Skip to main content
NCBI home page
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences logoLink to The Journals of Gerontology Series B: Psychological Sciences and Social Sciences
. 2022 Dec 13;78(4):629–638. doi: 10.1093/geronb/gbac193

Can Digital Communication Protect Against Depression for Older Adults With Hearing and Vision Impairment During COVID-19?

Amanda Zhang 1,✉, Kristen E Wroblewski 2, Terence E Imbery 3, Martha K McClintock 4, Louise C Hawkley 5, Jayant M Pinto 6
Editor: Rodlescia S Sneed
PMCID: PMC10066739  PMID: 36512652

Abstract

Objectives

During social isolation imposed by the coronavirus disease 2019 (COVID-19) pandemic, older adults with impaired hearing and vision potentially experienced more communication challenges, increasing their risk for poor mental health. Digital communication (e.g., video calls, e-mail/text/social media) may alleviate in-person isolation and protect against depression. We addressed this question using data from the National Social Life, Health, and Aging Project, a nationally representative panel study of community-dwelling older adults.

Method

Two thousand five hundred fifty-eight adults aged 55 and older comprised the analytic sample. Interviewer rating at baseline (2015–2016) classified those with vision impairment (VI) or hearing impairment (HI). Olfactory impairment (OI) was measured by objective testing. During COVID-19 (2020–2021), respondents reported how often they contacted nonhousehold family or friends and whether this was by phone, e-mail/text/social media, video, or in-person. They also quantified the frequency of depressive feelings.

Results

Older adults with VI or HI but not OI at baseline were significantly less likely to report regular use of video calling and e-mail/text/social media during the pandemic compared to those without impairment. Sensory impairments did not affect the frequency of phone or in-person communication. Adults with VI or HI were more likely to experience frequent depressive feelings during COVID-19. Video calls mitigated this negative effect of VI- and HI-associated depressive feelings in a dose-dependent manner.

Discussion

Among communication modalities, video calling had a protective effect against depressive feelings for people with sensory impairment during social isolation. Improving access to and usability of video communication for older adults with sensory impairment could be a strategy to improve their mental health.

Keywords: COVID-19, Depression, Digital communication, Sensory impairment, Video call

Hearing impairment (HI) and vision impairment (VI) are common in older adults and may lead to challenges with interpersonal communication, cognition, and daily functioning that increase the risk for depression (Armstrong et al., 2020; Lin, 2020; Mick et al., 2018; Rutherford et al., 2018). The coronavirus disease 2019 (COVID-19) pandemic and associated social isolation mandates introduced additional barriers that impeded personal interaction, potentially further increasing the risk for poor mental health. As a vulnerable group, older adults were encouraged to stay at home and limit their travel, resulting in reduced social contact frequency and reduced sense of social support (Luykx et al., 2020). Perceived support from others and having more extensive social networks are known to be important protective factors that lower the risk of depression (Gariépy et al., 2016; Santini et al., 2015).

Increasing the use of digital communication, including online messaging (via e-mail, text, and social media) and video calling, may be a strategy to alleviate in-person isolation and reduce depression during periods of isolation. Older adults’ use of technology for social connection has increased dramatically because the onset of the pandemic. Many older adults over 50 years of age report using video calling (45%), texting (37%), e-mailing (26%), and phone (29%) more frequently now than before the pandemic (Kakulla, 2021). In 2019, about half had never used video calling, but by 2020 70% had, with one in three video calling weekly (Kakulla, 2021).

Prior research suggests that the effects of digital communication on older adults’ mental health are generally positive. One longitudinal study comparing face-to-face contact with phone contact found that the rate of developing depression was similar between groups (Roh et al., 2015), suggesting that the efficacy of phone contact and face-to-face contact are similar. Another survey-based study found that phone and text/e-mail contact had functional equivalence to face-to-face contact in familial relationships but lacked the emotional equivalence (Burholt et al., 2020). Video calling has been proposed as an alternative to in-person interaction during the pandemic because it more closely approximates real-life social interaction. A recent study of a large nationally representative sample found no residual benefit of video calling in reducing depressive feelings after adjusting for face-to-face contact, but recognized that low rates of uptake may have underpowered the analysis (Hawkley et al., 2021).

Whether older adults with communication-based deficits experience the same benefits of digital communication compared to those without is less clear. Poor eyesight is often cited as a barrier to screen use, as the abilities to see detail, focus on close objects, and discriminate between colors decrease with age (Larsson et al., 2013; Piper et al., 2017). Likewise, adults with HI may experience poorer sound quality during electronic transmission. Due to these barriers, older adults with HI and VI are less likely to use the internet and technology in the first place (Gell et al., 2015; Henshaw et al., 2012). While these studies were performed at a time when the internet was accessed primarily through desktop computers and was less pervasive in daily life, a recent marketing survey found that rates of smartphone ownership were substantially lower in people with self-reported HI (53% vs 81%), supporting that the difference in technology uptake between those with sensory impairment and those without is still relevant in today’s smartphone era (Ofcom, 2019). At the same time, digital communication offers benefits of particular help to those with HI and VI, including a rich language of expression with pictures, videos, and emojis in addition to the written and spoken word, which can compensate for barriers using traditional communication modes (Kožuh & Debevc, 2020; Pittman & Reich, 2016). This may explain how one questionnaire-based study found that adults with HI were more likely to utilize social media to stay in touch with family and friends compared to those without HI (van Wier et al., 2021). Likewise, people with VI are starting to replace traditional assistive devices with smartphones and tablets due to their greater functionality and versatility (Martiniello et al., 2022). Despite these potential benefits, there is relatively little research on the effectiveness of digital communication for improving the mental health of the hearing or vision impaired.

This study aimed to (a) determine if older adults with sensory impairment reported greater frequency of depressive feelings during the COVID-19 pandemic, (b) characterize the use of digital (video call, e-mail/text/social media messaging) and traditional (phone, in-person) communication for older adults with sensory impairment, and (c) evaluate whether frequent use of digital communication had a beneficial effect on the association between sensory impairment and feelings of depression. We addressed this question using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative panel study of community-dwelling older adults to better understand how digital communication affects mental health and to inform strategies on how to best support an aging population in our increasingly digitized world.

Method

Sample

The NSHAP is a nationally representative panel study of older adults (Waite et al., 2017). A special NSHAP COVID-19 survey sample included 4,852 respondents from prior survey rounds. Data were collected between September 14, 2020 and January 27, 2021 using web, phone, and paper-and-pencil surveys. Responses were received from 2,672 individuals (58% conditional response rate). The final analytic sample included 2,558 adults aged 55 and older 
(92 respondents excluded) who were also interviewed in 2015–2016 (22 respondents excluded).

Measures

Sensory function

Hearing and vision were measured in 2015–2016 by interviewer rating. Interviewers were asked to rate respondents’ hearing and vision abilities on a scale from 1 to 5 with 1 being “practically blind/deaf” to 5 being “normal vision/hearing” based on the home interview interaction. We included individuals with OI as a negative control because, in contrast to hearing and vision, we did not expect olfaction to influence the usability of digital communication. Olfaction was measured using a validated, five-item odor identification test (Kern et al., 2014). Respondents were asked to smell a marker that contained a common odorant and then identify the smell from four word/picture choices. OI was defined as incorrectly identifying two or more odors as in previous studies (Kern et al., 2014).

Modes of communication

Respondents were asked how often, during a typical week since the pandemic started, respondents had contact with nonhousehold (a) family and (b) friends by (i) phone, (ii) messaging (e-mail, text, and social media), (iii) video calls (FaceTime, Skype, and Zoom), and (iv) in-person. Response options were never, less than once a week, about once a week, a few times a week, and at least daily.

Depression

Depressive symptoms were assessed in 2015–2016 and 2020–2021 by the question, “During the past month, how often have you felt depressed?” Options included rarely or none of the time (1), some of the time (2), occasionally (3), and most of the time (4).

Analysis

Subgroups of respondents with VI, HI, and/or OI were constructed based on the criteria described earlier. Descriptive statistics were conducted to compare each group in demographics, health status, internet use behaviors, and communication behaviors. Logistic regression was used to test whether the presence of sensory impairment was associated with differences in likelihood of regularly engaging with different modes of communication while controlling for survey mode, age, gender, race, household size, marital status, educational attainment, employment status, and internet use in 2015–2016. Linear regression was used to quantify the effect of communication mode and sensory impairment on the frequency of depressive feelings during COVID-19 while controlling for survey mode, age, gender, race, household size, marital status, educational attainment, employment status (2020–2021), physical health (2015–2016), internet use (2015–2016), and frequency of depressive feelings (2015–2016). For these latter models, an interaction term between sensory impairment and communication mode was included to isolate the effect of communication mode on the relationship between sensory impairment and the outcome variable (feelings of depression). All estimates were weighted to account for differential probabilities of selection and nonresponse using the covid_wt variable provided with the data.

Results

Out of 2,558 adults aged 55 and older, 226 (8.8%) met the criteria for VI, 221 (8.6%) for HI, and 104 (5.5%) for OI. About half of the respondents who met the criteria for VI also met the criteria for HI (n = 101), and 16 respondents met the criteria for VI, HI, and OI. Sample demographics are shown in Table 1.

Table 1.

Sample Demographic Characteristics Overall and Among Those With Vision Impairment (VI), Hearing Impairment (HI), Olfaction Impairment (OI), and No Impairment (NI); Categories Are Not Mutually Exclusive

Characteristic All VI HI OI NI
N 2,558 226 221 140 2,212
Age (mean [std]) 72.1 (9.5) 76.1 (10.2) 78.7 (9.5) 80.8 (6.9) 71.2 (9.2)
Gender
 Female 56.6% 50.0% 59.3% 53.6% 58.4%
 Male 43.4% 50.0% 40.7% 46.4% 41.6%
Race/ethnicity
 White, non-Hispanic 73.3% 68.2% 78.1% 72.9% 73.5%
 Black, non-Hispanic 13.9% 19.3% 11.9% 17.1% 13.6%
 Other, non-Hispanic 3.2% 1.7% 1.4% 1.4% 3.4%
 Hispanic 9.5% 11.5% 9.0% 8.6% 9.3%
Educational attainment
 Less than high school degree or equivalent 9.9% 19.5% 19.0% 20.7% 8.5%
 High school degree or equivalent 20.9% 26.5% 25.8% 17.9% 20.2%
 Associate’s degree or equivalent 33.6% 31.4% 29.4% 27.9% 36.4%
 Bachelor’s degree or higher 35.7% 22.6% 25.8% 33.6% 34.8%
Household size in 2021 (1–6; mean [std]) 2.18 (1.02) 2.21 (1.18) 2.10 (1.02) 2.12 (1.17) 2.17 (1.00)
Married in 2015 74.2% 69.0% 75.1% 69.3% 74.6%
Employed in 2021 41% 29% 29% 26% 43%
Self-rated physical health in 2015 (1 = poor, 5 = excellent; mean [std]) 3.40 (0.98) 3.08 (1.04) 3.18 (1.04) 3.53 (0.96) 3.44 (0.97)
Frequency of depressive feelings in 2015
 Rarely or none of the time 70.4% 67.7% 67.4% 72.1% 70.7%
 Some of the time 16.6% 18.6% 20.4% 17.9% 16.3%
 Occasionally 10.4% 11.1% 10.4% 9.3% 10.4%
 Most of the time 2.6% 2.7% 1.8% 0.7% 2.7%
Internet use in 2015
 Never used the internet or e-mail 18.5% 32.1% 34.0% 28.8% 16.4%
 Less than once a month 5.4% 9.5% 4.6% 6.8% 5.2%
 At least once a month, but not weekly 4.0% 3.7% 4.1% 6.8% 4.0%
 Several times a week, but not daily 13.9% 14.7% 13.9% 15.3% 13.7%
 Every day 58.1% 40.0% 43.3% 42.4% 60.7%
Survey mode
 Web 50.5% 39.4% 43.0% 36.4% 51.9%
 Phone 10.9% 13.3% 10.4% 14.3% 10.7%
 Paper-and-pencil 38.5% 47.3% 46.6% 49.3% 37.4%
Open in a new tab

Question 1: Did older adults with sensory impairment have more frequent depressive feelings during COVID compared to those without the respective sensory impairment?

Table 2 summarizes the frequency of depressive feelings for older adults with and without sensory impairment. Overall, a majority of older adults reported rarely or never feeling depressed in the last month. However, there was a trend toward more frequent feelings of depression for those with sensory impairment, most pronounced for those with VI (Table 2). Furthermore, adults with dual vision and HI were more likely to report more frequent feelings of depression (25%), compared to HI only (21%), but not VI only (26%).

Table 2.

Frequency of Depressive Feelings During COVID-19 (2020–2021) by Presence or Absence of Vision Impairment (VI), Hearing Impairment (HI), Olfactory Impairment (OI), and Dual Vision and Hearing Impairment

Mental health measure VI No VI HI No HI OI No OI Dual VI and HI VI only HI only
N 226 2,332 221 2,337 140 744 101 125 120
Frequency of depressive feelings in 2020–2021 (% [CI])
 Rarely or none of the time 51 [44, 58] 56 [54, 58] 53 [46, 59] 56 [54, 58] 59 [51, 68] 59 [55, 63] 47 [37, 57] 54 [45, 63] 58 [49, 67]
 Some of the time 24 [18, 29] 23 [21, 25] 24 [19, 30] 23 [21, 25] 19 [14, 28] 22 [19, 25] 28 [19, 37] 20 [13, 27] 21 [14, 29]
 Occasionally 19 [14, 24] 17 [16, 19] 20 [14, 25] 17 [16, 19] 21 [13, 26] 15 [13, 18] 18 [10, 25] 20 [13, 27] 21 [14, 29]
 Most of the time 6 [3, 10] 4 [3,5] 3 [1, 6] 4 [3, 5] 1 [0, 2] 3 [2, 4] 7 [2, 12] 6 [2, 10] 0 [0, 0]
Open in a new tab

Note: CI = confidence interval; COVID-19 = coronavirus disease 2019.

In multivariate analysis, those with VI had increased frequency of depressive feelings within the past month (β = 0.15, p = 0.02) after controlling for survey mode, demographic factors, baseline physical health, and baseline frequency of depressive feelings in 2015–2016 (Table 3). The effect was of a similar magnitude as being female (β = 0.16, p < .001). Those with HI or OI did not have significantly higher frequency of depressive feelings during the pandemic (p = .15 and p = .76, respectively).

Table 3.

Coefficients for Multivariate Linear Regression Estimating Frequency of Depressive Feelings During COVID-19 by Presence of Vision Impairment (VI), Hearing Impairment (HI), and Olfactory Impairment (OI)

Outcome variable: Frequency of depressive feelings (1–4)
Exposure variable: Vision Hearing Olfaction
β (p) β (p) β (p)
Vision impairment (ref: no VI) 0.15 (.016) NA NA
Hearing impairment (ref: no HI) NA 0.10 (.152) NA
Olfactory impairment (ref: no OI) NA NA 0.02 (.760)
Female (ref: male) 0.16 (<.001) 0.16 (<.001) 0.10 (.104)
Age (years, continuous) −0.00 (.077) −0.00 (.077) −0.00 (.973)
White race (ref: not White) −0.06 (.185) −0.06 (.171) 0.13 (.114)
Household size 0.01 (.722) 0.01 (.702) 0.02 (.417)
Married (ref: not married) −0.09 (.015) −0.11 (.008) 0.03 (.632)
Employed in 2021 −0.07 (.055) −0.07 (.052) 0.01 (.909)
Attained bachelor’s degree (ref: <bachelor’s degree) 0.11 (.004) 0.11 (.004) 0.08 (.161)
Frequency of depressive feelings in 2015 (1–4) 0.36 (<.001) 0.36 (<.001) 0.40 (<.001)
Self-rated physical health in 2015 (1–5) −0.10 (<.001) −0.11 (<.001) −0.08 (.005)
Mode (ref: web)
 Phone −0.18 (.002) −0.18 (.003) −0.23 (.006)
 Paper-and-pencil 0.04 (.309) 0.04 (.318) 0.04 (.546)
Open in a new tab

Note: COVID-19 = coronavirus disease 2019.

Question 2: Did older adults with sensory impairment differ in how frequently they used digital communication?

Voice-only phone calling was the most used form of communication used by older adults with or without sensory impairment (Figure 1). Greater than 80% of all respondents reported regular (weekly or more frequent) use of phone calling to contact friends and family during the pandemic. E-mail/text/social media messaging was the next most frequent mode (73%) followed by in-person contact (50%). Video calling was used the least (28%).

Figure 1.

Figure 1.

Open in a new tab

Frequency of regular (weekly or more frequent) use of (A) video calls, (B) e-mail/text/social media messaging, (C) phone calls, and (D) in-person visits during the COVID-19 pandemic among older adults with and without sensory impairment. COVID-19 = coronavirus disease 2019.

Older adults with VI or HI were significantly less likely to report regular (weekly or more frequent) use of video calling (VI: 19% vs 29% p = .001, HI: 14% vs 30% p < .001) and e-mail/text/social media (VI: 57% vs 74% p < .001, HI: 58% vs 74% p < .001) during the pandemic compared to those without impairment. These groups did not differ in the frequency of phone or in-person communication. Older adults with OI tended to be less likely to engage in regular e-mail/text/social media communication (61% vs 69% p = .054). When controlling for survey mode, demographic factors, and baseline internet use, those with VI or HI were about half as likely to engage in regular video calling (VI: odds ratio [OR] = 0.54, 95% confidence interval [CI; 0.35, 0.83], HI: OR = 0.60, 95% CI [0.38, 0.92]) (Figure 2). No significant difference was seen for other communication modes or for OI in similarly adjusted analyses.

Figure 2.

Figure 2.

Open in a new tab

Odds ratios (95% CI) of regular (weekly or more frequent) use of (A) video calls, (B) e-mail/text/social media messaging, (C) phone calls, and (D) in-person visits during the COVID-19 pandemic for older adults with sensory impairment compared to without sensory impairment. *p < .05, **p < .01, ***p < .001. CI = confidence interval; COVID-19 = coronavirus disease 2019.

Question 3: Did digital communication protect against depressive feelings associated with sensory impairment? Did this effect differ by communication mode or impairment type?

VI was associated with feeling depressed more frequently during the pandemic among those who never used video calling (β = 0.27, p < .01, Supplementary Table 1, regression analyses with interaction terms). The effect of VI on this increase in depressive feelings was mitigated by the frequency of video call use, with more frequent video calling being associated with decreased VI-associated feelings of depression (interaction β = −0.16, p = .03). Similar results were observed for HI-associated feelings of depression, with increased video call frequency being associated with decreased HI-associated depressive feelings (interaction β = −0.20, p = .01). No such patterns were observed for OI-related feelings of depression and video calling (interaction β = −0.13, p > .05).

Regarding e-mail/text/social media messaging, no significant effect was identified between the frequency of messaging and feelings of depression. The relationship between sensory impairment and feelings of depression did not vary by frequency of e-mail/text/social media communication.

Regarding phone communication, older adults without sensory impairment who called by phone more frequently were less likely to experience depressive feelings (p < .001 for those without VI, without HI; p = .04 for those without OI). However, older adults with VI exhibited the opposite effect, with increased calling by phone being associated with more frequent depressive feelings (interaction p = .01). This association between phone calls and depressive feelings was not observed for HI or OI. Similarly, for in-person communication, older adults without sensory impairment who engaged in in-person communication more frequently were less likely to experience depressive feelings (p < .001 for without VI, without HI, without OI). However, among older adults with sensory impairment, feelings of depression did not vary by frequency of in-person communication.

Women, those with more frequent feelings of depression at baseline in 2015–2016, and those with worse physical health at baseline in 2015–2016 were more likely to feel depressed more frequently during the pandemic, regardless of the presence of sensory impairment (Supplementary Table 1, all p < .001). Those with higher educational attainment (having a bachelor’s degree) experienced more frequent feelings of depression, and those who completed the survey via phone (versus web) were less likely to experience frequent feelings of depression (p < .01). No significant relationship was seen for baseline frequency of internet use on feelings of depression during COVID-19.

Sensitivity Analysis

Due to the prevalence of dual VI and HI, we also tested models controlling for HI in the regression for VI and vice versa to determine the specificity of our results to one particular sensory modality. This yielded results that were consistent, although mildly attenuated. Older adults with VI or HI remained less likely to use video calling compared to those without VI or HI (VI: OR = 0.6, 95% CI [0.38, 0.95], HI: OR = 0.70, 95% CI [0.44, 1.11]). Older adults with VI and HI who video called more frequently remained less likely to experience depressive feelings related to their sensory impairment (VI: interaction p = .04, HI: interaction 0.01).

We also considered the measure of self-reported change in communication frequency as opposed to absolute communication frequency. Most older adults did not increase digital communication because the pandemic started. Using self-reported change in communication frequency, older adults with sensory impairment were not more likely to increase video calling during the pandemic in adjusted analyses. Similarly, digital communication did not mitigate the effect of the sensory impairment on depressive feelings in these analyses.

We also considered separating adults aged 65 and older from adults aged 55–65, as familiarity and use of technology may look different in these groups. Specifically, people with VI or HI who are employed may have access to employer-provided technologies for communication. Regression models using the 65 and older population only yielded not just consistent, but even stronger, main results: The effect of VI on the increase in VI-associated depressive feelings was mitigated by frequency of video call use, with more frequent video calling being associated with decreased VI-associated feelings of depression (55+: interaction β = −0.16, p = .03; 65+: interaction β = −0.22, p < .01). Similar results were observed for HI-associated feelings of depression, with increased video call frequency being associated with decreased HI-associated depressive feelings (55+: interaction β = −0.19, p = .02; 65+: interaction β = −0.23, p < .01). Given consistent main results, the inclusion of age and employment status as covariates, and to be consistent with previous studies on older adults using NSHAP (Hawkley et al., 2021), we present the results of the 55 and older population in the main text.

Finally, we tested alternative cutoffs for defining VI and HI. Results using a less stringent cutoff of four instead of three (yielding more older adults who met criteria for VI or HI) were broadly consistent with the original results. More stringent cutoffs (2) reduced group size to the point of not being useful.

Discussion

We found that older adults with vision or HI were more likely to report feeling depressed during the COVID-19 pandemic, and that video calling, but not conventional phone calling or social media messaging, mitigated feelings of depression associated with vision or hearing loss. Older adults with OI were not more likely to feel depressed compared to those without impairment, and communication did not mitigate depressive feelings associated with OI (which we did not expect to affect communication and thus served as a negative control).

Our study supports the concept that the COVID-19 pandemic had a disproportionate impact on the mental health for people living with sensory impairment. People with VI or HI were more likely to report increased feelings of depression, with the effect being greater for vision than hearing. Adjusting for dual sensory impairment did not significantly alter results. We speculate that the larger effect size for VI may indicate that problems with vision cause a greater degree of functional disability compared to problems with hearing, while the burden of HI is primarily in the social domain (Crews & Campbell, 2004; Heyl & Wahl, 2014; Xiang et al., 2020). For example, during the pandemic, people with VI cited greater difficulty with daily tasks compared to those with HI or those with no impairment due to a lack of help (Bernard et al., 2022; Heinze et al., 2021). People with HI reported less willingness to engage in conversation and difficulty understanding others related to distancing and mask-wearing (Saunders et al., 2021). The greater degree of activity limitation associated with VI may compound the negative effect of communication limitation experienced both by those with VI and those with HI. In contrast to VI and HI, we found that older adults with OI were not more likely to report increased feelings of depression during the pandemic. This may be because the role of olfaction in maintaining intimate social relationships is not reliant on speech (Rochet et al., 2018), but rather is mediated by chemosensory signals when in close proximity to others (e.g., food enjoyment, personal hygiene, and mother–child bonding). Therefore, those with OI and those without OI may have been equally affected by isolation mandates that restricted activity outside the home but not within the home.

Video calling, but not e-mail/text/social media messaging or phone calling, mitigated the effect of sensory loss on increased feelings of depression. Compared to audio alone or written text, video calling may better simulate real-life contact and thereby attenuate depression related to social isolation. Social engagement theory posits that facial expressions observed during conversation improve bonding by signaling active social engagement (Porges, 2003). In addition to displaying body language, video calling allows users to share aspects of their daily life in real-time, a benefit that was cited by 100% of surveyed nursing home residents in an interview-based study (Tsai & Tsai, 2010). These benefits may explain the greater effectiveness and preference for video calling over voice-only modalities during the pandemic. In one study of geriatric patients faced with hospital visitation restrictions, patients reported significantly reduced anxiety and fear of death when video calling compared to phone calling (Dürst et al., 2022). Another study showed that older adults in long-term care and nursing homes preferred video calling to phone calling for connecting with others when given technological assistance (Sacco et al., 2020). For people with VI or HI, dual audio and visual cues can compensate for diminished sensation in one domain.

One counterintuitive finding was that increased frequency of phone calling was associated with greater feelings of depression for older adults with VI. This contradicts recent randomized control trials and cross-sectional studies finding that phone calling had a beneficial effect on depression among older adults writ large (Arpino et al., 2021; Kahlon et al., 2021; Roh et al., 2020). We suspect that older adults with VI who phone called frequently may have been more socially isolated at baseline and that increased phone calling reflected this relative isolation. Increased phone calling may also be a marker of a more severe visual deficit. Those with severe VI may be less adept at using alternative communication methods like video calling that require higher visual acuity to use, therefore, resort to increased phone calling instead.

No significant pattern was identified for the impact of e-mail/text/social media messaging on depressive feelings for older adults with sensory impairment. While it is well established that social media use can increase the risk of depression for young adults, whose use of this mode includes negative comparisons, increased feelings of isolation, and exposure to depressing news (Nesi & Prinstein, 2015; Primack et al., 2019), less is known about its effect on older adults, who may be more resilient to peer pressure (Rossi et al., 2021). Rather, older adults with HI may experience the benefits of social media unique to their conditions. Online text-based communication can enhance the accuracy of verbal transmission and avoids the potential anxiety of face-to-face social interaction (Naylor et al., 2020). Those who identify as deaf have long taken advantage of online communication, as shown by survey studies in which deaf participants were found to make intensive use of the internet and social media for social functions (Pilling & Barrett, 2007; van Wier et al., 2021). In a survey sent to hearing-impaired and nonhearing-impaired teenagers, hearing-impaired teens used the Internet more intensively than their peers (Barak & Sadovsky, 2008). In addition, hearing-impaired teens who used the internet had higher well-being scores than hearing-impaired teens who did not (Barak & Sadovsky, 2008). Many contextual factors likely play a role in the effects of social media on mental health, including the age of the user and the purpose for which social media is used.

We note that we did not observe a significant result when considering a change in self-reported frequency of digital communication (sensitivity analysis) as opposed to current level (main analysis). We believe this may be due to relatively low uptake of digital communication. As most respondents reported maintaining the same frequency of digital communication during the pandemic compared to before, we may not have had a large enough sample of older adults increasing digital communication to detect a pattern. Alternatively, the results regarding change in communication may indicate that increasing digital compensation has a compensatory and beneficial effect on mental health that supersedes any barriers related to sensory impairment at a certain threshold.

Despite potential benefits, older adults with HI or VI use digital communication less than those without deficits (Gell et al., 2015; Henshaw et al., 2012). Our study confirmed this trend, showing that older adults with HI or VI, but not OI, were half as likely to use video calling on a regular basis, even after controlling for factors known to influence technology use, such as baseline internet literacy, education, and age. Physical barriers such as sound distortion and difficulty reading screens can deter older adults with HI and VI from adopting these technologies. Advances in accessibility, including text captioning, wireless connection to hearing aids, enhanced screen contrast, and larger font size, have improved usability to some extent, but physical challenges remain.

Future research should determine how sensory impairment affects mental health, especially how its impact varies based on network size, relationship types, access to and usability of communication, and number and/or type of co-occurring sensory impairments. VI and HI commonly co-occur; in our data set, half of respondents who met criteria for VI also met criteria for HI. Older adults with multiple sensory impairment have been shown to face disproportionate challenges in several aspects of mental health and quality of life (Pinto et al., 2017). Finally, these topics should also be examined in regard to other outcomes, including loneliness and anxiety, which may differ among the impaired versus the unimpaired.

Strengths of this study include the use of a large, nationally representative data set rich with demographic and socioeconomic variables, allowing us to control for many important factors known to affect depression in older adults. Data collected at multiple points in time allowed us to control for baseline internet familiarity and mental health status so we could study how change in internet behavior influenced the change in depressive feelings. Finally, this study is the first to look at the link between sensory function, depression, and digital communication simultaneously, whereas previous studies focused on sensation and depression or digital communication and depression separately.

There are several limitations to our study. Hearing and vision were assessed by interviewer rating rather than objective means, so there may be inter-interviewer discrepancies. We also did not use a full scale to measure depression, so results may not be directly comparable to other studies. Finally, due to the essentially cross-sectional nature of our study, we cannot infer causality.

Conclusion

Video calling had a protective effect against depression for people with sensory impairment during social isolation, yet older adults with hearing or VI were less likely to use this and other digital forms of social communication during the pandemic. Promoting video calling, with special attention to accessibility and inclusion, could be a strategy to improve the mental health of millions of older adults with hearing or vision deficits during this and future crises that impinge on social life.

Supplementary Material

gbac193_suppl_Supplementary_Material
Click here for additional data file. (22.6KB, docx)

Acknowledgments

Thank you to members of the Olfactory Research Group for valuable discussions and to the Pritzker School of Medicine for support. Data from NSHAP are publicly available via the Inter-University Consortium for Politics and Social Research (Waite et al., access listed in references). Analytic methods and study materials are available on request. This study was not preregistered.

Contributor Information

Amanda Zhang, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.

Kristen E Wroblewski, Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA.

Terence E Imbery, Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA.

Martha K McClintock, Department of Comparative Human Development, The Institute for Mind and Biology, University of Chicago, Chicago, Illinois, USA.

Louise C Hawkley, NORC at University of Chicago, Chicago, Illinois, USA.

Jayant M Pinto, Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA.

Funding

The National Social Life, Health and Aging Project is supported by the National Institute on Aging and the National Institutes of Health (R01AG043538, R01AG048511, and AG043538-08S1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest

None declared.

References

  1. Armstrong, N. M., Deal, J. A., Betz, J., Kritchevsky, S., Pratt, S., Harris, T., Barry, L. C., Simonsick, E. M., & Lin, F. R. (2020). Associations of hearing loss and depressive symptoms with incident disability in older adults: Health, aging, and body composition study. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 75(3), 531–536. doi: 10.1093/gerona/gly251 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Arpino, B., Pasqualini, M., Bordone, V., & Solé-Auró, A. (2021). Older people’s nonphysical contacts and depression during the COVID-19 lockdown. Gerontologist, 61(2), 176–186. doi: 10.1093/geront/gnaa144 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barak, A., & Sadovsky, Y. (2008). Internet use and personal empowerment of hearing-impaired adolescents. Computers in Human Behavior, 24(5), 1802–1815. doi: 10.1016/j.chb.2008.02.007 [DOI] [Google Scholar]
  4. Bernard, A., Weiss, S., Rahman, M., Ulin, S. S., D’Souza, C., Salgat, A., Panzer, K., Stein, J. D., Meade, M. A., McKee, M. M., & Ehrlich, J. R. (2022). The impact of COVID-19 and pandemic mitigation measures on persons with sensory impairment. American Journal of Ophthalmology, 234, 49–58. doi: 10.1016/j.ajo.2021.06.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Burholt, V., Windle, G., Gott, M., & Morgan, D. J. (2020). Technology-mediated communication in familial relationships: Moderated-mediation models of isolation and loneliness. Gerontologist, 60(7), 1202–1212. doi: 10.1093/geront/gnaa040 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Crews, J. E., & Campbell, V. A. (2004). Vision impairment and hearing loss among community-dwelling older Americans: Implications for health and functioning. American Journal of Public Health, 94(5), 823–829. doi: 10.2105/ajph.94.5.823 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Disabled users access to and use of communication devices and services—Research summary: All disabled people . (2019). Ofcom. https://www.ofcom.org.uk/__data/assets/pdf_file/0023/132962/Research-summary-all-disabilities.pdf [Google Scholar]
  8. Dürst, A. -V., Graf, C. E., Ruggiero, C., Zekry, D., Boccardi, V., Monney, L., Joss, I., Vuilloud, K., Vespignani, G., Bosshard, W., Mecocci, P., Bula, C. J., & D’Amelio, P. (2022). Fighting social isolation in times of pandemic COVID-19: The role of video calls for older hospitalized patients. Aging Clinical and Experimental Research, 34(9), 2245–2253. doi: 10.1007/s40520-022-02188-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gariépy, G., Honkaniemi, H., & Quesnel-Vallée, A. (2016). Social support and protection from depression: Systematic review of current findings in Western countries. British Journal of Psychiatry, 209(4), 284–293. doi: 10.1192/bjp.bp.115.169094 [DOI] [PubMed] [Google Scholar]
  10. Gell, N. M., Rosenberg, D. E., Demiris, G., LaCroix, A. Z., & Patel, K. V. (2015). Patterns of technology use among older adults with and without disabilities. Gerontologist, 55(3), 412–421. doi: 10.1093/geront/gnt166 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hawkley, L. C., Finch, L. E., Kotwal, A. A., & Waite, L. J. (2021). Can remote social contact replace in-person contact to protect mental health among older adults? Journal of the American Geriatrics Society, 69(11), 3063–3065. doi: 10.1111/jgs.17405 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Heinze, N., Hussain, S. F., Castle, C. L., Godier-McBard, L. R., Kempapidis, T., & Gomes, R. S. M. (2021). The long-term impact of the COVID-19 pandemic on loneliness in people living with disability and visual impairment. Frontiers in Public Health, 9, 738304. doi: 10.3389/fpubh.2021.738304 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Henshaw, H., Clark, D. P. A., Kang, S., & Ferguson, M. A. (2012). Computer skills and internet use in adults aged 50-74 years: Influence of hearing difficulties. Journal of Medical Internet Research, 14(4), e113. doi: 10.2196/jmir.2036 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Heyl, V., & Wahl, H. -W. (2014). Experiencing age-related vision and hearing impairment: The psychosocial dimension. Journal of Clinical Outcomes Management, 21(7), 323–335. [Google Scholar]
  15. Kahlon, M. K., Aksan, N., Aubrey, R., Clark, N., Cowley-Morillo, M., Jacobs, E. A., Mundhenk, R., Sebastian, K. R., & Tomlinson, S. (2021). Effect of layperson-delivered, empathy-focused program of telephone calls on loneliness, depression, and anxiety among adults during the COVID-19 pandemic: A randomized clinical trial. JAMA Psychiatry, 78(6), 616–622. doi: 10.1001/jamapsychiatry.2021.0113 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kakulla, B. (2021). 2022 Tech Trends and Adults 50-Plus. AARP Research. doi: 10.26419/res.00493.001 [DOI] [Google Scholar]
  17. Kern, D. W., Wroblewski, K. E., Schumm, L. P., Pinto, J. M., Chen, R. C., & McClintock, M. K. (2014). Olfactory function in Wave 2 of the National Social Life, Health, and Aging Project. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 69(Suppl. 2), S134–S143. doi: 10.1093/geronb/gbu093 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kožuh, I., & Debevc, M. (2020). The utilisation of social media among users with hearing loss: An analysis of Facebook communities. Universal Access in the Information Society, 19(3), 541–555. doi: 10.1007/s10209-019-00658-x [DOI] [Google Scholar]
  19. Larsson, E., Nilsson, I., & Larsson Lund, M. (2013). Participation in social internet-based activities: Five seniors’ intervention processes. Scandinavian Journal of Occupational Therapy, 20(6), 471–480. doi: 10.3109/11038128.2013.839001 [DOI] [PubMed] [Google Scholar]
  20. Lin, F. R. (2020). Making sense of the senses in aging research. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 75(3), 529–530. doi: 10.1093/gerona/glaa028 [DOI] [PubMed] [Google Scholar]
  21. Luykx, J. J., Vinkers, C. H., & Tijdink, J. K. (2020). Psychiatry in times of the coronavirus disease 2019 (COVID-19) pandemic: An imperative for psychiatrists to act now. JAMA Psychiatry, 77(11), 1097–1098. doi: 10.1001/jamapsychiatry.2020.1225 [DOI] [PubMed] [Google Scholar]
  22. Martiniello, N., Eisenbarth, W., Lehane, C., Johnson, A., & Wittich, W. (2022). Exploring the use of smartphones and tablets among people with visual impairments: Are mainstream devices replacing the use of traditional visual aids? Assistive Technology, 34(1), 34–45. doi: 10.1080/10400435.2019.1682084 [DOI] [PubMed] [Google Scholar]
  23. Mick, P., Parfyonov, M., Wittich, W., Phillips, N., Guthrie, D., & Kathleen Pichora-Fuller, M. (2018). Associations between sensory loss and social networks, participation, support, and loneliness: Analysis of the Canadian Longitudinal Study on Aging. Canadian Family Physician Medecin de Famille Canadien, 64(1), e33–e41. doi: 10.1093/geroni/igx004.2643 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Naylor, G., Burke, L. A., & Holman, J. A. (2020). Covid-19 lockdown affects hearing disability and handicap in diverse ways: A rapid online survey study. Ear and Hearing, 41(6), 1442–1449. doi: 10.1097/AUD.0000000000000948 [DOI] [PubMed] [Google Scholar]
  25. Nesi, J., & Prinstein, M. J. (2015). Using social media for social comparison and feedback-seeking: Gender and popularity moderate associations with depressive symptoms. Journal of Abnormal Child Psychology, 43(8), 1427–1438. doi: 10.1007/s10802-015-0020-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Pilling, D., & Barrett, P. (2007). Text communication preferences of deaf people in the United Kingdom. Journal of Deaf Studies and Deaf Education, 13(1), 92–103. doi: 10.1093/deafed/enm034 [DOI] [PubMed] [Google Scholar]
  27. Pinto, J. M., Wroblewski, K. E., Huisingh-Scheetz, M., Correia, C., Lopez, K. J., Chen, R. C., Kern, D. W., Schumm, P. L., Dale, W., & McClintock, M. K. (2017). Global sensory impairment predicts morbidity and mortality in older U.S. adults. Journal of the American Geriatrics Society, 65(12), 2587–2595. doi: 10.1111/jgs.15031 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Piper, A. M., Brewer, R., & Cornejo, R. (2017). Technology learning and use among older adults with late-life vision impairments. Universal Access in the Information Society, 16(3), 699–711. doi: 10.1007/s10209-016-0500-1 [DOI] [Google Scholar]
  29. Pittman, M., & Reich, B. (2016). Social media and loneliness: Why an Instagram picture may be worth more than a thousand Twitter words. Computers in Human Behavior, 62, 155–167. doi: 10.1016/j.chb.2016.03.084 [DOI] [Google Scholar]
  30. Porges, S. W. (2003). Social engagement and attachment. Annals of the New York Academy of Sciences, 1008(1), 31–47. doi: 10.1196/annals.1301.004 [DOI] [PubMed] [Google Scholar]
  31. Primack, B. A., Karim, S. A., Shensa, A., Bowman, N., Knight, J., & Sidani, J. E. (2019). Positive and negative experiences on social media and perceived social isolation. American Journal of Health Promotion, 33(6), 859–868. doi: 10.1177/0890117118824196 [DOI] [PubMed] [Google Scholar]
  32. Rochet, M., El-Hage, W., Richa, S., Kazour, F., & Atanasova, B. (2018). Depression, olfaction, and quality of life: A mutual relationship. Brain Sciences, 8(5), 80. doi: 10.3390/brainsci8050080 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Roh, H. W., Hong, C. H., Lim, H. K., Chang, K. J., Kim, H., Kim, N. -R., Choi, J. W., Lee, K. S., Cho, S. -M., Park, B., & Son, S. J. (2020). A 12-week multidomain intervention for late-life depression: A community-based randomized controlled trial. Journal of Affective Disorders, 263, 437–444. doi: 10.1016/j.jad.2019.12.013 [DOI] [PubMed] [Google Scholar]
  34. Roh, H. W., Lee, Y., Lee, K. S., Chang, K. J., Kim, J., Lee, S. J., Back, J. H., Chung, Y. K., Lim, K. Y., Noh, J. S., Son, S. J., & Hong, C. H. (2015). Frequency of contact with non-cohabitating adult children and risk of depression in elderly: A community-based three-year longitudinal study in Korea. Archives of Gerontology and Geriatrics, 60(1), 183–189. doi: 10.1016/j.archger.2014.09.007 [DOI] [PubMed] [Google Scholar]
  35. Rossi, R., Jannini, T. B., Socci, V., Pacitti, F., & Lorenzo, G. D. (2021). Stressful life events and resilience during the COVID-19 lockdown measures in Italy: Association with mental health outcomes and age. Frontiers in Psychiatry, 12, 635832. doi: 10.3389/fpsyt.2021.635832 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Rutherford, B. R., Brewster, K., Golub, J. S., Kim, A. H., & Roose, S. P. (2018). Sensation and psychiatry: Linking age-related hearing loss to late-life depression and cognitive decline. American Journal of Psychiatry, 175(3), 215–224. doi: 10.1176/appi.ajp.2017.17040423 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Sacco, G., Lléonart, S., Simon, R., Noublanche, F., Annweiler, C., & Study Group, TOVID. (2020). Communication technology preferences of hospitalized and institutionalized frail older adults during COVID-19 confinement: Cross-sectional survey study. JMIR MHealth and UHealth, 8(9), e21845. doi: 10.2196/21845 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Santini, Z. I., Koyanagi, A., Tyrovolas, S., Mason, C., & Haro, J. M. (2015). The association between social relationships and depression: A systematic review. Journal of Affective Disorders, 175, 53–65. doi: 10.1016/j.jad.2014.12.049 [DOI] [PubMed] [Google Scholar]
  39. Saunders, G. H., Jackson, I. R., & Visram, A. S. (2021). Impacts of face coverings on communication: An indirect impact of COVID-19. International Journal of Audiology, 60(7), 495–506. doi: 10.1080/14992027.2020.1851401 [DOI] [PubMed] [Google Scholar]
  40. Tsai, H. -H., & Tsai, Y. -F. (2010). Older nursing home residents’ experiences with videoconferencing to communicate with family members: Older nursing home residents’ experiences. Journal of Clinical Nursing, 19(11–12), 1538–1543. doi: 10.1111/j.1365-2702.2010.03198.x [DOI] [PubMed] [Google Scholar]
  41. Waite, L. J., Cagney, K. A., Dale, W., Hawkley, L. C., Huang, E. S., Lauderdale, D. S., Laumann, E. O., McClintock, M. K., O’Muircheartaigh, C. A., & Schumm, L. P. (2017). National Social Life, Health, and Aging Project (NSHAP): Round 3 and COVID-19 Study, [United States], 2015-2016, 2020-2021: Version 7 (Version v7) [Data set]. ICPSR—Interuniversity Consortium for Political and Social Research. doi: 10.3886/ICPSR36873.V7 [DOI] [Google Scholar]
  42. van Wier, M. F., Urry, E., Lissenberg-Witte, B. I., & Kramer, S. E. (2021). A comparison of the use of smart devices, apps, and social media between adults with and without hearing impairment: Cross-sectional web-based study. Journal of Medical Internet Research, 23(12), e27599. doi: 10.2196/27599 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Xiang, X., Freedman, V. A., Shah, K., Hu, R. X., Stagg, B. C., & Ehrlich, J. R. (2020). Self-reported vision impairment and subjective well-being in older adults: A longitudinal mediation analysis. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 75(3), 589–595. doi: 10.1093/gerona/glz148 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

gbac193_suppl_Supplementary_Material
Click here for additional data file. (22.6KB, docx)

Articles from The Journals of Gerontology Series B: Psychological Sciences and Social Sciences are provided here courtesy of Oxford University Press

RESOURCES