Rewiring Connection: The Potential for Digital Technology to Address Loneliness and Depression Among Older Adults

Loneliness and social isolation increase the risk of premature death, disease, depression, and dementia.^1–3 The risks are so significant that the U.S. Surgeon General identified loneliness and social isolation as an epidemic in 2023,⁴ comparing the increased risk of premature death to that of smoking 15 cigarettes a day.¹ Social connection includes more than just the number of relationships but also their frequency, dependability, and level of satisfaction. The COVID-19 pandemic amplified the significant risks posed by loneliness and social isolation for individual health and longevity. It also led to technology rapidly developing as a means to improve social connection. Technology can increase opportunities to be in touch with friends and family, provide avenues for social participation for those with disabilities or mobility difficulties who may not have ease of access to social outlets, and provide spaces for connection and support.⁵ However, technology can also be harmful to social connectedness and may amplify loneliness and social isolation by replacing in-person opportunities, diminishing the quality of our interactions, and can even reduce self-esteem.⁶ This, in turn, can lead to greater loneliness and reduced social connection.

Research indicates that while 75% of adults over the age of 65 utilize the internet, older adults feel the least confident in their technology-related skills.⁴ Additionally, while society’s transition to including technology in all aspects of life feels all encompassing, it is important to note that technological resources are not equitably available. Research indicates that ethnically diverse groups utilize technology the least,⁷ and satisfaction with some forms of digital connectedness is low among patients with depression.⁸

In this issue of Journal of General Internal Medicine (JGIM), Xie et al. correctly bring to the forefront the dearth of research investigating ethnically diverse older adults with depression; and therefore, they aim to assess their experiences with technology during the COVID-19 pandemic. In this paper, the team describes a qualitative exploration of individuals participating in a randomized psychosocial trial about a clinically focused telehealth peer support intervention (PEERS) designed for older adults with diagnosed depression. The population of focus is non-white minoritized and “underserved” (defined by lower socio-economic status) in the randomized controlled trial (RCT) design and is central to the analysis.

Authors nicely foreground their population of interest, given known challenges with digital technology use among less affluent groups and limited social networks among many older adults, particularly with depression. They also note tensions in the known benefits and drawbacks of virtual forms of connection, with some studies demonstrating “displacement” or digital connection as a poor substitution and others demonstrating “stimulation” or enhanced connecting via digital applications. They also nicely describe how poor substitution can be at least partially explained by structural and social barriers to use. Thus, there exists a need to determine which of these factors are important and how they come into play to mitigate loneliness and depression.

The team conducted 67 interviews as the basis for a thematic inductive analysis. Roughly two-thirds of the sample received the intervention with the remainder receiving the control (study staff informal socialization via phone). The vast majority were single women living alone, and most reported having a health-related social need. The median age was 71 years. Half identified as Black. On average, the group met the criteria for moderate depression.

The analysis constructed four themes categorized into two domains: social disruption because of COVID-19 and technology challenges. Within each domain, the analysis presents an overall picture, and amplified effects on minoritized/underserved groups. Central findings, which are largely supported in the literature (papers cited and others⁹) suggest that COVID-19 was a time of great social strain, but for most of the participants the virtual care option did not address the deficits. Though the authors do not reflect on their initial framework, their findings suggest that, among those interviewed, virtual displacement was more likely to occur compared to a stimulated or enhanced experience. This experience was particularly acute for those with fewer resources and where the technology barriers — from availability to ability — were more pronounced.

Authors note some limitations, including the extent to which their sample missed additional heterogeneous characteristics (they did not speak with severely depressed individuals, or non-English speakers). Other areas that we might want to go farther to think about — and indeed, what stimulated our thinking — are the need to address what authors describe as “understanding the nuances of technology to relieve social isolation.” We suggest paying greater attention to this call in the following ways.

First, do we sufficiently understand the clinical nuances of using technologies to address the interconnections between isolation, social support, and clinical depression? In other words, when individuals engage in a technological platform premised on forging social connections, are they addressing one, some, or all of these challenges? It seems that by better understanding the associated mechanisms of action, we can better optimize clinical tools to address separate and related social and mental health needs.

Second, is technology able to “stimulate” or enhance social support outside of clinical interventions? This study focuses on technology to participate in clinically driven support, but what are the experiences of older adults with clinical depression embarking upon more naturalistic or everyday uses of technology to make socially supportive connections? Programs that incorporate story-making, affinity, and interest groups such as the Life Story Club are designed to bring older adults together to share stories and connect.¹⁰ There is also a range of available technologies and applications designed for social connecting (e.g., Facetime, WhatsApp, voice and video recordings), some synchronous and others asynchronous. Are these effective at combating loneliness in older adults with depression? How would these approaches need to be adapted or tailored to stimulate value for these populations?

Third, the reviewed study was conducted during the COVID-19 pandemic, a time when being in face-to-face social relations brought about great fear for personal health and safety. It is important to consider the ways in which technology fits into the present landscape, as those social fears largely abate, to foster greater social connection. Participants reported significant social conflict due to sheltering in place as well as a real difficulty finding support when they did not live with someone who understood technology. When we take the constraints due to the pandemic out of the contributing burden, how does technology fit into the landscape to foster greater social connection? What are the best methods or levels of support required when available resources have changed in a post-pandemic world? What are the ways in which in-person and virtual connection optimally combine and interact?

These are obviously more questions that any one study can address. With Xie et al. starting the conversation, we hope for more intellectual investment to understand technological possibilities and rewire and harness its innovations in thoughtful, inclusive, and socially connected ways.

Data Availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.