INTRODUCTION AND OVERVIEW

Frequent social connectivity with a variety of social partners is associated with better psychological well-being and physical health, as well as increased longevity (Umberson and Montez, 2010). We can think of social connectivity along a spectrum from fully socially engaged to socially isolated. Empirical evidence suggests a dose–response association between degree of social connection and positive health outcomes (Tanskanen and Anttila, 2016); that is, the more social connection, the greater the impact on health and well-being.

Globally, there is increasing concern about trends in social connectivity, loneliness, and social isolation (Holt-Lunstad et al., 2017; Klinenberg, 2016). Indeed, Great Britain established a national commission on loneliness to address this concern (Klinenberg, 2016). Prevalence of social isolation in the US is difficult to estimate, but demographic trends portend increasing social disconnectedness in the future due to rising rates of childlessness, increasing numbers of never married and previously married individuals, smaller households, and falling community involvement in formal groups (Holt-Lunstad et al., 2017). Given population aging, lack of social connectivity is likely to become an increasing population concern.

Social networks tend to diminish in size as people age—in part, due to retirement and deaths of friends and family, as well as increased physical frailty and reduced mobility (Klinenberg, 2016). The Pew Research Center (2009) reports that social networks have declined by about a third in size over the past few decades. Moreover, among older people in the United States, men may be more at risk of social isolation than women (Klinenberg, 2016), and Black Americans may be more at risk than their non-Black counterparts (Umberson et al., 2017).

A number of public health and research initiatives address the issue of social dis/connection in older populations. This chapter addresses how different technologies may promote social connection and decrease social isolation in late life. We consider two related issues. First, we marshal available evidence to consider whether and how technologies can be used to promote social connection and well-being in older populations. Second, we consider how mobile technologies can be used to study social connectivity and health linkages in older adults. Social connections are fundamental to overall health and well-being throughout life, and mobile technologies may provide critical tools for generating and supporting those connections for older populations.

INFORMATION AND COMMUNICATION TECHNOLOGIES IN LATE LIFE

The term “information and communication technologies” (ICTs) has been used to encompass the broad range of these technologies, which include smartphones, specialized apps, web-based sites with information about health and other topics, social media, videoconferences, voice activated virtual assistants, and a variety of other applications (see Table 4-1 for a full listing; Mitzner et al., 2019). Recent national surveys conducted by the Pew Research Center reported that nearly three quarters of adults over aged 65 used the internet (73%; Anderson et al., 2019), and the majority of adults over age 65 have cell phones (91%).

Older adults lag behind younger age groups in use of many technologies. For example, most young adults use smartphones (90%) and social media (86%). Yet only 40 percent of older adults use smartphones, with use declining with age (e.g., 59% of 65 to 69-year-olds compared to 17% of adults over age 80), and only a third of older adults use social media (34%; Anderson and Perrin, 2017; Anderson et al., 2019). Further, Cotten (2017) points out that Pew Research Center data likely overestimate technology use in old age due to exclusion of older adults who are unlikely to use technologies (e.g., those in skilled nursing care or suffering dementias) and who are unable to respond to smartphone or web-based surveys.

Among adults over the age of 65 who use ICTs, facilitation of social connection and communication with friends and family are among the most prevalent reasons (Cotten et al., 2012; Sims et al., 2017). Several types of ICTs may be especially useful in fostering social connection, but older adults may use these technologies selectively. For example, older adults may be more comfortable placing calls on mobile phones, due to familiarity with phones in general. They may be less likely to use smartphones that allow texting or apps such as YouTube and Twitter where individuals share information.

Research also suggests that older adults are willing to embrace voice-activated intelligent assistants (e.g., Alexa; Google assistant; Siri), but it is not clear that these assistants improve feelings of social connection (Koon et al., 2019). One small study involved semi-structured interviews with 12 older adults to evaluate their experience with Amazon Echo. Older adults were positive overall about the voice-activated assistant for music, weather, and information but reported frustrations with social aspects, such as the device's inability to understand their accent or giving the response “I don't know what you mean.” Even adults who mastered tasks that facilitated communication with friends or family questioned whether it was more useful than the phone (Koons et al., 2019). Thus, the devices may assist with practical tasks, but it is not clear whether these technologies assist in social connection or that they can substitute for human interactions in some situations.

SOCIAL USE OF TECHNOLOGIES AND WELL-BEING IN LATE LIFE

Researchers are particularly interested in whether ICTs can be used for social connection to improve social engagement, social isolation, loneliness, depressive symptoms and depression, life satisfaction, and physical wellbeing. To date, many studies have documented benefits of different forms of ICT use on these outcomes (Cotten et al., 2012, 2014; >Heo et al., 2015). In documenting these associations, however, the majority of research has relied on cross-sectional data, with only a few studies using longitudinal data. Moreover, one study of 92 adults over the age of 50 found that introducing tablets increased (rather than decreased) loneliness (Pauly et al., 2019), perhaps due to social comparisons that arise via SNSs.

On the whole, however, adults seem to benefit from use of ICTs. Reciprocally, older adults with better well-being may be more motivated to use technologies. Data from the HRS (i.e., 2006, 2008 or 2012 waves of data) revealed that internet use was associated with fewer symptoms of depression cross-sectionally and longitudinally (Cotten et al., 2012, 2014). Chopik (2016) examined cross-sectional data from the HRS and linked use of social technologies (e.g., email, SNS, online video/phone calls, online chatting/instant messaging, smartphone usage) to a variety of positive outcomes (e.g., reduced loneliness, better life satisfaction, fewer chronic conditions, better health). These associations are also evident among adults in very late life. Sims et al. (2017) recruited a nationally representative sample of 445 adults over age 80. Older adults reported their use of 16 technologies (e.g., online banking, video games, digital books, fitness trackers, email, video calls). Using more devices or apps was positively associated with feeling connected to loved ones and life satisfaction and negatively associated with loneliness and functional limitations. Furthermore, use of ICTs for social connection was associated with less loneliness and better psychological well-being, above and beyond the number of devices.

Longitudinal studies have also confirmed the direction of these associations over time. Cotten and colleagues examined ratings of internet use from 2002 to 2008 in the HRS. Controlling for prior depression and prior internet use, they found that internet use reduced the probability of a future depressive state by about 33%. Likewise, Szabo and colleagues (2019) studied over 1,000 New Zealand adults aged 60 to 77 and assessed three purposes for online engagement: social (e.g., engaging with friends/family), instrumental (e.g., banking), and informational (e.g., health information). Over four years, from 2013 to 2016, use of technologies for social purposes was associated with decreased loneliness and increased social engagement, which in turn were associated with better psychological well-being.

The literature has also focused more specifically on benefits of using SNSs. The Georgia Tech Home Lab study provided detailed information regarding Facebook use. This cross-sectional convenience study included 142 volunteer participants over the age of 50 who completed a brief survey of social media use (e.g., Skype and Facebook) and traditional communication media (e.g., phone, face-to-face, letter). Bell et al. (2013) analyzed these data and found that older adults who used Facebook were more satisfied with their social lives than older adults who did not use Facebook, but they were not less lonely.

Individuals use SNSs in several ways, but three types of behaviors stand out: (a) social communication directed at specific individuals, (b) broadcast communications to the broader network, and (c) passive consumption of social partners' posts. Hutto and colleagues (2015) also drew on the convenience sample in the Georgia Tech Home Lab to show that older adults who engaged in directed communications via SNSs (as opposed to broadcast and passive communications) were less lonely and more satisfied with their lives.

National data may tell a different story about Facebook use and wellbeing in adulthood. Shakya and Christakis (2017) conducted a longitudinal study of US households using three waves of Gallup's web-based polling data (2013 to 2015). The survey asked about the people that participants could confide in or spend time with (referred to as “real world” social networks). Participants also provided the researchers access to their Facebook accounts. Notably, the study by definition excluded adults who did not use Facebook (i.e., over half of older adults). The researchers examined the number of Facebook friends, the number of times participants “liked” someone else's content, clicked on links posted by friends, and updated their own status on Facebook. Cross-sectional and prospective analyses revealed that real-world social connections were associated with better self-rated psychological health, life satisfaction, and physical health. Facebook behaviors (e.g., liking another's content and clicking links posted by friends) were associated with poorer well-being. Furthermore, the negative effects of Facebook were comparable or greater than the positive effects of having real-world social connections. This study did not provide analyses by age, and future research is necessary to disentangle these patterns in older populations.

In sum, ICTs may not substitute for face-to-face social contact and connection but may provide older people with opportunities to connect to the social world virtually. Additional research is necessary to understand how phone use, texting, video conferencing, and other one-to-one social connections via ICT might be beneficial in the absence of other face-to-face connection.

INTERVENTIONS TO IMPROVE SOCIAL CONNECTION VIA ICT USE

Given the number of devices available to facilitate communication easily and inexpensively, interventions to mitigate social isolation and improve social connectedness in late life are tenable. For example, the World Health Organization recently launched a digital application (or app) to provide healthcare and social workers resources necessary to reduce social isolation in late life (Chaib, 2019).

Randomized controlled studies of interventions have begun to examine ICT use to alleviate social distress or promote social connection. A synthesis of this literature is limited because studies use different definitions of social involvement, vary in ICTs examined, and may not include long-term follow-up. Likewise, some intervention studies intended to enhance social connection via ICTs have relied on small samples, qualitative data, or demonstration projects. Furthermore, because these interventions typically target older adults who are not familiar with the technologies, the intervention must include training elements. Training may introduce social contacts that are difficult to account for in assessments of the intervention (Shillair et al., 2015).

Intervention studies with control groups present convincing findings regarding the benefits of ICT use. Shillair and colleagues (2015) conducted a randomized controlled trial (RCT) introducing laptop computers and internet access to improve loneliness and social isolation. The study drew on a convenience sample residing in assisted living and independent living communities. The intervention occurred over 8 weeks and involved training on laptop computers. The study also included a placebo group (received the same number of sessions with the trainers, but no ICT use) and a true control (no ICT/no placebo training). The effects of the ICTs on life satisfaction over time (3 months, 6 months, 12 months) depended on attitudes toward ICT use (Tsai et al., 2019). Older adults who grew more confident about using ICTs to communicate also felt more socially supported, and their overall life satisfaction grew higher over time (Shillair et al., 2015). As such, introduction of ICTs is not a panacea, but rather depends on training and time for the person to become comfortable with these technologies.

Another intervention, the Personal Reminder Information Social Management System (PRISM) study recruited 300 volunteers over the age of 65 residing independently in the community. The intervention provided participants with a mini desktop PC with free internet access, a printer, and free access to the internet, including a calendar, photo feature, emails, and online help. The email feature included a “buddy tab” intended to foster social connections between study participants. A control group received similar information in a binder with opportunities to form connections to other participants by sharing their phone number and interests with other participants in their group. At 6 months postrandomization, participants in the PRISM condition showed greater improvements in ratings of loneliness and social support than the binder group, but these differences disappeared at 12 months postrandomization when both groups showed improvements (Czaja et al., 2018). Although these intervention studies point in the direction of benefits from technology for social involvement, some smaller studies have shown opposite effects of using social functions on portable ICTs, perhaps due to feelings of exclusion that increase loneliness (Pauly et al., 2019).

Finally, older adults' social lives typically involve enclaves of social partners who have long histories of interactions, who are educationally similar, and who share cultural backgrounds (McPherson et al., 2001). As such, older adults who do not use technologies are likely to have older friends and relatives who do not use technologies for communication. Interventions that target one older adult may be ineffective in the absence of including the broader social circle.

USING MOBILE TECHNOLOGIES IN RESEARCH ON SOCIAL CONNECTIVITY

Although the literature regarding older adults' use of mobile technology has focused broadly on ICTs, researchers have specifically used mobile technologies to examine older adults' social lives. Using mobile technologies, scholars have generated self-reports of activities and mood throughout the day, observations of conversations, location, and activity level, and links between daily social connections and well-being outcomes.

CONCLUSION

Social networks become smaller as people age, and older people are more likely than their younger counterparts to report feeling lonely and socially isolated (Kemperman et al., 2019). ICT use in older populations offers great promise for fostering social connection. The use of mobile technologies to gather data on the social connectivity of older people in relation to their health and well-being can lay groundwork for effective policies and practice strategies to enhance social connection. However, the limitations of such strategies must also be considered by recognizing that mobile technologies may not always be effective substitutes for in-person social contact. Below, we briefly review several major themes in the current research evidence on mobile technology use and social connectivity with older populations and identify strategic directions for future research.

The first major theme concerns the need for additional research on information and communication technologies and social connection among older adults. Today's older people grew up in an era devoid of such technologies, and thus opportunities, constraints, and rewards of information and communication technologies are highly likely to differ for younger and older age cohorts. Use of technology has largely saturated younger cohorts, whereas there are sizable discrepancies in use of technologies in late life. Older adults who are well off typically use new technologies, whereas those who are less well off typically do not (Hargittai, 2018). These discrepancies reflect education and resources; older adults who have greater access and knowledge are more likely to adopt these technologies. Moreover, Black and Hispanic Americans are less likely to have broadband connections at home, which reduces the usefulness of ICTs (and the potential human capital they are associated with) and may lead to disparities.

Other disparities reflect social resources. Individuals who are more socially engaged and socially connected through family and friends are also more likely to have social partners who provide them with technologies, provide instruction in usage, and serve as targets for connection through SNSs (e.g., Facebook). Further, women are more likely than men to use technology for social networking (Kim et al., 2017).

Second, current research evidence on the use of and benefits from ICT is limited because many studies rely on small samples and cross-sectional designs. These approaches reflect the challenges of defining sampling in older adults. It is highly likely that the use of mobile technologies for social connection are affected by the mental, physical, and cognitive status of people as they age, and disentangling these factors in research is complex. Studies that have used national samples with longitudinal data suggest that ICT use in late life is beneficial (e.g., Cotten, et al., 2014). Nevertheless, much of this research is limited to two national datasets (NHATS, HRS), both of which have limited items addressing ICT use. Substantial investment is required to execute studies that draw on multiple items and multiple methods to assess social connection and use of technologies over time.

Third, given the growing burden of dementia in aging societies, there is a pressing need for research examining interventions to increase the use of ICTs to foster social connectivity. Interventions and programs using such technologies may be particularly important to assist people with cognitive impairment and their caregivers. Nevertheless, early intervention studies on how technologies can alleviate caregiver burden have had limited success, and the costs of the technologies outweighed the benefits. Relatively low cost technologies, such as GPS, may assist caregivers to locate persons with dementia who tend to wander, though the ethics of using such devices has also been questioned (Mahoney and Mahoney, 2010). Future intervention research might focus on the feasibility, ethics, and dissemination of these existing low-cost technologies.

In this chapter, we discussed several ways in which ICTs intersect with the well-being of older populations: (a) older people's use of ICTs with regard to social connection, (b) factors that facilitate or set up barriers for the use of such technologies, (c) the impact of using these technologies for social connection to improve well-being in late life, (d) interventions to increase social connectivity via adoptions of ICTs, and (e) research applications using mobile technologies. ICTs offer many opportunities to enhance feelings of social connection among older populations, and to promote their well-being. ICTs may also confer benefits outside of promoting social connection, such as health monitoring, banking, and other daily tasks. Future research should consider the potential costs and benefits across ICTs used by older people, with close attention to the purpose and consequences of different types of ICTs. As future cohorts grow older, the use of ICTs for social connection in late life may continue to grow.

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