For many older people, the COVID-19 pandemic increased levels of loneliness and isolation. They were unable to visit friends and family, and access in-person support. Low levels of digital literacy among older people also prevented them from making the most of online support services. Here, Dr Lis Boulton assesses the effects that the pandemic had on older people and she highlights some of the ways that older people can be supported now and in the future.

• During the first COVID-19 lockdown in the UK, many voluntary and community sector organisations worked to maintain contact with older people through phone calls and digital technologies.
• Digital inequalities among older people meant that they found it harder to access services and support since many of them adopted a ‘digital first’ policy.
• Although it is important to support older people to gain digital skills and access to digital technologies, this should not prevent organisations from having alternative methods of communication, like the telephone.

During the first wave of the COVID-19 pandemic, millions of older adults (70+) across the UK were advised to avoid contact with people living outside their household. This, and the subsequent prolonged periods of national lockdowns and local restrictions, has meant that many people have not been able to spend time in close contact with their friends and family. The shielding requirement put a spotlight on the need to understand how to minimise the impact of loneliness and social isolation. So, what can we do throughout the pandemic and beyond?

Older adults are already more likely to have long-term illness or disability, to live alone and to be widowed, all of which are risk factors for loneliness. Social distancing places them at even higher risk than normal of social isolation and loneliness, which can adversely affect quality of life, wellbeing and mental health, and are associated with physical ill health and mortality. For people living alone, the lack of contact can seem even more acute, particularly if they have been unable to form a ‘household bubble’.

The move from face-to-face support to remote delivery

In the voluntary and community sector, many existing social care services have not been able to operate as commissioned, since March 2020. In some services, there has been a shift to providing remote support instead. Examples can be found in older adults’ day services, where attendance at a centre has been replaced with telephone calls to check in on older adults; group telephone calls to chat with other attendees; and video calls to play games or talk about shared interests. Face-to-face befriending and support services have also had to change their mode of operation to be delivered remotely. This has required rapid service redesign, staff and volunteer training, and new systems to monitor delivery.

What makes an effective remotely delivered intervention?

In order to find the essential ingredients of a successful remotely delivered befriending or social support service, a group of researchers from across the UK conducted a rapid evidence review of reviews in Spring 2020. We identified five different types of remotely delivered intervention, each with a different impact on social isolation, loneliness, or both.

1. Supported video-communication interventions, such as Skype, showed significant decreases in feelings of loneliness and increases in social support scores.
2. Telephone contact was only used in two studies, but qualitative findings showed reduced feelings of loneliness and social isolation.
3. Online discussion groups and forums showed mixed results. The majority of studies showed increases in social support, but only two showed reductions in loneliness.
4. Social networking sites have the potential to reduce loneliness in older adults, but the evidence here is weak. Older adults appeared to value fewer, stronger relationships, as opposed to many weaker ties.
5. Multi-tool interventions (providing a computer, training, messaging, chat groups) demonstrated significant decreases in loneliness, but not always increases in social support.

Regardless of the technology used for delivery, the review highlighted that interventions with the following characteristics are effective:

• the opportunity for close relationships to develop;
• shared experiences (such as being a carer), or characteristics (such as being of similar age, or background);
• some form of pastoral care (eg light-touch oversight of a discussion forum by professionals, or opportunities for participants to contact professionals for advice).

The problem of access to digital technologies

Existing reviews on digital technologies for addressing social isolation and loneliness show a preoccupation with interventions that are delivered solely through digital technologies. This is problematic and inequitable, as 77% of people aged 70+ have low levels of digital engagement. In the Lloyds Bank’s Consumer Digital Index Report of 2020, results show that for the 48% of the people currently offline, there is nothing that would encourage them to go online. Concerns over online safety, lack of digital skills, lack of interest, prohibitive costs, and fear of getting things wrong are commonplace among those not online.

During the COVID-19 pandemic, access to many services has moved online, thus creating and exacerbating inequalities. It has become difficult for people who do not have access to digital technologies to be full citizens, when there is a ‘digital first’ policy within services. Difficulties with shopping, paying bills, accessing health services and connecting with friends and family have all been experienced by those who are not online.

Supporting people to get online

There are examples of successful projects to reduce digital exclusion across the UK. The Good Things Foundation and Age UK’s Get Connected Stay Connected initiatives both provide devices, data packages, doorstep set up and training, and ongoing support to access the internet. The pandemic has provided an opportunity to encourage more people to get online, as they understand the disadvantages they face if they are not. Policymakers should ensure that these programmes continue to receive funding long term, so that those new to digital technologies and internet use can remain engaged.

Don’t forget the telephone

However, it is important to recognise that there will continue to be many people, not just older adults, who are not online. These people should not be disadvantaged in accessing services, information and shopping, but it is clear that they often are. Public bodies and services need to communicate with people in other ways, such as the telephone, so that they feel heard and included.

Models of befriending and social support delivered through the telephone have been commonplace in statutory and voluntary sector services for many years. Age UK and the Royal Voluntary Service are among the organisations delivering and expanding befriending and support services over the telephone, as well as having an ‘online community’ offer.

Using the telephone to deliver interventions to address loneliness and social isolation is more inclusive, as many of the obstacles older adults report in relation to engaging online do not apply. The characteristics described above, related to effective remotely delivered digital interventions, apply just as well to delivery using the telephone.

Policymakers, commissioners and service providers should work together to develop befriending and social support services that connect people based on shared experiences and interests, so that close relationships can develop. These services should be well linked into information and advice services, so that there is easy access to professionals when it is needed. Policymakers should not focus exclusively on digital technologies as a means of connecting people remotely, as there will always be a need for alternative modes of delivery. Don’t forget the telephone – using it alongside digital technologies will make connections more inclusive.

This blog presents independent research funded by the National Institute for Health Research. The views expressed are those of the author and not necessarily those of the National Health Service, National Institute for Health Research, Department of Health and Social Care, or its partners. 

This article was originally published in On Digital Inequalities, a collection of thought leadership pieces on how to address the inequalities we are seeing in the digital space, published by Policy@Manchester.

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