Sarah Chapman looks at a Cochrane rapid reviewA rapid review is a simplified systematic review that can be done in a few weeks to produce timely evidence for decision-making. on whether video calls can reduce loneliness in older people, at a time when many people are still unable to have face-to-face contact with others due to the Covid19 pandemic.
“The best first-line antidepressant for older people is probably companionship.” This powerful statement from BMJ Learning, shared by a doctor on Twitter recently, got me thinking again about the extent to which companionship can be provided remotely, via our screens. We’ve recently seen some easing of some of our lockdown restrictions and the arrival of another new phrase as we welcome ‘social bubbles’, which allow some single people (not those shielding) to join one other household for visits and stays. But for many people living alone this will not end their social isolation. To ‘bubble’ might be new but to be lonely is not and of course there are no easy answers to this widespread problem, pandemic or no pandemic.
Might video calls have an important part to play, particularly at the moment? As lockdown restrictions pushed lots of us into different ways of using technology, video calls may have felt like something of a lifeline for many as in-person visits to our homes and opportunities to meet elsewhere came to a sharp halt. A Cochrane rapid review, one of several simplified systematic reviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. done quickly to produce timely evidence for decision-making, aimed to assess the effectiveness of video calls for reducing social isolation and loneliness in older adults. The review also set out to explore the impact of video calls on depression and quality of life.
The evidence on video calls
The review authors looked for studies involving people with an average age of at least 65 and that investigated “any interventionA treatment, procedure or programme of health care that has the potential to change the course of events of a healthcare condition. Examples include a drug, surgery, exercise or counselling. in which a core component involved the use of the internet to facilitate video calls or video conferencing through computers, smartphones or tablets with the intention of reducing loneliness or social isolation, or both”.
They were able to include just three studies with a total of 201 people, comparing video calls to ‘usual care’ in nursing homes in Taiwan. None looked at social isolation. They each used scales to measure loneliness (the UCLA Loneliness Scale) and depression (the Geriatric Depression Scale), and one studyAn investigation of a healthcare problem. There are different types of studies used to answer research questions, for example randomised controlled trials or observational studies. measured quality of life, using a Taiwanese adaptation of the Short‐Form 36‐question health survey (SF‐36).
They found that:
- video calls may make little or no difference to scores on the UCLA Loneliness Scale compared to usual care at three months, but the evidence is very uncertain.
- video calls may have a small effect on symptoms of depression at one‐year follow‐up, but this evidence is also very uncertain.
- video calls may make little or no difference to quality of life, but the evidence is very uncertain.
What does this mean?
The review authors’ bottom line is that there is currently only very uncertain evidence on the effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of video calls to reduce loneliness or depression in older adults and they found no studies on the impact of video calls on social isolation. An important evidence gap.
This does not mean that video calls don’t have any effects in older people, either beneficial ones or undesirable ones. We simply don’t have reliable evidence to inform us about this.
One problem with the evidence in this review is that there are only three small studies, with few people, so it could be that the studies were just too small to detect any effects of video calls. Another is that the studies used unreliable methods or didn’t clearly describe what they did. But there are other problems too.
Maybe the people in those studies weren’t lonely in the first place…
Here’s an important consideration. The included studies did not specifically recruit people who were lonely or socially isolated. How are researchers going to show that the thing they are testing (video calls in this case) is having an effect on loneliness if the people taking part aren’t lonely? It’s a problem! Not a unique one either. Very sensibly, the review authors call for future research to involve older people who are demonstrably lonely and/or socially isolated at the start.
They also point out that we need evidence from a range of different settings. What holds for residents in nursing homes in Taiwan may not be applicable to older adults at home in Ireland, for example, or indeed in nursing homes in other countries.
Also, none of these studies were done during the Covid-19 pandemic. The comparisons in research conducted now, say video calls versus no social contact, might be very different from pre-pandemic options, such as video calls versus alternative forms of social contact. A more stark contrast might perhaps have been more likely to show effects of video calls. There will be other factors too, particular to our current context. So much has changed for us all in these last months; life before Covid can seem distant, intangible, lost. I think in this extraordinary, unimaginable, time many of us have found new ways of being lonely…
As always (and this is a common problem), it would be useful to know what constitutes ‘usual care’. What if ‘usual care’ in one nursing home is to have activities for residents, communal meals and so on, but in another people are cared for largely in their rooms and without access to these kinds of activities? ‘Usual care’ is potentially many versions of something.
What about you and your loved ones?
While this rapid review is the kind of research that people making policy decisions may want to consider, even the best evidence can only ever be part of the picture when it comes to decisions by or with individuals. As I discussed in this recent blog on what may help older people to take their medication correctly, it’s essential to consider a person’s individual preferences and other aspects of their circumstances that Professor Victor Montori, calling for ‘careful and kind care’, refers to as their biology and biography. Let’s think about THIS person, not just people like them.
What are your experiences of video calls as an older person or someone keeping in touch with older people? I hope you are finding they are helping in this potentially lonely time.
Join in the conversation on Twitter with @CochraneUK @SarahChapman30 @CochraneCCRG or leave a comment on the blog. Please note, we cannot give medical advice and we will not publish comments that link to commercial sites or appear to endorse commercial products.
References and further reading (pdf).
Sarah Chapman has nothing to disclose.