Figure 4. Synthesis of studies included in the integrative review. Ribeirão Preto, SP, Brazil, 2020.

Authors/Year	Categories	Objectives	Study Design	Main Results	Conclusions
Aarts, Peek, Wounters (2015) 25	1.The use of the internet	To identify whether the use of social networks is related to a lower level of loneliness and improved mental health.	Quantitative study, carried out with 626 Dutch older adults. A formulated question was used to determine the use of social networks, as well as the instruments: Loneliness Scale and Mental Health Inventory. The questionnaires were applied online, and those older adults who did not have a personal computer or internet access, and who wanted to participate in the study, received equipment for data collection.	A total of 56.2% (n=352) of the participants reported using social media several days a week. The use of social networking sites was not related to loneliness in general and emotional and social loneliness in particular, or to mental health. Older adults aged 65 to 74 had lower levels of mental health compared to those aged 60 to 64. The number of medical conditions present was significantly related to lower levels of mental health.	The use of social media was not related to loneliness and mental health. There were no differences in levels of loneliness and/or mental health between users who had access to social media and those who did not.
Jones, et al. (2015) 26	1.The use of the internet	To assess the impact of a project on loneliness, well-being and the perceived value of using the internet, aimed at older adults.	Quantitative study, carried out with 144 older adults in the United Kingdom. The intervention activities were carried out through individual sessions or in small groups with the aim of teaching how to use the internet. The instruments used were: Lubben Social Network Scale (LBNS-6), De Jong Gierveld Loneliness Scale (DJG-6), Warwick-Edinburgh Short Mental Well-Being Scale (SWEMWBS), Life Satisfaction Scale, Independence, using a question from the index of the measure Investigating Choice Experiments for the Preferences of Older People Capability measure (ICECAP) and questions from the Personal eHealth Readiness Questionnaire (PERQ).	The results showed that the number of contacts with other people increased from 13.7 to 17.6; loneliness scores were reduced from 2.38 to 1.80; and mental well-being improved from 24.06 to 24.96. Participants valued better communication with family and friends and highlighted better health care with the use of the internet. Having the internet was valued less compared to having a TV, however, more than, for example, having a weekly visit from a cleaning lady.	The social networking of the participants increased, their loneliness decreased, and their mental well-being improved after the intervention. Better communication with family and friends as a benefit of using the internet was ranked highest out of six aspects by the older adults, followed by being entertained or stimulated and feeling more confident related to their newly learned skills.
Delello, McWhorter (2017) 27	2. Communication Devices	To assess whether Information and Communication Technologies (ICTs), specifically, iPads, improved the lives of the older adults.	Mixed methods study, carried out in a community center with 19 older adults in 2014. Training sessions were offered in small groups, fortnightly. After the 6-week training period, a new assessment was performed with demographic information, multiple-choice questions and open-ended questions.	In the pre-test results, 13 (68%) of the participants reported being unfamiliar with an iPad prior to training. In post-experience surveys, 16 (90%) of the respondents rated their iPad use at a “medium to high” skill level.	The use of the technology increased knowledge, fostered closer family ties, and led to a greater overall connection to society.
Czaja, et al. (2018) 28	3.Types of Communication	To gather evidence on the value of a Simple Computer System, Designed for older adults (Personal Information and Social Management System -PRISM).	Mixed methods study. A randomized and controlled clinical trial was carried out with 300 participants, 150 older adults in the Intervention Group - PRISM (IG) and 150 older adults in the Control Group - Binder (CG), in three cities in the United States. The intervention involved the use of a special interface aimed at the older adult population (PRISM). It lasted 12 months, with assessments at baseline, 6, and 12 months after randomization. The study population consisted of older adults who lived alone and were at risk of social isolation. The control group was called Binder and received only printed content. Instruments used: Friendship Scale, Loneliness Scale, Interpersonal Support Evaluation List, Lubben Social Network Index, Quality of Life Scale, Perceived Vulnerability Scale, and the SF-36. Longitudinal data on the impact of access to the PRISM system were also collected.	The participants in the PRISM group reported less loneliness and increased social support and perceived well-being 6 months after the start of the study, as well as a greater decline in social isolation, when compared to the Binder group. Group differences were not maintained at 12 months; however, those in the PRISM condition maintained gains beyond baseline values in the loneliness and social support outcomes.	Access to technology applications such as the PRISM can increase social connectivity and reduce loneliness among older adults and has the potential to change attitudes towards technology and increase self-efficacy in using technology.
Zamir, et al. (2018) 29	3.Types of Communication	To identify barriers and facilitators for implementing video calls for older adults in care settings.	Qualitative study, with an action research approach. An intervention was carried out with the implementation of video calls, through a simple mobile device, with the name: Skype on Wheels (SoW). The project was carried out in hospitals and homes for older adults in the United Kingdom, with the participation of 8 older adults and 8 family members, performing video calls. An ethnographic approach consisting of observations, unstructured interviews, writing of memos, feedback forms and reflective diaries was undertaken to collect data from a small number of cases. Variables were analyzed according to themes, such as: attitudes, care environment, loneliness and isolation.	About half of the residents used video calling once or twice a month after implementation. The rest held video calls less frequently, taking advantage of opportunities like birthdays, important family occasions, or when close family members went on vacation. There were barriers with the device, due to its peculiar design, internet problems and anxiety when handling the small screen (cell phone). However, regarding the signs of loneliness and isolation, the participants showed a positive reaction to staying close and reconnecting with family members, only presenting insecurity related to self-esteem and appearance due to hospitalization.	The SoW intervention can help older people in care settings to become better connected with their families, however, if implemented as part of a rigorous assessment, co-production of the intervention at each recruitment site may be necessary to overcome barriers and maximize engagement.
Jarvis, Chipps, Padmanabhanunni (2019) 30	2.Communication Devices	To explore older people’s experiences and assessments of the usefulness of an intervention to reduce feelings of loneliness.	Qualitative study with 32 older adults, 15 (IG) and 17 (CG), who lived in a residential care complex in Durban, South Africa. Participants in the intervention group received training in the use of smartphones and a chat application (WhatsApp). Results were measured through discussion in a focus group. Content analysis was performed to evaluate the group discussions and social media data.	The intervention group showed improvement in their levels of loneliness. The intervention reduced loneliness through four main means, namely: strengthening existing social bonds, facilitating the development of new social contacts, promoting cognitive flexibility, and increasing self-efficacy and self-confidence.	The analyses indicated that the cell phone was used to alleviate the perceptions of loneliness and isolation, therefore facilitating the construction of the social network, increasing self-efficacy and improving the cognitive flexibility of the older adults.
Srivastana, Panigrahi (2019) 31	1.The use of the internet	To assess whether the use of ICTs has a positive effect on the social participation of older adults, whether social isolation has a negative effect on their social participation, whether loneliness moderates the effect of ICTs on social isolation, and whether loneliness moderates the influence of social isolation on social participation.	Quantitative study carried out in India with 240 participants. An instrument developed and validated by the researchers was used, covering sociodemographic data and the use of ICTs such as WhatsApp, Facebook and e-mail. For the variables of social isolation, social participation and loneliness, a Likert-type scale was used, with questions taken from the Loneliness Scale (UCLA), social isolation constructs and definitions of terms by the researchers, to ensure a greater ease of response for the older adults.	The older people who used ICTs were less socially isolated. The ability to access and disseminate information had positive effects, due to maintaining connections and managing new connections. Older adults who did not have a network of contacts did not use ICTs, directly affecting their contacts with friends and family. Loneliness did not impact the relationship between social isolation and social participation, however, it had a significant effect on the relationship between ICTs and social isolation, concluding that in the sample, lonely older people did not use ICTs, which was associated with greater isolation.	For the older adults, social inclusion depended on the use of specific ICTs for socialization. This can help older adults to participate more in the current techno-society, however programs and policies are needed that promote the use of specific ICTs for socialization among them, since their use can increase the level of activity, which can lead to an increase in social participation and a reduction in social isolation.
Neves, et al. (2019) 32	2.Communication Devices	To evaluate the feasibility of an application for the older adults public on a communication device (iPad)	Mixed methods study, carried out with 12 older adult residents of a Long Stay Institution for the Elderly (LSIE), in Canada. Participants used the tablet with the application for 3 months. The application had an easy-to-understand interface, with four options (automatic messages, video, photo or voice recording) all for the purpose of communication. There was a pre, middle and post research stage. In the pre-stage, an individual training session and application of the Social Support Scale (Duke Social Support Scale) and Solitude Scale (UCLA) were performed, as well as semi-structured interviews with participants and family members. In the middle of the study period, the printed manual and tablet with the application were delivered for use during the 3 months, after half the time, the scales were reapplied. In the post-stage, the application of the scales was repeated, interviews were carried out with family members and usability and accessibility tests were carried out.	Audio was the most used function, followed by image messages and then video. For some, the audio option was easier to use than cell phones, which are often “too small” and “difficult to operate”. The app was seen as an additional means of communication and the relatives of three older women reported an increase in the frequency of communication due to the use of the tool. The app influenced the perception of well-being of 7 of the 12 participants, who reported an impact on their positive mood, self-efficacy and comfort with technology.	Despite being older adult residents of an LSIE, and being vulnerable to social isolation and loneliness, no participant showed high levels of social isolation. The tool may have been less effective for these older adults, especially since at least one bond (available and participatory) is necessary for social interaction.
Fang, et al. (2019) 33	1.The use of the internet	To examine the association between ICT use and psychological adjustment, psychological distress and sense of community among older adults and whether these factors depend on their levels of loneliness.	Quantitative study performed with 738 older adults in Hong Kong. The interviews were carried out by telephone. The use of ICTs was evaluated through two questions, on a Likert-type scale. Loneliness was assessed using the Revised Loneliness Scale (R-UCLA), psychological stress using the Kessler Scale, and sense of community using the Brief Sense of Community Scale (BSCS). Sociodemographic variables, financial sufficiency and self-rated health were also evaluated.	More frequent ICT use was associated with a lower psychological adjustment and higher levels of loneliness among the older adults. There was no correlation between ICT use and loneliness, psychological distress or sense of community with moderate significance. Loneliness was negatively associated with psychological distress and sense of community. The sample results suggested that ICT use predicted more psychological distress only among the loneliest older adults. ICT use predicted a lower sense of community among the lonelier older adults.	The use of ICTs was not necessarily beneficial for the sample. The authors highlighted the need for professionals and researchers to be vigilant about the symptoms that problematic Internet use causes in older adults, especially among the lonely and socially vulnerable. The risks of ICT use among older people are much less understood than its potential benefits. Identifying the mechanisms and limiting conditions related to problematic use is essential to make the most of the benefits that ICTs bring.
Ten Bruggencate, Luijkx, Sturm (2019) 34	2.Communication Devices	To assess the role that social technology plays in the social life of older people	Qualitative study with 15 older adults who regularly (more than once a week) used some form of social technology (WhatsApp, Facebook, Skype, email). The interviews covered topics such as: Attitude (how they felt about social technology?). Questions of why and how they started using social technology. What, with whom (network), but mainly why (reasons) the older people used social technology. Especially covering situations where the older adults used social technology.	The social technological devices (hardware) most used by the participants were the landline phone, the smartphone and the tablet. The applications most used by the participants were WhatsApp and email. The use of most participants was influenced by their children and grandchildren; the participants reported that social technology is a good resource to communicate and contact them. The role social technology played in the participants’ lives and the time they spent using social technology varied. Most participants used social technology every day because it allowed them to communicate more easily with their friends and family. Some of the participants emphasized that they could not live without social technology. There were reports that social technology was a means or resource to connect the older person to the members of their network and to society.	Social technology strengthened the older people’s existing social relationships and structures and brought depth and fun to social relationships.
Tsai, et al. (2020) 35	3.Types of Communication	To evaluate the effect of a smartphone-based videoconferencing program on feelings of loneliness, depressive symptoms and quality of life of LSIE residents.	A quantitative, quasi-experimental study carried out among 62 older people living in Long Stay Institutions for the Elderly (LSIEs) in Taiwan. Participants were divided into the IG=32 and CG=30. The intervention consisted of interaction with family members once a week (minimum of 5 minutes) for 6 months, using a smartphone and the LINE application. Data were collected at 1, 3 and 6 months, using the self-report instruments: Mini Mental State Examination (MMSE for inclusion criteria), Loneliness Scale (UCLA), Geriatric Depression Scale, Quality of Life (SF-36).	The smartphone video conferencing intervention reduced feelings of loneliness in the older adult residents at 1, 3, and 6 months. The IG was older than the CG. The decrease in feelings of loneliness scores from baseline to 6 months was significantly greater in the IG than in the CG. The videoconference intervention did not improve the residents’ depressive symptoms at any time, however, it had positive effects on vitality at 6 months, in addition, it had positive effects on QoL indicators for pain, vitality and physiological dimensions of health at 6 months, but not on physical function.	It was suggested that allowing older residents to use these communication and information technologies improves their overall outlook, as well as them reporting that they “felt young” or “became members of the modern generation”.