Is Anybody Out There?
by Mind Over Matter V 13:
Online Social Interactions & Cognition
As you might suspect, there is a high cost associated with the widespread lockdown measures that have been instituted across the globe in response to the COVID-19 pandemic.
According to a recent study conducted by Dr. Tzung-Jeng Hwang and colleagues (published in International Psychogeriatrics in 2020), while robust social restrictions may be necessary to help prevent the spread of COVID-19, the implementation of unprecedented public health measures has led to elevated levels of loneliness and social isolation, particularly in older adults, which in turn produce physical- and mental-health related repercussions.
OLDER ADULTS ARE PARTICULARLY VULNERABLE TO SOCIAL ISOLATION AND LONELINESS AS THEY ARE FUNCTIONALLY VERY DEPENDENT UPON FAMILY MEMBERS AND/OR SUPPORTS BY COMMUNITY SERVICES.
It is important, though, to keep in mind that social distancing is not the same as social disconnection, the latter having detrimental implications on mortality. There are numerous ways to maintain feelings of being connected to others despite having to maintain physical distance from your loved ones and friends, including communicating through online video chats (such as Zoom and Skype) and social media platforms (such as Instagram, Facebook, and Twitter).
Loneliness and depressive symptoms are related to worsening cognition over time. A systematic review and meta-analysis led by Dr. Jisca S. Kuiper in 2015, and supported by subsequent studies, concluded that loneliness and social isolation were significantly associated with incident dementia.
A BURGEONING BODY OF RESEARCH SUGGESTS THAT LOW SOCIAL CONTACT IS A RISK FACTOR FOR DEMENTIA, WITH MULTIPLE STUDIES DEMONSTRATING THAT THOSE WITH POOR SOCIAL SUPPORT SYSTEMS OVER THE LIFESPAN DO WORSE COGNITIVELY.
A meta-analysis of 51 research articles (published in 2019 in the Journal of Alzheimer’s Disease) looked at social isolation and cognitive function later in life and found that low levels of social isolation (characterized by high engagement in social activity and large social networks) were associated with better late-life cognitive function. Moreover, having a robust social network was found to be beneficial for protecting brain health.
Recent research published in The Journals of Gerontology: Series B in February 2021 investigated social contact and cognitive ability to determine if the way in which individuals interact socially affects cognitive function. As online interactions continue to increase for all populations, including for older adults, the researchers wanted to explore the implications of this shift.
“We know there is a growing number of older adults who are not replacing but supplementing traditional or offline interactions, like phone conversations and in-person meetings, with online communication modes. E-mailing, for example, is particularly favoured by many older adults,” noted Dr. Snorri B. Rafnsson, the lead author of the study and an Associate Professor in the Geller Institute of Ageing and Memory at the University of West London in the United Kingdom.
The researchers used data from the English Longitudinal Study of Ageing (ELSA), which has followed and interviewed more than 11,000 women and men between the ages of 50 and 90 since 2002. Specifically, they looked at the ELSA’s data regarding social contact, via both traditional in-person methods (for example, getting together with people and talking on the phone) and non-traditional online avenues (such as communicating through e-mail).
OFFLINE & ONLINE INTERACTION
Dr. Rafnsson and his team analyzed the data on how older adults interacted with others (both offline and online) and how frequently they did so, as well as information on episodic memory function (being the part of our long-term memory involved in recollecting specific events and experiences, such as our first day of school or our wedding day). Its impairment “is a hallmark sign of Alzheimer’s disease, and therefore dementia,” noted Dr. Rafnsson.
The study confirmed that frequent offline, or in-person or phone interactions, were related to better memory function over time.
PERHAPS MORE NOTABLY, THOUGH, FREQUENT ONLINE INTERACTIONS (AND SPECIFICALLY E-MAILING) WERE ASSOCIATED WITH ADDITIONAL OR FURTHER MEMORY BENEFITS.
The participants who supplemented their in-person interactions performed better than those who rarely interacted or who did not interact at all online, even when those who did not use online interactions had a robust in-person social network.
Previous research had suggested that frequent offline social interactions help older adults with long-term cognition because being with loved ones may assist in recalling the past and engaging the memory system. Additionally, if interactions are meaningful and supportive, then “this could also possibly reduce stress and anxiety,” according to Dr. Rafnsson.
He believes that the reason supplementing offline interactions with online ones incurs more memory benefits is twofold. First, engaging online gives people an additional avenue or tool to “facilitate meaningful interactions.” Second, it is likely that using new technologies means that an older adult must learn how to do so.
Whether it is learning to use a computer, tablet, smart phone, or new software program such as e-mail, Zoom, and/or FaceTime (each of which have been especially predominant during the pandemic), it is a form of skill-building.
“We know from parallel literature that learning to use and engage with new technology may potentially offer older adults more direct cognitive stimulation,” said Dr. Rafnsson. Cognitive improvements may be discernible in those who use both offline and online modes of contact because of the simultaneous benefits of socializing (in multiple ways) and engaging the parts of the brain that help us to learn new skills.
Dr. Rafnsson also highlighted an important finding of his study: amongst those who experienced hearing loss, memory function was positively related to both online and offline modes of engagement. He believes that this association could be because those with reduced hearing may engage differently online. For example, writing an e-mail could allow someone to “concentrate more, particularly if the hearing loss reduces or blocks out background noise.”
Accordingly, there may be unexpected cognitive benefits when hearing loss and online interactions are combined. Parenthetically, the 2017 Lancet Commission on dementia prevention, intervention, and care identified hearing loss as one of the modifiable risk factors for dementia.
Dr. Rafnsson and his team had worked on this research project prior to the pandemic. The associated increase in digital interactions makes their findings even more pressing. Some older adults with dementia fared particularly poorly when lockdowns were announced, noted Dr. Rafnsson, due to the “disruption of routines and increased social isolation,” whereas others “seem to be managing optimally and coping quite well.”
It is worth exploring whether technology played a role in these disparate experiences. Were those who managed well already using online socializing methods? Did they have support for learning these new technologies, whether through family members or institutional aid?
AGE & USE OF DIGITAL TECHNOLOGY
A 2017 Pew Research Center study found that while seniors are consistently adopting new technologies, there still exists a “digital divide” within this age cohort. Only 26% of Internet users ages 65 or older reported that they feel “very confident” when using computers, smartphones, or other electronic devices. About three-quarters of older adults indicated that they need others to show them how to use new devices, and 28% of those over the age of 65 have a disability or health issue that may impact their ability to use digital technology. This group has been found to be less likely to use a variety of digital assets – from the Internet in general to devices such as smartphones or tablet computers.
Taken together, these barriers need to be acknowledged when it comes to older adults and digital technology, as we increasingly rely upon technology for work, education, socializing, and more, and especially considering the research finding that using technology may very well improve cognitive outcomes for older adults.
A November 2020 article published in Frontiers in Psychiatry looked at the effects of the COVID-19 pandemic on older adults specifically and noted that while technology may have gone a long way to mitigate the negative effects of the crisis in the general population, the situation is more complicated in the elderly population. Access to (and the ability to proficiently use) technology is much lower in older populations than in younger adults.
This results in a “paradoxical situation,” in which the population most affected by the pandemic lockdowns is also the population least helped by the digital tools aiming to mitigate the negative effects, noted Gabrielle Martins Van Jaarsveld, a PhD Candidate in the Department of Psychology, Education and Child Studies at the Erasmus University Rotterdam in the Netherlands, and the author of the article.
What needs to be done, then, so that older adults can reap the benefits of digital social contact? In the short term, Martins Van Jaarsveld believes that awareness of the problem is the first step. “Digital solutions that the elderly cannot access are not solutions for them,” she said. Long-term solutions must include a focus on improving digital literacy.
“WE CANNOT WAIT UNTIL THE PROBLEM SOLVES ITSELF, AS THE YOUNGER GENERATION BECOMES THE OLDER GENERATION, WHICH IS THE APPROACH COMMONLY CONSIDERED, BECAUSE WE’RE ONLY GOING TO GET MORE DIGITAL IN THE NEXT TEN TO TWENTY YEARS.”
Not everyone has a willing family member to teach her or him the necessary tools. Communities and governments need to start offering technologies that older adults can use, and to teach them the skills “they need to make use of it,” she said.
Dr. Rafnsson agrees that long-term solutions need to be fostered. “We shouldn’t think about the use of technology as a quick fix,” he noted. And the solutions are not necessarily one-size-fits-all. Future research will need to examine which online platforms and modes work best and for whom, since technology changes so rapidly.
In light of the recent findings that combined offline and online social contact can improve cognition, Dr. Rafnsson hopes that there might be policy implications aimed at preventing cognitive decline through the promotion of “better social connections in older adults, particularly for high-risk groups, including those living with impaired hearing, and those whose regular social engagement may be restricted or challenged.”
The pandemic has accelerated our inevitable transition into an increasingly digital future. Now that we know that digital engagement may well improve brain health, there has never been a better time to include everyone into the digital fold.
The Digital Divide
Access to (and the ability to proficiently use) technology is much lower in older populations than in younger adults. This uneven distribution of technological access and skill is often referred to as the “digital divide,” and researchers have suggested that it has continued to increase as the rate of technological innovation accelerates.
While this problem is not new, during the COVID-19 pandemic the digital divide has resulted in a large segment of the population who are unable to make use of the various digital measures put in place to help mitigate the negative physical, psychological, and social effects of the crisis.