Changes in depressive symptoms, social support, and loneliness over 1 year after a minimum 3-month videoconference program for older nursing home residents

“Residents’ physical status and cognitive status were measured at baseline using the Barthel Index [32], which assesses performance of activities of daily living (ADLs), and MMSE [26], respectively.”

“Differences between groups were compared at four points (baseline, 3 months, 6 months, and 12 months) using multiple linear regression with the generalized estimating equation (GEE) method [37].”

“Similarly, after controlling for residents’ age and length of residency, the changes in GDS scores were on average significantly lower in the experimental group than in the comparison group at 3, 6, or 12 months (beta = –2.64, –4.33, and –4.40, respectively, all P .001).”

“Residents’ physical status and cognitive status were measured at baseline using the Barthel Index [32], which assesses performance of activities of daily living (ADLs), and MMSE [26], respectively.”

“As shown in Table 3, the average UCLA Loneliness Scale score of the experimental group was higher at baseline than that of the comparison group (beta = 3.94, P = .09).”

“Appraisal support or so-called affirmational support involves communicating information that is relevant to self-evaluation, rather than to problem solving [15,16].”

“These results are consistent with those of another study done in the United States [41] showing that loneliness was significantly reduced in 22 community-dwelling elderly people after 4 months of computer use.”

“This finding likely explains why depression and loneliness did not significantly change after intervention in White and colleagues’ study [40].”

“This prevalence of depression varied from 25% to 45% in Western countries [5,6] and was 52%–54% in Taiwan [7-9].”

“Our 1-year attrition rate was high (35/90, 39%), as previously reported in similar longitudinal studies [38,39].”

“Elderly nursing home residents in Taiwan were shown by Tsai and colleagues [24] to have significantly fewer depressive symptoms and less loneliness after a 3-month program of 5 minutes/week of videoconference interactions with family members.”

“The sample size was estimated based on the rule that 15 participants were needed for each variable [25].”

“Among these interventions, social support is one of top importance because the social support systems older people use are closely related, both in quality and in quantity, to their health and quality of life [13,14].”

“Older people who live in nursing homes have a higher prevalence of depression, which contributes to excessive morbidity [3], than do those who live in communities [4].”

“Although most nursing home residents have become functionally dependent due to poor physical health, their psychosocial needs do not decrease [17].”

“Nursing home placement has been widely discussed in the literature as a stressful life event that challenges older people [2].”

“This weekly frequency was chosen to reflect the frequency of in-person visits to a nursing home resident for the majority of families [28,29], and 3 months was chosen to allow them time to adjust to the new videoconference program [30,31].”

“Thus, interventions have been used to enhance the quality of life in this group of people [12].”

“This weekly frequency was chosen to reflect the frequency of in-person visits to a nursing home resident for the majority of families [28,29], and 3 months was chosen to allow them time to adjust to the new videoconference program [30,31].”

“These results might be due to videoconference use providing a “social presence” to older adults [42].”

“Providing real-time audiovisual telecommunication systems to nursing home residents in Hong Kong [21] and Japan [22] has been shown to add a new dimension for the majority who lack the skills and capacities to adapt to the nursing home environment.”

“Providing real-time audiovisual telecommunication systems to nursing home residents in Hong Kong [21] and Japan [22] has been shown to add a new dimension for the majority who lack the skills and capacities to adapt to the nursing home environment.”

“Our videoconferencing program was funded by the National Science Council, an agency of the Taiwan government (NSC97-2314-B-182-018), to Hsiu-Hsin Tsai, Principle Investigator.”

“Many nursing home residents also experience loneliness [10], which has been associated with cognitive deterioration and hopelessness [11].”

“Videoconferencing has also been demonstrated as a feasible way to promote social interactions among nonspeaking people living in communities [20] and between the frail elderly and their caregivers [23].”

“This weekly frequency was chosen to reflect the frequency of in-person visits to a nursing home resident for the majority of families [28,29], and 3 months was chosen to allow them time to adjust to the new videoconference program [30,31].”

“This prevalence of depression varied from 25% to 45% in Western countries [5,6] and was 52%–54% in Taiwan [7-9].”

“This weekly frequency was chosen to reflect the frequency of in-person visits to a nursing home resident for the majority of families [28,29], and 3 months was chosen to allow them time to adjust to the new videoconference program [30,31].”

“Older people who live in nursing homes have a higher prevalence of depression, which contributes to excessive morbidity [3], than do those who live in communities [4].”

“Our videoconferencing program was funded by the National Science Council, an agency of the Taiwan government (NSC97-2314-B-182-018), to Hsiu-Hsin Tsai, Principle Investigator.”

“They also might feel comforted by seeing their family member’s actual state and would not worry that the family member was hiding a problem to allay anxiety if he or she could not visit [45].”

“Our videoconferencing program was funded by the National Science Council, an agency of the Taiwan government (NSC97-2314-B-182-018), to Hsiu-Hsin Tsai, Principle Investigator.”

“Our videoconferencing program was funded by the National Science Council, an agency of the Taiwan government (NSC97-2314-B-182-018), to Hsiu-Hsin Tsai, Principle Investigator.”

“Our videoconferencing program was funded by the National Science Council, an agency of the Taiwan government (NSC97-2314-B-182-018), to Hsiu-Hsin Tsai, Principle Investigator.”

“Many nursing home residents also experience loneliness [10], which has been associated with cognitive deterioration and hopelessness [11].”

“However, one-third of nursing home residents were found to seldom have visitors [18].”

“Though family members may have limited time to visit residents in person, telephone calls can reduce residents’ loneliness [20].”

“…(for a review, see Choi, Kong, & Jung, 2012), and among the elderly, brief interventions such as videoconferencing with friends and family (Tsai & Tsai, 2011) or simply learning to use social technologies (Cotton et al., 2013; Fokkema & Knipscheer, 2007; Shapira, Barak, & Gal, 2007) have…”

“RCTs comprised 6 studies [36,39,43,47,51-52]; another 6 were cohort studies (2 with a control group [30,35] and 4 without [31,38,41,44]).”

“Internet Use, Contact with Others, and Loneliness Among Older Adults Internet use enables older adults to stay in contact with others [20,21] and communicate with their social ties [22,23].”

“These two interventions involved videoconferenced interactions with family members.(68,69) One videoconference intervention was rated effective, with marked reductions in loneliness.”

“Increased social engagement has been linked to decreased risk of cognitive decline (T. F. Hughes et al., 2013), and interventions aimed at increasing social engagement have been shown to decrease depression and loneliness (e.g., Tsai & Tsai, 2011).”

“Previous evidence is mixed on whether use of the internet reduces or enhances loneliness [63,64], but this review suggests that internet-based peer interaction may have a benefit for family caregivers.”

“Symptoms of depression Three studies comparing video calls and usual care examined symptoms of depression using the Geriatric Depression Scale (Tsai 2010; Tsai 2011; Tsai 2020).”

“Social facilitation Videoconference program 2 None 1 Good quality RCT [47], 1 Fair quality RCT [48] Mutual help network 1 None 1 Fair quality NRCT [65] Other 2 2 Good quality RCTs [46, 51] None”

“Whilst Tsai and Tsai (2011) did not record a mean average age, they identified that 48% of their sample were under 65.”

“Interaction via videoconference has also been shown to reduce depression and loneliness in elderly nursing home residents [24].”

“However, this contrasts with that of other studies, where one-to-one settings using non-PA interventions were more effective in reducing loneliness in older healthy adults (Banks et al., 2008; Findlay, 2003; Kahlbaugh et al., 2011; Tsai et al., 2011), according to Hagan et al.”

“Tsai, 2011 Taiwan Nursing home residents (N¼90) Exclusion: moderate or severe cognitive impairment (MMSE score 16 for those with no formal education or MMSE score 20 for those with at least a primary school education) Nursing homes randomized Pretestposttest (2 groups) Videoconferencing (at…”

“Previous studies have revealed that face-to-face contact through video-calls may be more useful for older people than telephone calls or written correspondence in reducing loneliness [9 – 11].”

“Tsai and Tsai (41) show that only 3 months of 5 minutes per week of videoconferencing interaction with family alleviated depressive symptoms and loneliness for nursing home residents, as compared to a control group, over a period of a year.”

“…those living in institutions (Drageset, Kirkevold, & Espehaug, 2011; Savikko, Routasalo, Tilvis, Strandberg, & Pitkälä, 2005; Tijhuis et al., 1999; Tsai & Tsai, 2011), although the significance of social resources among those living in their own homes compared with those living in institutions…”

“Only two studies included long-term follow-up (greater than 14weeks), assessing loneliness changes up to five and 12months post-intervention, respectively (Chiang et al., 2010; Tsai & Tsai, 2011).”

“…stress reduction has been shown to improve self-compassion in medical students (Erogul, Singer, McIntyre, & Stefanov, 2014 Loneliness may be modifiable through use of technology to facilitate social interactions (Tsai & Tsai, 2011) or to foster new relationships (Weinert, Cudney, & Hill, 2008).”

“Accordingly, it is indicated that participation in internet-based activities and the use of SIBAs in interventions for older adults might reduce experiences of loneliness (Ballantyne et al., 2010; Cotten et al., 2013; Tsai and Tsai, 2011).”

“Some studies reported that moderate internet usage had a positive effect on older adults’ mental health [59,60], while other studies indicated that frequent or problematic internet use could exacerbate loneliness through increasing social isolation, and reducing offline social interaction with family, friends or other…”

“The social internet, e.g. Facebook 53 and video conferencing 54 have long been used to socialise with friends and family and have been found to be an affective intervention for reducing loneliness.”

“Nine RCTs were grouped in this broad category, which included studies from Taiwan (n = 3) (Tsai and Tsai, 2011; Chen et al., 2015; Huang et al., 2016), the United States (Jessen et al., 1996; Rosen et al., 1997), the Czech Republic (n = 1) (Vankova et al., 2014), South Africa (n = 1) (le Roux and…”

“Among the 27 programs included in this review, only 2 (7%) programs were conducted in Asian countries [54,79].”

“As an intervention to reduce loneliness and social isolation, video calls are recommended to maintain the social network [18,19].”

“The authors also observed specific, purposeful technology trainings to be effective in reducing loneliness, including programs utilizing mobile phones (135), electronic pen pals (163), and videoconferencing software (147, 151, 152).”

“In a study of Taiwanese nursing home residents, depressive symptoms were decreased after a video-conference intervention that taught them how to use the Internet and to arrange videoconferencing appointments with their distant relatives (Tsai & Tsai, 2011).”

“…(40) USA Videophone 3 months Assisted Living, Retirement Facility Tsai et al. (2010) (27) Taiwan Laptop (Skype, MSN) 3 months Nursing Home Tsai and Tsai (2011) (23) Taiwan Laptop (Skype, MSN) 12 months Nursing Home Siniscarco et al. (2017) (24) USA Tabletop (Skype) 2 months Nursing Home Zamir et…”

“Further, there was some evidence across studies that interventions focused on using video chat/video conferencing (also especially with family members) were more effective in relieving older adults ’ loneliness and depressive symptoms than other functions of social media (Teo et al ., 2019, Tsai et al ., 2010; Tsai &…”

“The use of technologies such as videocalls or/and calls is likely to be less effective in residents with dementia than in other types of residents (16, 24).”

“There is a group of studies employing cross-sectional research designs which found internet use beneficial in reducing loneliness (Sum et al., 2008; Lelkes, 2013; Heo et al., 2015; Tsai and Tsai, 2011; Blažun et al., 2012).”

“As far as treatment delivery is concerned, interventions were administrated by external experts (23, 26–30, 33, 34, 36, 37, 39, 41, 43–47, 50–52, 54, 55, 57, 59, 60, 62–65, 68, 70–74) or trained staff (31), and in many cases by experts, together with the involvement of staff members (21, 22, 32, 38, 40, 48, 49, 53, 56…”

“The possibilities of VR to alleviate loneliness and social isolation have been studied in [159,160] and the video-conference interaction program in [161].”

“Since video chat provides the richest media for mimicking in-person contact, it has a fundamental benefit for increasing social and emotional connectedness, in turn reducing feelings of loneliness (Tsai and Tsai, 2011; Teo et al., 2019; Ibarra et al., 2020).”

“Choi et al. [56] proposed that using technology products can enhance social support among older adults through activities such as video calls with family or friends [57], communication [58, 59], or simply learning how to use technology products [60–62].”

“The effectiveness of video calls with family in reducing psychological distress has been demonstrated (Tsai & Tsai, 2011) and such video calls could be facilitated and especially encouraged frequently and on a regular basis by long-term care facilities (Gorenko et al., 2021).”

“…to be at a low risk of attrition bias (Slegers et al., 2008) and five studies were at a high risk of attrition bias (Shapira et al., 2007; Tsai and Tsai, 2011; Hind et al., 2014; Tsai et al., 2015, 2020) as a relatively large number of participants in these studies did not complete the training…”

“…performance (e.g., Ball et al., 2002; Shatil et al., 2014; Ballesteros et al., 2015; Kim et al., 2015), depression (e.g., Spek et al., 2007; Tsai & Tsai, 2011; Preschl et al., 2012; Dear et al., 2015a; Jøranson et al., 2015; Titov et al., 2015; Firth et al., 2017a), anxiety (e.g., Zou et al.,…”

“Frequency of ICT use decreased over time, while the length of calls increased Tsai and Tsai (2011)36 Longitudinal quasi- experimental study Videoconferencing RACF 60+, no smartphone videoconferencing experience, friends or family members willing to participate Improved perceived loneliness at 3, 6…”

“Indeed, previous studies on long-term care facility residents’ remote social ties have used standardized scales, such as the Geriatric Depression Scale [10], combined with loneliness and social support behavior scales [11] or with loneliness and quality of life scales [30].”

“7 (53,8) 3 (23,1) Time since LTCH admission [Months: mean § SD (range)] 31,3 § 20,9 (7-87) Family caregivers (n = 13) Age (years) [mean § SD (range)] 59,6 § 10,3 (42-74) Gender Female [number.”

“Telehealth physical activity interventions with a social component have been less studied, yet there are some promising findings regarding efficacy for decreasing feelings of loneliness and depression [27].”

“(2020) examined whether smartphone-based videoconferencing for NH residents and family members had an impact on healthcare outcomes,(18) as was seen with laptop-based conferencing.(15,16) Although there was a reduction in loneliness, unlike laptop-based videoconferencing, there was no difference in depressive symptoms…”

“…the effects of personal contact in samples comprised of people who were primarily cognitively intact; findings supported a small, positive impact on loneliness ( Reed, 1986 ; Robinson et al., 2013 ; Schwindenhammer, 2014 ; Tsai and Tsai, 2011 ; Tsai et al., 2020 ; van der Heide et al., 2012 ).”

“The 3 quantitative studies led by Tsai included multiple measures of outcomes, including 1 week (n = 1), 44 1 month (n = 1), 46 3 months (n = 3), 43,44,46 6 months (n = 2), 43,46 and 12 months (n = 1) 43 post-intervention.”

“Despite the documented benefits of using Internet communication technologies for nursing home residents, 6,7,14 few empirical data are available to date on family members’ acceptance of and factors related to the use of videoconferencing to communicate with nursing home residents in Taiwan.”

“…model for successful aging, the current pandemic has highlighted the role of digital social connectivity, and social interactions facilitated by technology or through social relationships for staying connected with people ((Baltes & Baltes, 1990; Tsai & Tsai, 2011; Weinert et al., 2008).”

“Moreover, it is possible to motivate NH residents by offering meaningful activities such as joining in a book club and videoconferences (Tsai and Tsai, 2011; Mondaca et al. , 2019), creating an audi-obook club; and making practical arrangements for the residents to listen to audio books.”

“…programs, and befriending programs, in which participants have reported reduced loneliness and depression along with increased social connections; emotional and social support; and confidence (Ballantyne et al., 2010; Cattan et al., 2011; Newall & Menec, 2015; Tsai & Tsai, 2011; Tsai et al., 2010).”

“Research has found social engagement to be an important predictor of successful aging among lesbians (Fredriksen-Goldsen et al., 2015), which has been linked to improved mental health outcomes, including reduced cognitive decline, depression, and loneliness (Hughes et al., 2013; Tsai & Tsai, 2011).”

“Videoconferencing use with relatives has a positive impact in terms of social support and reducing feelings of loneliness and depression (Tsai et al., 2010; Tsai and Tsai, 2011), thus making residents’ daily life more fulfilling (Tsai and Tsai, 2010).”

“, animator, technical manager, care staff members) usually set up the video calling device and initiate the video calls [34,35].”

“In addition, lower mean levels of loneliness and depressive symptoms were found in a videoconferencing program for older adults in nursing homes after administering the intervention for 3 months [31].”

“Several RCTs showed that videoconferencing programs and peer interactions were effective in reducing loneliness and depressive symptoms among older adults and nursing home residents [22].”

“In addition, previous studies have investigated information and communication technology methods such as internet-based videoconferencing and the overall impact of internet usage to maintain contact with family and friends, with varying levels of efficacy [20-22].”

“For example, digital communication solutions (eg, tablets with video and sound; telepresence robots) for interactions between patients and family [12,13].”