.1007/s11136-016-1309-3.
    1. Leigh-Hunt N., Bagguley D., Bash K., Turner V., Turnbull S., Valtorta N., Caan W. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152(1), 157-171.
    1. Luhmann M., Hawkley L. C. (2016). Age differences in loneliness from late adolescence to oldest old age. Developmental Psychology, 52(6), 943-959. doi:10.1037/dev0000117.
    1. Luo Y., Hawkley L. C., Waite L. J., Cacioppo J. T. (2012). Loneliness, health, and mortality in old age: A national longitudinal study. Social Science & Medicine, 74(6), 907-914. doi:10.1016/j.socscimed.2011.11.02810.1016/j.socscimed.2011.11.028.
    1. Machielse A. (2015). The heterogeneity of socially isolated older adults: A social isolation typology. Journal of Gerontological Social Work, 58, 338-356. doi:10.180/01634372.2015.1007258.
    1. Masi C. M., Chen H.-Y., Hawkley L. C., Cacioppo J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15(3), 219-266. doi:10.1177/1088868310377394.
    1. McHugh Power J. E., Dolezal L., Kee F., Lawlor B. A. (2018). Conceptualizing loneliness in health research: Philosophical and psychological ways forward. Journal of Theoretical and Philosophical Psychology, 38(4), 219-234. doi:10.1037/teo0000099.
    1. McKenna M., Collins J., Brownson RC. (2010). Current issues and challenges in chronic disease control. In Wegner M. V. (Ed.), Chronic disease epidemiology and control (pp. 1-24). American Public Health Association.
    1. Meek K., Bergeron C., Towne S., Ahn S., Ory M., Smith M. (2018). Restricted social engagement among adults living with chronic conditions. International Journal of Environmental Research and Public Health, 15(1), 158. doi:10.3390/ijerph15010158.
    1. Mendes de Leon C. F., Glass T. A., Berkman L. F. (2003). Social engagement and disability in a community population of older adults: The New Haven EPESE. American Journal of Epidemiology, 157(7), 633-642. doi:10.1093/aje/kwg028.
    1. Mund M., Freuding M. M., Möbius K., Horn N., Neyer F. J. (2020). The stability and change of loneliness across the life span: A meta-analysis of longitudinal studies. Personality and Social Psychology Review, 24(1), 24-52. doi:10.1177/1088868319850738.
    1. National Academies of Sciences, Engineering, and Medicine (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. Retrieved from .
    1. Newall N. E. G., Chipperfield J. G., Bailis D. S. (2014). Predicting stability and change in loneliness in later life. Journal of Social and Personal Relationships, 31(3), 335-351. doi:10.1177/0265407513494951.
    1. Nicolaisen M., Thorsen K. (2012). Impairments, mastery, and loneliness. A prospective study of loneliness among older adults. Norsk Epidemiologi, 22(2), 143-150. doi:10.5324/nje.v22i2.1560.
    1. Ong A. D., Uchino B. N., Wethington E. (2016). Loneliness and health in older adults: A mini-review and synthesis. Gerontology, 62(4), 443-449. doi:10.1159/000441651.
    1. O’Rourke H, Collins L, Sidani S. (2018). Interventions to address social connectedness and loneliness for older adults: A scoping review. BMC Geriatrics, 18(1), 1-13.
    1. Peels D. A., De Vries H., Bolman C., Golsteijn R. H. J., Van Stralen M. M., Mudde A. N., Lechner L. (2013). Differences in the use and appreciation of a web-based or printed computer-tailored physical activity intervention for people aged over 50 years. Health Education Research, 28(4), 715-731. doi:10.1093/her/cyt065.
    1. Peels D. A., Van Stralen M. M., Bolman C., Golsteijn R. H., De Vries H., Mudde A. N., Lechner L. (2012). Development of web-based computer-tailored advice to promote physical activity among people older than 50 years. Journal of Medical Internet Research, 14(2), e39. doi:10.2196/jmir.1742.
    1. Pels F., Kleinert J. (2016). Loneliness and physical activity: A systematic review. International Review of Sport and Exercise Psychology, 9(1), 231-260. doi:10.1080/1750984X.2016.1177849.
    1. Petitte T., Mallow J., Barnes E., Petrone A., Barr T., Theeke L. (2015). A systematic review of loneliness and common chronic physical conditions in adults. The Open Psychology Journal, 8(Suppl 2), 113-132. doi:10.2174/1874350101508010113.
    1. Poscia A., Stojanovic J., La Milia D. I., Duplaga M., Grysztar M., Moscato U., Onder G., Collamati A., Ricciardi W., Magnavita N., Magnavita N. (2018). Interventions targeting loneliness and social isolation among the older people: An update systematic review. Experimental Gerontology, 102, 133-144. doi:10.1016/j.exger.2017.11.017.
    1. Puts M. T. E., Shekary N., Widdershoven G., Heldens J., Lips P., Deeg D. J. H. (2007). What does quality of life mean to older frail and non-frail community-dwelling adults in The Netherlands? Quality of Life Research, 16(2), 263-277. doi:10.1007/s11136-006-9121-0.
    1. Qualter P., Vanhalst J., Harris R., Van Roekel E., Lodder G., Bangee M., Maes M., Verhagen M., Maes M. (2015). Loneliness across the life span. Perspectives on Psychological Science, 10(2), 250-264. doi:10.1177/1745691615568999.
    1. R Core Team (2019). A language and environment for statistical computing. Retrieved from .
    1. Raina P., Gilsing A., Mayhew A. J., Sohel N., van den Heuvel E., Griffith L. E. (2020). Individual and population level impact of chronic conditions on functional disability in older adults. PLoS One, 15(2), e0229160. doi:10.1371/journal.pone.0229160.
    1. Remillard M. L., Mazor K. M., Cutrona S. L., Gurwitz J. H., Tjia J. (2014). Systematic review of the use of online questionnaires of older adults. Journal of the American Geriatrics Society, 62(4), 696-705. doi:10.1111/jgs.12747.
    1. Richard A., Rohrmann S., Vandeleur C. L., Schmid M., Barth J., Eichholzer M. (2017). Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS One, 12(7), e0181442. doi:10.1371/journal.pone.0181442.
    1. Rico-Uribe L. A., Caballero F. F., Olaya B., Tobiasz-Adamczyk B., Koskinen S., Leonardi M., Haro J. M., Chatterji S., Ayuso-Mateos J. L., Miret M. (2016). Loneliness, social networks, and health: A cross-sectional study in three countries. PLoS One, 11(1), e0145264. doi:10.1371/journal.pone.0145264.
    1. Robins L. M., Hill K. D., Finch C. F., Clemson L., Haines T. (2016. a). The association between physical activity and social isolation in community-dwelling older adults. Aging & Mental Health, 22, 175-182. doi:10.1080/13607863.2016.1242116.
    1. Robins L. M., Jansons P., Haines T. (2016. b). The impact of physical activity interventions on social isolation among community-dwelling older adults: A systematic review. Research & Reviews: Journal of Nursing and Health Sciences, 2(1), 62-71.
    1. Shvedko A., Whittaker A. C., Thompson J. L., Greig C. A. (2017). Physical activity interventions for treatment of social isolation, loneliness or low social support in older adults: A systematic review and meta-analysis of randomised controlled trials. Psychology of Sport and Exercise, 34(1), 128-137.
    1. Smith K. J., Victor C. (2018). Typologies of loneliness, living alone and social isolation, and their associations with physical and mental health. Ageing and Society, 39(8), 1709-1730. doi:10.1017/S0144686X18000132.
    1. Steffens N. K., Cruwys T., Haslam C., Jetten J., Haslam S. A. (2016). Social group memberships in retirement are associated with reduced risk of premature death: Evidence from a longitudinal cohort study. BMJ Open, 6(2), e010164. doi:10.1136/bmjopen-2015-010164.
    1. Tak E., Kuiper R., Chorus A., Hopman-Rock M. (2013). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: A meta-analysis. Ageing Research Reviews, 12, 329-338. doi:10.1016/j.arr.2012.10.001.
    1. The Lancet (2020). The global burden of disease study 2019. Retrieved from .
    1. Tilvis R. S., Laitala V., Routasalo P. E., Pitkälä K. H. (2011). Suffering from loneliness indicates significant mortality risk of older people. Journal of Aging Research, 2011, 1-5. doi:10.4061/2011/534781.
    1. Twisk J, De Boer M, De Vente W, Heymans M. (2013). Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. Journal Clinical Epidemiology,66, 1022-1028.
    1. United Nations (2019). World population ageing. . Retrieved from .
    1. Üstün T. B., Chatterji S., Kostanjsek N., Rehm J., Kennedy C., Epping-Jordan J., Saxena S., von Korff M., Pull C. (2010). Developing the world health organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88(11), 815-823. doi:10.2471/blt.09.067231.
    1. Valtorta N., Hanratty B. (2012). Loneliness, isolation and the health of older adults: Do we need a new research agenda? Journal of the Royal Society of Medicine, 105(12), 518-522. doi:10.1258/jrsm.2012.120128.
    1. Valtorta N. K., Kanaan M., Gilbody S., Ronzi S., Hanratty B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: Systematic review and meta-analysis of longitudinal observational studies. Heart, 102(13), 1009-1016. doi:10.1136/heartjnl-2015-308790.
    1. van Hees S. G. M., van den Borne B. H. P., Menting J., Sattoe J. N. T. (2020). Patterns of social participation among older adults with disabilities and the relationship with well-being: A latent class analysis. Archives of Gerontology and Geriatrics, 86, 103933. doi:10.1016/j.archger.2019.10393310.1016/j.archger.2019.103933.
    1. Victor C. R., Yang K. (2012). The prevalence of loneliness among adults: A case study of the United Kingdom. The Journal of Psychology, 146(1-2), 85-104. doi:10.1080/00223980.2011.613875.
    1. Volders E., Bolman C. A. W., de Groot R. H. M., Verboon P., Lechner L., Lechner Lilian. (2020). The effect of active plus, a computer-tailored physical activity intervention, on the physical activity of older adults with chronic illness(es)-A cluster randomized controlled trial. International Journal of Environmental Research and Public Health, 17(7), 2590. doi:10.3390/ijerph17072590.
    1. Volders E., Bolman C., Groot R., Lechner L. (2019). The effect of Active Plus, a computer-tailored physical activity intervention, on cognitive functioning of elderly people with chronic illness(es)–Study protocol for a randomized controlled trial. BMC Public Health, 19(1), 1-10.
    1. Ware J.E., Kosinski M., Keller S.D. (1995). SF-12: How to score the SF-12 physical and mental healht summary scales. The Health Institute, New Engeland Medical Center.
    1. World Health Organisation (2018. a). Noncommunicable diseases: Country profiles 2018. Retrieved from .
    1. World Health Organisation (2018. b). What is healthy ageing. Retrieved from , .
    1. World Medical Association (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194. doi:10.1001/jama.2013.281053.
    1. Wrzus C., Hänel M., Wagner J., Neyer F. J. (2013). Social network changes and life events across the life span: A meta-analysis. Psychological Bulletin, 139(1), 53-80.
    1. Zubala A., MacGillivray S., Frost H., Kroll T., Skelton D. A., Gavine A., Gray N. M., Toma M., Morris J. (2017). Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PLoS One, 12(7), e0180902. doi:10.1371/journal.pone.0180902.

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