由于许多国家对行动的限制,目前的COVID-19大流行已被确定为老年人孤独感和社会孤立感增加的可能触发因素。孤独和社会孤立一直被认为是老年人身心健康不良的危险因素。通过扩大参与者的社交圈或增加与现有熟人的联系频率,视频通话可以帮助老年人在当前危机期间保持联系。
这项快速审查的主要目的是评估视频通话在减少老年人社交孤立和孤独感方面的有效性。该评论还试图解决视频通话在减轻抑郁症状和改善生活质量方面的有效性。
我们搜索了中央,MEDLINE,PsycINFO和CINAHL从2004年1月1日至2020年4月7日。我们还检索了相关系统综述的参考文献。
随机对照试验(RCT)和准RCT(包括集群设计)符合纳入条件。我们排除了所有其他研究设计。纳入研究的样本需要具有至少65岁的平均年龄。我们纳入的研究包括参与者,无论他们在基线时是否经历孤独或社会孤立的症状。任何涉及使用互联网促进通过计算机进行视频通话或视频会议的核心组件的干预,旨在减少孤独或社交孤立的智能手机或平板电脑,或者两者兼而有之,在老年人中有资格纳入.我们在综述中纳入了研究,如果他们报告了孤独的自我报告措施,社会孤立,抑郁症或生活质量的症状。两位评论作者筛选了25%的摘要;第三位评论作者解决了冲突。一位评论作者筛选了其余的摘要。第二篇评论作者筛选了所有排除的摘要,我们通过共识或让第三篇评论作者参与解决了冲突。对于全文文章,我们遵循相同的过程。
一位评论作者提取了数据,另一位评论作者检查了。主要结果是孤独和社会隔离,次要结果是抑郁症状和生活质量。一位审查作者根据GRADE方法对主要结果的证据的确定性进行了评级,另一位审查作者检查了评级。我们对主要结局进行了固定效应荟萃分析,孤独,和次要结果,抑郁症的症状。
我们确定了三项集群准随机试验,其中包括201名参与者。纳入的研究将视频通话干预与疗养院的常规护理进行了比较。这些研究都不是在COVID-19大流行期间进行的。每一项研究都使用加州大学洛杉矶分校孤独量表来衡量孤独感。总分从20(最孤独)到80(最孤独)不等。证据非常不确定,表明视频通话可能导致UCLA孤独感量表与三个月时的常规护理相比几乎没有差异(平均差异(MD)-0.44,95%置信区间(CI)-3.28至2.41;3项研究;201名参与者),6个月时(MD-0.34,95%CI-3.41~2.72;2项研究;152名参与者)和12个月时(MD-2.40,95%CI-7.20~2.40;1项研究;90名参与者).由于研究的局限性,我们将这些证据的确定性降低了三个级别,不精确性和间接性。纳入的研究均未报告社会隔离是结果。每一项研究都使用老年抑郁量表测量抑郁症的症状。总分范围从0(更好)到30(更差)。证据非常不确定,表明在三个月的随访(MD0.41,95%CI-0.90至1.72;3项研究;201名参与者)或六个月的随访(MD-0.83,95%CI-2.43至0.76;2项研究,152名参与者)。证据表明,在一年的随访中,视频通话可能对抑郁症状产生很小的影响,尽管这一发现是不准确的(MD-2.04,95%CI-3.98至-0.10;1项研究;90名参与者)。由于研究的局限性,我们将这些证据的确定性降低了三个级别,不精确性和间接性。只有一项研究,有62名参与者,报告生活质量。该研究使用台湾人对简短形式36问题健康调查(SF-36)的适应性来衡量生活质量,它由八个分量表组成,用于衡量生活质量的不同方面:身体功能;身体角色;情感角色;社会功能;疼痛:活力;心理健康;和身体健康。每个子量表的评分从0(健康状况不佳)到100(健康状况良好)。证据非常不确定,表明分配给常规护理的人与分配给视频通话的人在三个月的身体功能评分中可能几乎没有差异(MD2.88,95%CI-5.01至10.77),身体作用(MD-7.66,95%CI-24.08至8.76),情感角色(MD-7.18,95%CI-16.23至1.87),社会功能(MD2.77,95%CI-8.87至14.41),疼痛评分(MD-3.25,95%CI-15.11至8.61),活力得分(MD-3.60,95%CI-9.01至1.81),心理健康(MD9.19,95%CI0.36至18.02)和身体健康(MD5.16,95%CI-2.48至12.80)。由于研究的局限性,我们将这些证据的确定性降低了三个级别,不精确性和间接性。
基于这篇综述,目前有非常不确定的证据表明视频通话干预对减少老年人孤独感的有效性。该审查没有包括任何报告视频通话干预措施在解决老年人社会孤立方面有效性的证据的研究。关于视频通话对抑郁症状结果的有效性的证据非常不确定。未来在这一领域的研究需要使用更严格的方法和更多样化和代表性的参与者。具体来说,未来的研究应该针对老年人,明显孤独或社会孤立的人,或者两者兼而有之,在一系列设置中,以确定视频通话干预在这些结果需要改进的人群中是否有效。
The current COVID-19 pandemic has been identified as a possible trigger for increases in loneliness and social isolation among older people due to the restrictions on movement that many countries have put in place. Loneliness and social isolation are consistently identified as risk factors for poor mental and physical health in older people. Video calls may help older people stay connected during the current crisis by widening the participant\'s social circle or by increasing the frequency of contact with existing acquaintances.
The primary objective of this rapid review is to assess the effectiveness of video calls for reducing social isolation and loneliness in older adults. The review also sought to address the effectiveness of video calls on reducing symptoms of depression and improving quality of life.
We searched CENTRAL, MEDLINE, PsycINFO and CINAHL from 1 January 2004 to 7 April 2020. We also searched the references of relevant systematic reviews.
Randomised controlled trials (RCTs) and quasi-RCTs (including cluster designs) were eligible for inclusion. We excluded all other study designs. The samples in included studies needed to have a mean age of at least 65 years. We included studies that included participants whether or not they were experiencing symptoms of loneliness or social isolation at baseline. Any intervention in which a core component involved the use of the internet to facilitate video calls or video conferencing through computers, smartphones or tablets with the intention of reducing loneliness or social isolation, or both, in older adults was eligible for inclusion. We included studies in the review if they reported self-report measures of loneliness, social isolation, symptoms of depression or quality of life. Two
review authors screened 25% of abstracts; a third
review author resolved conflicts. A single
review author screened the remaining abstracts. The second review author screened all excluded abstracts and we resolved conflicts by consensus or by involving a third
review author. We followed the same process for full-text articles.
One
review author extracted data, which another
review author checked. The primary outcomes were loneliness and social isolation and the secondary outcomes were symptoms of depression and quality of life. One review author rated the certainty of evidence for the primary outcomes according to the GRADE approach and another
review author checked the ratings. We conducted fixed-effect meta-analyses for the primary outcome, loneliness, and the secondary outcome, symptoms of depression.
We identified three cluster quasi-randomised trials, which together included 201 participants. The included studies compared video call interventions to usual care in nursing homes. None of these studies were conducted during the COVID-19 pandemic. Each study measured loneliness using the UCLA Loneliness Scale. Total scores range from 20 (least lonely) to 80 (most lonely). The evidence was very uncertain and suggests that video calls may result in little to no difference in scores on the UCLA Loneliness Scale compared to usual care at three months (mean difference (MD) -0.44, 95% confidence interval (CI) -3.28 to 2.41; 3 studies; 201 participants), at six months (MD -0.34, 95% CI -3.41 to 2.72; 2 studies; 152 participants) and at 12 months (MD -2.40, 95% CI -7.20 to 2.40; 1 study; 90 participants). We downgraded the certainty of this evidence by three levels for study limitations, imprecision and indirectness. None of the included studies reported social isolation as an outcome. Each study measured symptoms of depression using the Geriatric Depression Scale. Total scores range from 0 (better) to 30 (worse). The evidence was very uncertain and suggests that video calls may result in little to no difference in scores on the Geriatric Depression Scale compared to usual care at three months\' follow-up (MD 0.41, 95% CI -0.90 to 1.72; 3 studies; 201 participants) or six months\' follow-up (MD -0.83, 95% CI -2.43 to 0.76; 2 studies, 152 participants). The evidence suggests that video calls may have a small effect on symptoms of depression at one-year follow-up, though this finding is imprecise (MD -2.04, 95% CI -3.98 to -0.10; 1 study; 90 participants). We downgraded the certainty of this evidence by three levels for study limitations, imprecision and indirectness. Only one study, with 62 participants, reported quality of life. The study measured quality of life using a Taiwanese adaptation of the Short-Form 36-question health survey (SF-36), which consists of eight subscales that measure different aspects of quality of life: physical function; physical role; emotional role; social function; pain: vitality; mental health; and physical health. Each subscale is scored from 0 (poor health) to 100 (good health). The evidence is very uncertain and suggests that there may be little to no difference between people allocated to usual care and those allocated to video calls in three-month scores in physical function (MD 2.88, 95% CI -5.01 to 10.77), physical role (MD -7.66, 95% CI -24.08 to 8.76), emotional role (MD -7.18, 95% CI -16.23 to 1.87), social function (MD 2.77, 95% CI -8.87 to 14.41), pain scores (MD -3.25, 95% CI -15.11 to 8.61), vitality scores (MD -3.60, 95% CI -9.01 to 1.81), mental health (MD 9.19, 95% CI 0.36 to 18.02) and physical health (MD 5.16, 95% CI -2.48 to 12.80). We downgraded the certainty of this evidence by three levels for study limitations, imprecision and indirectness.
Based on this review there is currently very uncertain evidence on the effectiveness of video call interventions to reduce loneliness in older adults. The review did not include any studies that reported evidence of the effectiveness of video call interventions to address social isolation in older adults. The evidence regarding the effectiveness of video calls for outcomes of symptoms of depression was very uncertain. Future research in this area needs to use more rigorous methods and more diverse and representative participants. Specifically, future studies should target older adults, who are demonstrably lonely or socially isolated, or both, across a range of settings to determine whether video call interventions are effective in a population in which these outcomes are in need of improvement.