Tech use flourishes during pandemic, particularly among seniors

Published on January 10, 2022 in RINewsToday

Over the course of 71 episodes of the widely-acclaimed Sopranos, Dr. Jennifer Melfi met with Tony Soprano in her office. The office had paneled walls, was decorated with a diploma on the wall, and next to that was a bookshelf filled with books. Melfi was counseling Mob Boss Tony Soprano for anxiety and depression. This was the typical office setting in any community before the COVID-19 pandemic spread like wildfire across the nation.  But now with the ongoing COVID-19 pandemic, therapists are using alternative ways to reduce increasing depression and mental health needs of the patients. The typical face-to face therapy, like Melfi offered Soprano and her other patients, has been replaced by computer and smartphone-based tele-treatment. 

While it remains unclear whether the technique is as effective as face-to-face psychotherapy that takes place in an office, they do offer a promising alternative to address the growing mental health needs spawned by the continuing COVID-19 pandemic, and in a safe way, according to a research study published last month by the Washington, DC based American Psychological Association.  

“The year 2020 marked 30 years since the first paper was published on a digital intervention for the treatment of depression. It also marked an unparalleled inflection point in the worldwide conversion of mental health services from face-to-face delivery to remote, digital solutions in response to the COVID-19 pandemic,” said lead author Isaac Moshe, MA, a doctoral candidate at the University of Helsinki in a Dec. 13 statement announcing the study’s findings.

“Given the accelerated adoption of digital interventions, it is both timely and important to ask to what extent digital interventions are effective in the treatment of depression, whether they may provide viable alternatives to face-to-face psychotherapy beyond the lab and what are the key factors that moderate outcomes,” he said.

The research article, “Digital interventions for the treatment of depression: A meta-analytic review,” was published online in the journal Psychological Bulletin. Psychological Bulletin, published on Dec. 13, 2021.

According to researchers, digital interventions, instead of the face-to face counseling sessions, typically require patients to log in to a software program on a computer website or app to read, watch, listen to, and interact with a series of content structured modules or lessons. Individuals oftentimes receive homework assignments relating to the modules and regularly complete digitally administered questionnaires relevant to their presenting mental health problems. This allows clinicians to monitor their progress and outcomes in cases where digital interventions include human support. Digital interventions are not the same as teletherapy, which has gotten much attention during the pandemic, according to Mosh, noting that teletherapy uses videoconferencing or telephone services to facilitate one-on-one psychotherapy.

“Digital interventions have been proposed as a way of meeting the unmet demand for psychological treatment,” notes Moshe. “As digital interventions are being increasingly adopted within both private and public health care systems, we set out to understand whether these treatments are as effective as traditional face-to-face therapy, to what extent human support has an impact on outcomes, and whether the benefits found in lab settings transfer to real-world settings,” he said.

According to the website article, researchers conducted a meta-analysis of 83 studies testing digital applications for treating depression, dating as far back as 1990 and involving more than 15,000 participants in total, 80% adults and 69.5% women. All of these studies were randomized controlled trials comparing a digital intervention treatment to participants on a waitlist or receiving no treatment at all, or those receiving treatment as usual or with face-to-face psychotherapy. The researcher primarily focused on individuals with mild to moderate depression symptoms. 

Overall, researchers found that digital interventions improved depression symptoms over control conditions, but the effect was not as strong as that found in a similar meta-analysis of face-to-face psychotherapy. There were not enough studies in the current meta-analysis to directly compare digital interventions to face-to-face psychotherapy, and researchers found no studies comparing digital strategies with drug therapy.

But digital treatments that involved a human component, whether in the form of feedback on assignments or technical assistance, were the most effective in reducing depression symptoms. This may be partially explained by the fact that a human component increased the likelihood that participants would complete the full intervention, and compliance with therapy is linked to better outcomes, according to Moshe.

Depression is predicted to be the leading cause of lost life years due to illness by 2030. At the same time, less than 1 in 5 people receive appropriate treatment, and less than 1 in 27 in low-income settings. A major reason for this is the lack of trained health care providers,” Moshe said. “Overall, our findings from effectiveness studies suggest that digital interventions may have a valuable role to play as part of the treatment offering in routine care, especially when accompanied by some sort of human guidance.” 

Tech use by Seniors skyrocketed

As noted above, while the continuing COVID-19 pandemic has increased the popularity of using digital intervention, teletherapy uses videoconferencing or telephone services to facilitate one-on-one psychotherapy, a newly released AARP Tech Trends reports an increased use of technology by seniors to facilitate social contact to families and friends to reduce isolation.

According to AARP’s report released on Dec. 21, tech use by people age 50 and over, skyrocketed during the pandemic and those new habits and behaviors appear to continue.  What’s more, 70% of those surveyed purchased tech last year, with spending far greater today than it was in 2019; $821 now as versus $394, then. Smartphones, and related accessories, along with Bluetooth headsets topped the list of their purchases, but smart home technology was vital to them, too.

Unsurprisingly the researchers say that technology use has facilitated social connectedness with others throughout the pandemic. They found that the rates of reliance on tech for social connection is consistently high across age ranges: 76% of those in their 50s, 79% of those in their 60s, and 72% of people 70+ all count tech as their link to their families and the wider world.

“The pandemic redrew the lines: Tech has gone from a nice-to-have to a need-to-have for Americans 50+, and their new habits are here to stay,” said Alison Bryant, AARP Senior Vice President of Research in a Dec. 21 statement announcing the study’s findings. “Those who can afford tech are spending a lot more than they did just a few years ago – more than twice what they spent in 2019. And their motivations vary: Some use tech to work, others to stay connected to family and friends, and others still to enable them to age in place or get assistance with needs. At the same time, we’re also mindful of the digital divide, where a lack of affordability can also mean no access to tech and its benefits,” says Bryant.

The Tech report noted that seniors continue to incorporate tech into their daily lives. Certain tech behaviors formed during the ongoing pandemic appear to be here to stay such as video chat, making online purchases, ordering groceries, doing banking, and engaging in health services, with seniors making more purchases and financial transactions online compared to previous years. 

Researchers also found that during the last two years, older adults’ usage of a home assistant and owning a wearable has doubled. The Tech study also reveals that learning how to use and manage smart home technology is a top interest of seniors. Smartphones continue to be adopted in new ways to manage day-to-day living and entertainment. This year, one third of seniors ordered take-out food from a restaurant and one in four listened to podcasts on their smartphones. 

Health-related innovations and daily objects that automatically track health measures on tech devices are also of top interest, say the researchers, noting that 42% of older adults feel tech is not designed with them in mind.

Finally, the AARP Tech Trends report found that 30% of older adults are using tech to pursue personal passions, mostly with video content. Streaming content continues to increase with most of them subscribing on average to three platforms. 

With the ongoing COVID-19 pandemic not going away in the near future, the use of technology will continue to increase to maintain contact with family and friends, to access education, telehealth services, for use in financial transitions, shopping, and entertainment.  

With Thanksgiving approaching, beat the Holiday Blues

Published on November 22, 2021 in RINewsToday

Just a year ago, the coronavirus (COVID-19) pandemic transformed the way we celebrated the traditional Thanksgiving dinner. Normally a personal gathering day with family and close friends, the cooler weather pushed people inside where the virus more easily spreads, forcing families to meet on Zoom for turkey dinner and catching up.

Today, COVID-19 vaccines have made it safer to bring families together to this annual holiday gathering. With the nation’s borders now open and 195 million Americans fully vaccinated and new travel guidelines in place, AAA predicts more than 53.4 million people are expected to travel to reunite with their loved ones, the highest single-year increase since 2005.

But like previous Thanksgiving celebrations, not every family gathering will be as serene as the one portrayed in Noman Rockwell’s iconic Freedom from Want painting that appeared in the March 6, 1943 issue of the Saturday Evening Post. Thoughts of attending the upcoming gathering might just tear open psychological wounds and bring to the surface bad memories, triggering stress, tension, and even depression.

Increased family demands and obligations that begin before Thanksgiving and continue through Christmas, and finally New Year’s Eve, can bring about the holiday blues, sad feelings specific to the holiday season. While there is no formal diagnosis of the holiday blues, these feelings are quite real for some people. Usually, it is felt by people who are going through the first holiday after a loss of a significant person in their life or a bad childhood memory from past the holidays. 

Holiday stresses brought about by last minute shopping for gifts, baking and cooking, cleaning and hosting parties, and even having unrealistic expectations can trigger depression. It can also bring about a feeling of malaise, tiredness, headaches, excessive drinking and overeating and even difficulty in sleeping.

COVID-19 and the Holiday Blues

At the beginning of the COVID-19 pandemic there was less stress because people were not doing face-to-face gatherings, says Elaine Rodino, Ph.D., psychologist in private practice for over 41 years in California and Pennsylvania. “But it still came up because they were worried about Uncle Morrie showing up on Zoom,” she says.

The COVID-19 pandemic is overshadowing this year’s holiday season yet again, says Rodino, who is former president of the American Psychological Associations’ Division 46 (Society for Media Psychology & Technology), and Division 42 (Psychologists in Independent Practice), the Los Angles County Association, and the Central Pennsylvania Psychological Association.

“There’s plenty of mitigating news this year about inflation and how prices are higher on almost all items including Thanksgiving Day dinner. People having financial issues this year can let themselves feel better by realizing that they are not alone. Many people are suffering economically through no fault of their own,” Rodino says.

“We’ve been experiencing many new ways of having to think about things,” adds Rodino, urging people to “be flexible and find new ways to enjoy life with less dependence on material things.”

According to Rodino, preplanning your visit can be the best way to reduce holiday blues. “Give thought to what you’re expecting and determine if your expectations are valid or just wishful thinking. Then decide to literally “make the best of it” by focusing on the good things and the good reasons why you’re making this visit,” she advises.

Putting the Kibosh on Hot Topics at Dinner

What can you do to steer away from heated political debates or sensitive issues including “why aren’t you vaccinated?”

Stressful situations at Thanksgiving gatherings can be reduced if you give thought to what to expect in visiting with your relatives. “Plan ahead on how you’re going to avoid being taken down a rabbit hole of controversy. How are you are going to pivot away from conversations when you see them going in a dangerous direction?”  

Rodino adds, “Remember who they are and how they think. Since it’s only a limited time visit, try to remain neutral. Don’t try to change anyone’s thinking. Things usually go badly when people try to convince others to think the way they do. That never goes well.”

You can plan ahead about how you will handle these conversations. “Do not fight!  There will be no winner. Talk about sports, the weather (not climate change), how delicious the food is, even how cute the dog is,” recommends Rodino.

“It’s best to accept that everyone has their own opinions (even if some seem very bizarre). Just think to yourself that you will soon be going back to your own home. You do not need to try to convince anyone about anything,” adds Rodino.

“When feeling stress, it’s important to realize that it’s time limited. Take care of yourself, whether it’s exercising, taking a warm bath, or just taking a break and reading a book. “There needs to be just some time that you just check out from the holiday stress part,” she says.

The holiday blues should begin to fade away by the first couple of weeks in January, notes Rodino. “So, if people are still feeling that, like say the second, third week of January, then they really should talk with a psychologist, because there could be issues that really need to be sorted out and processed,” she says.

With the ongoing pandemic we need to create new ways of doing things, says Rodino, noting that “People need to become creative and think up new ways to celebrate.”

As to compiling other strategies to cope with the holiday blues, Rodino suggests Googling ideas for surviving the pandemic holidays. “There’s something there for everyone,” she says.

Depression and Suicidal Thoughts

During this time of year, some may even feel a little depressed or have suicidal thoughts. Losses of all types can weigh heavily on anyone, but loss from COVID-19 has tragically impacted on so many and we can now add the pandemic to the challenges many face along with unemployment, experiencing painful chronic illnesses, or just feeling isolated from others. Sometimes, you aren’t ready for professional help from a doctor or mental health professional. Sometimes, you just need someone to talk to.

Think about calling The Samaritans of Rhode Island – where trained volunteers “are there to listen.” Incorporated in 1977, the Pawtucket-based nonprofit program is dedicated to listening to those in need through its nonjudgment befriending hotline/listening line program serving all of the state’s 39 cities and towns.

Executive Director, Denise Panichas, of the Rhode Island branch, notes that the communication-based program teaches volunteers to effectively listen to people no matter the caller’s issues or status. “You don’t need insurance, you don’t need to be in crisis, you don’t need to be in professional care, you don’t need a diagnosis to call. Most importantly, conversations are free, confidential and anonymous.

And, Panichas notes, for those in professional care, Samaritan volunteers can  be there to listen when family, friends and professionals are not available.

Panichas noted The Samaritans of Rhode Island Listening Line is also a much-needed resources for caregivers and older Rhode Islanders. Caregiving is both rewarding but most caregivers don’t want to talk about the stress to family and friends. Caregivers don’t want to be a bother to anyone. Caregivers need to know, however, that they are never a bother to our Listening line volunteers.

This year, The Samaritans partnered with Rhode Island Meals on Wheels to share information about the availability of the Listening Line services to homebound seniors. Family members are encouraged to share The Samaritans telephone number with seniors who are family members living alone, or even for those seniors living in facilities – most have private phones and they can call, too.

The Samaritans of Rhode Island can be the gateway to care or a “compassionate nonjudgmental voice on the other end of the line,” Panichas notes. “It doesn’t matter what your problem is, be it depression, suicidal thoughts, seeking resources for mental health services in the community, or being lonely or just needing to talk, our volunteers are there to listen.”

Suicide prevention education is still a very important feature of the agency’s mission. For persons in need of more information about suicide emergencies, The Samaritans website, http://www.samaritansri.org, has an emergency checklist as well as information by city and town including Blackstone Valley communities from Pawtucket to Woonsocket.

Holiday giving to financially support the programs of The Samaritans of Rhode Island is always welcomed. Donations can be made online at its website or by mail to: The Samaritans of Rhode Island, P.O. Box 9086, Providence Rhode Island 02940.

Emergency? Call 911. Need to talk? Call a volunteer at The Samaritans. Call 401.272.4044 or toll free in RI (1-800) 365-4044.

Report Outlines Strategy for Combating Senior’s Social Isolation and Loneliness

Published in the Woonsocket Call on March 1, 2020

Nearly one in four older adults residing in the community are socially isolated. Seniors who are experiencing social isolation or loneliness may face a higher risk of mortality, heart disease and depression, says a newly released report from the National Academies of Sciences, Engineering and Medicine (NASEM), a Washington, D.C.-based nonprofit, nongovernmental organization.

For seniors who are homebound, have no family, friends or do not belong to community or faith groups, a medical appointment or home health visit may be one of the few social interactions they have, notes the NASEM report released on Feb. 27, 2020. “Despite the profound health consequences — and the associated costs — the health care system remains an underused partner in preventing, identifying, and intervening for social isolation and loneliness among adults over age 50,” says the report.

“I’m pleased the AARP Foundation sponsored study by NASEM confirms the connection between social isolation or loneliness and death, heart disease and depression for older adults. It also finds that the health care system and community-based organizations have a critical role to play in intervening,” says AARP Foundation President Lisa Marsh Ryerson.

“We also know social isolation, like other social determinants of health, must be addressed to increase economic opportunity and well-being for low-income older adults,” says Ryerson.

Addressing Social Isolation and Loneliness

The 266-page NASEM report, “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System,” undertaken by the Committee on the Health and Medical Dimensions of Social Isolation and loneliness in Older Adults, outlines five goals that the nation’s health care system should adopt to address the health impacts of social isolation and loneliness. It also offers 16 recommendations for strengthening health workforce education and training, leveraging digital health and health technology, improving community partnerships, and funding research in understudied areas.

Although social isolation is defined as an objective lack of social relationships, loneliness is a subjective perception, say the NASEM report’s authors. They note that not all older adults are isolated or lonely, but they are more likely to face predisposing factors such as living alone and the loss of loved ones. The issue may be compounded for LGBT, minority and immigrant older adults, who may already face barriers to care, stigma and discrimination, the report says.

Social isolation and loneliness may also directly result from chronic illness, hearing or vision loss, or having mobility issues. In these instances, health care providers might be able to help prevent or reduce social isolation and loneliness by directly addressing the underlying health-related causes.

“Loneliness and social isolation aren’t just social issues — they can also affect a person’s physical and mental health, and the fabric of communities,” said Dan Blazer, J.P. Gibbons professor of Psychiatry Emeritus and professor of community and family medicine at Duke University, and chair of the committee that wrote the report in a statement announcing the its release. “Addressing social isolation and loneliness is often the entry point for meeting seniors’ other social needs — like food, housing and transportation,” he says.

Providing a Road Map…

The 16 recommendations in this report provides a strategy as to how the health care system can identify seniors at risk of social isolation and loneliness, intervene and engage other community partners.

As to improving Clinical Care Delivery, the report calls for conducting assessments to identify at-risk individuals. Using validated tools, health care providers should perform periodic assessments, particularly after life events that may increase one’s risk (such as a geographic move or the loss of a spouse).
The NASEM report also recommends that social isolation be included in electronic health records (EHRs). If a patient is at risk for or already experiencing social isolation, providers should include assessment data in clear locations in the EHR or medical records.

It’s important to connect patients with social care or community programs, too. The NASEM report notes that several state Medicaid programs and private insurers already has programs that target the social determinants of health. These programs can be more intentionally designed to address social isolation and loneliness of the older recipients. Health care organizations could also partner with ride-sharing programs to enable older adults to travel to medical appointments and community events, the report recommends.

The NASEM report also suggests that as more evidence becomes available, roles that health care providers are already performing — such as discharge planning, case management and transitional care planning — can be modified to directly address social isolation and loneliness in older adults. The report also details other interventions that the health care system might consider may include mindfulness training, cognitive behavioral therapy, and referring patients to peer support groups focused on volunteerism, fitness, or common experiences such as bereavement or widowhood.

Strengthening health professional education and training can be another strategy to combating the negative impacts of social isolation and loneliness. The NASEM report calls for schools of health professions and training programs for direct care workers (home health aides, nurse aides and personal care aides) to incorporate social isolation and loneliness in their curricula. Health professionals need to learn core content in areas such as the health impacts of social isolation and loneliness, assessment strategies, and referral options and processes, say the report’s authors.

The NASEM report warns that there are ethical Implications for using Health Technology to reduce social isolation and loneliness. Technologies that are designed to help seniors — including smart home sensors, robots and handheld devices — might intensify loneliness and increase social isolation if they are not easy to use or attempt to substitute for human contact. Moreover, the report found that 67 percent of the current assisitive technologies in dementia care were designed without considering their ethical implications. Developers of technology should properly assess and test new innovations, taking into account privacy, autonomy and the rural-urban digital divide.

The NASEM report says that more research is need because of evidence gaps and calls for more funding of studies to determine the effectiveness of interventions in clinical settings; to develop measures to identify at-risk individuals; and identify trends among younger adults as they age (such as use of technology and economic trends) that may inform how the health care system should target social isolation and loneliness in the future. More research is also needed to identify approaches and interventions that best meet the needs of LGBT and ethnic minority populations.

The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

For a copy of the NASEM report, go to http://www.nap.edu/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the .