1 Introduction
In this systematic literature review, we consult academic articles related to our research question: what is the impact of technology on social isolation for older persons in Sweden? By focusing our study on social isolation, we examine a definite condition that has been associated with lower quality of life outcomes (Dahlberg, 2021) and is incredibly important to nationwide policy discussions and social service interventions.
Social isolation, changes in social isolation, and perceptions of social isolation have been incredibly relevant during the Covid-19 pandemic, and remain relevant in a post-pandemic world. Social isolation is a state of being that contributes to a higher risk of loneliness (Dahlberg, 2021). Loneliness has been associated with lower quality of life, and adverse physical and mental health outcomes (Dahlberg, 2021). Definitions of social isolation by different researchers vary depending on the indicators used for measurement, which can include but are not limited to, an individual’s living situation, family connections, community involvement, social activities, phone communication, and internet communication. In broad terms, social isolation is a condition that takes into account an individual’s level of social interaction.
Protective measures and lockdown protocols in Sweden included social distancing, which was especially relevant for older persons who were at an increased risk for developing Covid-19 and experiencing severe symptoms that could lead to death (Centers for Disease Control and Prevention, 2024). The motivation to keep people in their own homes and away from crowded public areas resulted in an increased institutional reliance on technology for healthcare, news, communication, and in other areas. With recent shifts in technology use in mind, as well as specific vulnerability of people ages 65+, we acknowledge the importance of Covid-19 in our analysis.
Population ageing is a well-known global demographic shift, and technological development has been a strong mechanism of social change for the past few generations. We are interested in how these two phenomena interact. Where do older persons fit into the picture? As the number of older people in Sweden increases, we seek to better understand how to meet the growing needs of the 65+ community and ascertain to what degree technology should be utilized in social services to reduce social isolation. What can recent scientific data tell us about social isolation outcomes for older persons’ –a birth cohort that was first introduced to the computer well into adulthood– in conversation with technology use?
2 Search strategy
2.1 Databases
We used three databases: Scopus, PubMed, and CINAHL in our research. Scopus was our preferred database because it is multipurpose. Ageing and Social change is an interdisciplinary field, and we wanted to ensure that articles published by researchers in different fields such as economics, sociology, anthropology, and epidemiology, were included. We then searched in PubMed and CINAHL to access any additional articles that fit our search criteria and were specific to medicine, nursing, health, and allied health. It is important to mention here that we used an identical system of keywords when searching in each distinct database. In addition, after receiving the resulting list of articles based on our keywords (in each distinct database) we screened articles using the same inclusion and exclusion criteria.
2.2 Keywords
We used the AND function, because we only wanted to find articles that mentioned all 4 of our search words, or at least one word from each category listed somewhere in the article title, article abstract, or article keywords. Our categories included desired demographic (individuals of the age of 65), topic of focus (social isolation), mechanism (technology), and location (Sweden). We did not want to consider articles that did not fit this criteria. It is important to mention our intentionality when selecting keywords. We selected multiple commonly used words and phrases to describe each category (with the exception of location). We did this because researchers may have a preference for one term or the other, in which case relevant articles may have been missed.
Our Keywords:
“older population*” OR “older person*” OR ageing OR elderly* OR “older person*” OR “older people*” OR “senior citizen*”
AND
“social isolation*” OR loneliness* OR “social exclusion*”
AND
technology OR digital* OR ai OR “artificial intelligen*” OR robot OR “information technology*” OR it OR “digital tool*”
AND
Sweden
2.3 Inclusion/Exclusion Criteria
We decided to exclude articles that were not peer reviewed to provide initial quality control, and assurance of basic acceptance in the scientific community. Due to language skills in the Masters Programme, and accessibility of information, we excluded both articles that were not written in english, and articles that did not have an available translation into english. For specifications relating to publishing date, we narrowed in on 2020-2024 because of our interest in pandemic and post pandemic conditions. Therefore, we excluded articles published before the onset of the pandemic in 2020. We also excluded articles where the data was focused outside Sweden and articles that did not include data with adults 65+.
A limitation of the selection process is the slight differences in the interface between Scopus, PubMed, and CINAHL. However, no articles are used in our paper which did not fulfill all the criteria mentioned. In such cases that one database did not have a function to include one of our preferences, we simply screened for it later on in the process. An example of this is in the case of peer-reviewed articles. CINAHL was the only database that had a feature to automatically screen for peer-reviewed articles, so in the instance of Scopus and PubMed, we checked that all articles fulfilled this criteria manually.
2.4 Assessment for Eligibility
At this point in the process, we began reading the Abstract of the remaining articles to assess for eligibility, moving into the full text if we deemed it necessary to decide whether it was relevant to our research question. Reasons for article irrelevance fell into 7 categories. Reason #1 (n=10) was duplication. Given that we used three databases, we had some articles that were available in more than one database, and since we only needed to consider one of them, the other copy(ies) were/was deleted. Reason #2 (n=1) was not peer-reviewed. Reason #3 (n=24) was social isolation without technology. We deemed this category as irrelevant because discussion of our mechanism was missing. Reason #4 (n=1) was technology without social isolation. Similar to the last category, since we are interested in the impact that technology has on social isolation, we excluded articles that did not include data or discussion of the topic of focus. Reason #5 (n=3) was neither social isolation of technology. In these cases, the researchers were studying mechanisms and focus topics that had no connection to ours, such as disordered eating habits and cardiovascular healthcare equipment.
Reason #6 (n=1) was no research conducted in Sweden. For the purposes of our study, we decided that articles that included data from Sweden AND other countries, or COMPARED to other countries were relevant, but if the research had no basis in Swedish society, individuals, or institutions, it was deemed irrelevant. In this case, the long term care facilities where the researcher collected data were in Switzerland. Reason #7 (n=2) was our inability to access the journal due to paywall of some other technical obstruction.
We assessed a total of 53 articles from 3 databases and ended up with 11 relevant articles. These 11 articles were read and comprehensively analyzed for our paper about the impact of technology on social isolation for older persons in Sweden. Below is a comprehensive PRISM flow diagram of our process:
Note. Adapted from Page MJ, et al. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.
3 Literature review
Social isolation among older persons is a pressing situation, particularly in the context of the COVID-19 pandemic. This literature review synthesizes findings from eleven articles that investigate the impact of technology on social isolation for older persons in Sweden. The review focuses on the methodologies employed, the theoretical frameworks utilized, and the implications of technology in mitigating social isolation.
3.1 Overview of Methods
The methodological approaches represented in the studies reviewed are diverse. These methodologies can be placed broadly under quantitative, qualitative, and mixed-methods approaches.
A number of studies utilized large-scale surveys combined with panel data analysis in order to assess the interrelationship between technology use and social isolation. For instance, Caro et al. (2022), in their analysis, draw a panel data from the COME-HERE survey, while Silva et al. (2022) execute a quantitative analysis of data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Quantitative approaches, such as these, have allowed researchers to identify general trends and correlations between technology use and social isolation in large populations.
The qualitative studies have richly explored in-depth experiences of technology use among older persons. Qualitative content analysis with interviews was used by Blusi et al. (2023) and Fritz et al. (2024) to explore the issue in-depth at the individual level of perspectives and experiences. Particularly, such methods would be useful for uncovering nuances of how and whether contact with technology influences the perception of social connectedness among older persons.
Some of the researchers preferred mixed-methods approaches in which quantitative and qualitative techniques should be combined for an issue to be comprehensively understood (Johansson-Pajala et al., 2022). Additionally, Dahlberg (2021) performed a literature review, synthesizing existing research into comprehensive overlying themes and knowledge gaps.
Thunberg & Arnelid (2023) conducted an online survey among Swedish municipalities, which established a unique perspective related to the institutional adoption of technology for elder care. This approach provided insight into the broader societal context in which older persons use technology.
The diversity of methods employed reflects the complexity and the need for multifaceted approaches to understand the effects of technology on social isolation among older persons in Sweden.
3.2 Theoretical Frameworks and Concepts
The studies reviewed drew upon various theoretical frameworks and concepts that provide the basis for the current understanding of the relationship between technology and social isolation among older persons.
One prominent framework is social isolation theory, which posits that reduced social interactions can lead to increased feelings of loneliness. This theory underlines the importance of maintaining social connections, particularly for older persons who may experience diminished social networks due to factors such as health issues or the loss of loved ones (Caro et al., 2022). By framing the research within this theory, studies can effectively explore how technology serves as a tool to mitigate social isolation and enhance social engagement.
The concept of the digital divide was featured in several studies, including Caro et al. (2022) and Silva et al. (2022). This framework underlined disparities in access and utilization across populations, which, by all means, remained relevant to this analysis of changes in social isolation among older persons due to technology.
These studies, focused on companion robots, such as the work of Thunberg & Arnelid (2023) and Thunberg & Ziemke (2021), were underpinned by theoretical frameworks relevant to human-robot interaction. Such studies provide an insight into the ways older persons perceive and engage with robotic technologies designed to offer companionship and alleviate feelings of loneliness.
The studies also incorporate concepts related to welfare technology, which refers to the use of information and communication technology (ICT) to improve the quality of life for vulnerable populations, including older persons. This framework emphasizes the potential of technology to enhance social connectedness and address the challenges of social isolation (Fritz et al., 2024).
Although not explicitly stated, most of the approaches undertaken in these studies underpin the concept of social support, how technology-mediated communication may be used to provide emotional and social support for older persons, thereby alleviating feelings of isolation. Additionally, the concept of social network emphasizes the protective role of personal social connections against loneliness and health decline. This theory suggests that strong social networks can buffer the negative effects of isolation, making it essential to explore how technology can facilitate the maintenance and strengthening of these networks (Kulmala et al., 2021).
These theoretical frameworks and concepts provide a lens through which findings of the studies would be interpreted for an understanding of the complex relationship between technology and social isolation among older persons in Sweden.
3.3 Positive Impact of Technology on Social Isolation for Older Persons in Sweden
Some research identified how technology reduces social isolation by being able to maintain contact with family and friends. Furthermore, Caro et al. (2022) and Silva et al. (2022), have presented empirically that internet users have lower levels of social isolation, hence indicating the role that could be achieved via digital communication tools to be socially connected. For instance, Löfgren et al. (2021) found that technology, particularly during the pandemic, has helped older persons maintain social connections through tools such as social media and video calls. This adaptability has provided a sense of belonging and continuity in their social lives, demonstrating that technology can enhance social participation and mitigate feelings of isolation.
Indeed, technology has been found to facilitate various forms of social engagement. According to Blusi et al. (2023), Information and Communication Technologies (ICTs) can have a positive impact on social isolation as it can enable older persons to engage in various socio-activities and also keep in contact with others, including relationships that might not have been feasible if meetings had to be face-to-face.
The use of companion robots in care settings has shown promise in the reduction of loneliness and social isolation. Thunberg & Arnelid (2023) reported positive impacts of companion robots on social isolation in Swedish municipalities, however, effectiveness may vary among individuals.
Accordingly, technology can facilitate information and services that may help alleviate the effects of social isolation in older persons. For instance, e-health services and online communities may provide them with support and resources which would otherwise be inaccessible by traditional means.
3.4 Challenges and Limitations
One of the most barriers identified across multiple studies is represented by the digital divide. Caro et al. (2022) and Silva et al. (2022) reported that numerous older persons face barriers in technology adoption in the presence of lack of access, limited digital literacy, and physical or cognitive limitations.
As Dahlberg (2021) mentioned, technology-based solutions have potential to keep social relations going but cannot fully replace physical contacts. In particular, this limitation became evident in the context of the COVID-19 pandemic discussed by Thunberg & Ziemke (2021).
Fritz et al. (2024) recognized privacy concerns as one of the possible barriers to effective use of ICT tools by older persons. Such privacy concerns might dampen engagement with technology, which can enhance feelings of isolation.
The complexity of some technologies is overwhelming for older persons (Löfgren et al., 2021). This, in turn, results in frustration and disengagement. This challenge calls for the need for user-friendly designs and comprehensive support systems, as suggested by Fritz et al. (2024).
Some studies specifically mentioned that increased use of technology might contribute to increasing isolation if it replaces face-to-face contact. Thunberg & Arnelid (2023) suggested that a potential scenario would be where robots replace human interaction in care settings.
These barriers can hinder the effectiveness of technology as a solution to social isolation, emphasizing the importance of tailored support and training to ensure that all older persons can benefit from digital tools (Palmer et al., 2022).
3.5 Contextual Factors
The impact of technology on social isolation among older persons in Sweden is not the same across all cases. Certain contextual factors influence the effectiveness of technological interventions. According to Thunberg & Ziemke (2021), the impact of companion robots depends on individual preferences, hence the need for personalized approaches toward implementing technologies. Besides, access to supporting systems, including family members, caregivers, and institutional support, is considered of high importance for successful technology adoption and use by older persons. The drivers of the digital divide usually involve socioeconomic factors, access to technology, and more importantly, the capability to use technology (Caro et al., 2022). Physical and cognitive health can immensely affect the engagement of an older person in technology. This can also greatly affect the effectiveness of technology in addressing social isolation.
4 Conclusion
The literature review highlights the fact that while technology may have many favourable impacts, they also has adverse effects on the condition of social isolation among elderly in Sweden. On one hand, technologies such as video calls, social media, and companion robots have been shown to enhance social connectedness and reduce feelings of isolation. These new tools have kept the older persons in contact with family and friends, and this contact provides that sense of belonging and support (Blusi et al., 2023; Thunberg & Arnelid, 2023). But all of these technologies are contingent on some fundamentals such as digital literacy, access to technology, and individual preferences.
Along with the possible advantages, there are also many obstacles to the use of technology by older persons. Some of these include the digital divide, the lack of ICT literacy, and privacy concerns (Fritz et al., 2024). Besides that, some older people won’t accept the spread of new technology because it is too complicated or they are not interested in it. From this perspective, it was also possible to employ theories like the Technology Acceptance Model (Kim, 2024) and Social Support Theory (Hupcey, 1998) to gain some very useful understandings about the factors that affect technology adoption and its impact on social isolation (Caro et al., 2022; Silva et al., 2022).
However, there are research gaps that need to be addressed. While quantitative methods have been employed in several studies to assess the relationship between technology and social isolation, there is a need for more qualitative research that will delve into the diverse ways that older persons experience technology. More information about the personal and contextual variables that mediate technology use and its effects on social isolation can be provided by qualitative research. Although some research has been done in Sweden, more research is needed within the Swedish context, which includes the distinctive cultural, social, and technological aspects that shape the interplay of technology and social isolation of older persons in Sweden.
The bottom line is technology holds a promise of mitigating the problem of social isolation in older persons in Sweden. However, concerns about the digital divide and varying levels of digital literacy must be resolved. Future research should cover the type of technologies used for social bonding, the diverse demographic population including their psychological elements of loneliness, and the utilization of informal support structures in older persons’ lives, thereby establishing the long-term effectiveness of interventions.
5 References
About Covid-19. Centers for Disease Control and Prevention (Accessed September 14 2024) https://www.cdc.gov/covid/about/index.html
Blusi, M., Lindgren, H., & Nilsson, I. (2023). Factors to Consider when Introducing Digital Social Activities to Older Persons with Home Care. Studies Health Technology Inform., 302, 453–457.
Caro, J. C., Clark, A. E., D’Ambrosio, C., & Vögele, C. (2022). The impact of COVID-19 lockdown stringency on loneliness in five European countries. Social Science and Medicine, 314.
Dahlberg, L. (2021). Loneliness during the COVID-19 pandemic. Aging & Mental Health, 25(7), 1161–1164.
Hupcey, J. E. (1998). Clarifying the social support theory‐research linkage. Journal of Advanced Nursing, 27(6), 1231–1241. https://doi.org/10.1046/j.1365-2648.1998.01231.x
Fritz, J., Von Heideken Wagert, P., Gusdal, A. K., Johansson-Pajala, R.-M., & Eklund, C. (2024). Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives. JMIR AGING, 7.
Johansson-Pajala, R.-M., Gusdal, A., Eklund, C., Florin, U., & Von Heideken Wagert, P. (2022). A codesigned web platform for reducing social isolation and loneliness in older people: a feasibility study. Informatics for Health and Social Care, 48:2, 109–124.
Kim, S. D. (2024). Application and Challenges of the Technology Acceptance Model in Elderly Healthcare: Insights from ChatGPT. Technologies, 12(5), 68–68. https://doi.org/10.3390/technologies12050068
Kulmala, J., Tiilikainen, E., Lisko, I., Ngandu, T., Kivipelto, M., & Solomon, A. (2021). Personal Social Networks of Community-Dwelling Oldest Old During the Covid-19 Pandemic—A Qualitative Study. Front: In Public Health, 0:770965.
Löfgren, M., Larsson, E., Isaksson, G., & Nyman, A. (2021). Older adults’ experiences of maintaining social participation: Creating opportunities and striving to adapt to changing situations. Scandinavian Journal of Occupational Therapy, 29(7587–597).
Palmer, K., Monaco, A., Kivipelto, M., Onder, G., Maggi, S., Michel, J.-P., Prieto, R., Sykara, G., & Donde, S. (2020). The potential long‐term impact of the COVID‐19 outbreak on patients with non‐communicable diseases in Europe: consequences for healthy ageing. Aging Clinical and Experimental Research, 32, 1189–1194.
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