ABSTRACT
Background: Social isolation and loneliness are more common in older adults and are associated with a serious impact on their well-being, mental health, physical health, and longevity. They are a public health concern highlighted by the COVID-19 pandemic restrictions, hence the need for digital technology tools to enable remotely delivered interventions to alleviate the impact of social isolation and loneliness during the COVID-19 restrictions. Objectives: To map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings. Search Methods: We searched the following databases from inception to May 16, 2021, with no language restrictions. Ovid MEDLINE, Embase, APA PsycInfo via Ovid, CINAHL via EBSCO, Web of Science via Clarivate, ProQuest (all databases), International Bibliography of the Social Sciences (IBSS) via ProQuest, EBSCO (all databases except CINAHL), Global Index Medicus, and Epistemonikos. Selection Criteria: Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate following the eligibility criteria. Data Collection and Analysis: We developed and pilot tested a data extraction code set in Eppi-Reviewer and data were individually extracted and coded based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map. Main Results: We included 200 articles (103 primary studies and 97 systematic reviews) that assessed the effects of digital interventions to reduce social isolation and/or loneliness in older adults. Most of the systematic reviews (72%) were classified as critically low quality, only 2% as high quality and 25% were published since the COVID-19 pandemic. The evidence is unevenly distributed with clusters predominantly in high-income countries and none in low-income countries. The most common interventions identified are digital interventions to enhance social interactions with family and friends and the community via videoconferencing and telephone calls. Digital interventions to enhance social support, particularly socially assistive robots, and virtual pets were also common. Most interventions focused on reducing loneliness and depression and improving quality of life of older adults. Major gaps were identified in community level outcomes and process indicators. No included studies or reviews assessed affordability or digital divide although the value of accessibility and barriers caused by digital divide were discussed in three primary studies and three reviews. Adverse effects were reported in only two studies and six reviews. No study or review included participants from the LGBTQIA2S+ community and only one study restricted participants to 80 years and older. Very few described how at-risk populations were recruited or conducted any equity analysis to assess differences in effects for populations experiencing inequities across PROGRESS-Plus categories. Authors' Conclusions: The restrictions placed on people during the pandemic have shone a spotlight onto social isolation and loneliness, particularly for older adults. This evidence and gap map shows available evidence on the effectiveness of digital interventions for reducing social isolation or loneliness in older adults. Although the evidence is relatively large and recent, it is unevenly distributed and there is need for more high-quality research. This map can guide researchers and funders to consider areas of major gaps as priorities for further research.
ABSTRACT
This is the protocol for an evidence and gap map. The objectives are as follows: This EGM aims to map available evidence on the effects of in-person interventions to reduce social isolation and/or loneliness across all age groups in all settings.
ABSTRACT
OBJECTIVE: To evaluate the extent to which Cochrane Musculoskeletal systematic reviews assess and analyze health equity considerations. METHODS: We included Cochrane Musculoskeletal systematic reviews that included trials with participants aged ≥ 50 years and that were published from 2015 to 2020. We assessed the extent to which reviews considered health equity in the description of the population in the PICO (Patient/Population - Intervention - Comparison/Comparator - Outcome) framework, data analysis (planned and conducted), description of participant characteristics, summary of findings, and applicability of results using the PROGRESS-Plus framework. The PROGRESS acronym stands for place of residence (rural or urban), race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital, and Plus represents age, disability, relationship features, time-dependent relationships, comorbidities, and health literacy. RESULTS: In total, 52 systematic reviews met our inclusion criteria. At least 1 element of PROGRESS-Plus was considered in 90% (47/52) of the reviews regarding the description of participants and in 85% (44/52) of reviews regarding question formulation. For participant description, the most reported factors were age (47/52, 90%) and sex (45/52, 87%). In total, 8 (15%) reviews planned to analyze outcomes by sex, age, and comorbidities. Only 1 had sufficient data to carry this out. In total, 19 (37%) reviews discussed the applicability of the results to 1 or more PROGRESS-Plus factor, most frequently across sex (12/52, 23%) and age (9/52, 17%). CONCLUSION: Sex and age were the most reported PROGRESS-Plus factors in any sections of the Cochrane Musculoskeletal reviews. We suggest a template for reporting participant characteristics that authors of reviews believe may influence outcomes. This could help patients and practitioners make judgments about applicability.
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Health Equity , Humans , Socioeconomic Factors , Social Class , OccupationsABSTRACT
BACKGROUND: Musculoskeletal conditions are the leading cause of years lived with disability for older adults. Limitations in functional ability affect healthy aging for aging populations worldwide. Thus, it is important to assess effects of interventions on the multiple dimensions of function for older adults. OBJECTIVES: To assess: (1) which domains of function are assessed in reviews published by the Cochrane Musculoskeletal Group inclusive of older adults, and (2) the extent to which these reviews evaluate effects and/or applicability of findings for older adults. METHODS: We included all reviews published by the Cochrane Musculoskeletal Review Group after 2015 including participants over the age of 50 (n = 52). We extracted data on how the activities and participation domains of the International Classification of Functioning (ICF) were measured. We assessed the extent to which reviews included methods to evaluate effects across age, according to the framework in the Cochrane Handbook chapter on equity and specific populations. RESULTS: The median age of participants across reviews was 54 years (range 16-94). ICF domains assessed in reviews, in descending order of frequency, were: domestic life (90%), mobility (89%), self-care (87%), interpersonal interactions and relationships (65%), community, social, and civic life (64%), major life areas (31%), communication (2%), general tasks and demands (0%) and learning and applying knowledge (0%). In evaluating effects across age, the age of participants was described by 73% of reviews and 54% mentioned age in the description of the condition, 21% planned subgroup analysis by age and none were able to conduct this analysis. Only 17% described applicability of results to older people. CONCLUSIONS: Reviews published by the Cochrane Musculoskeletal Group inclusive of older adults assess most domains of functional ability with the exception of communication, general tasks and knowledge domains. None of these reviews were able to conduct a subgroup analysis across age, indicating a need to improve the consideration of age in both Cochrane reviews as well as in primary studies.
