Impact of digital social media on the perception of loneliness and social isolation in older adults

Abstract Objective: to synthesize knowledge about the use of social media and the perception of loneliness and/or social isolation in older adults. Method: integrative literature review with primary studies published in full, in Portuguese, English or Spanish, between September 2014 and July 2020 in the databases: American Psychological Association Database, Cumulative Index to Nursing & Allied Health Literature, Latin American and Caribbean Health Sciences Literature databases, Web of Science and PubMed. Results: 11 articles were included, categorized based on the types of technologies: “the use of the Internet”, encompassing social networking sites, the internet and applications; “communication devices”, with the use of smartphones, tablets and iPads and “types of communication” covering the use of interpersonal means of communication in the digital age, such as video calls and emails. There were positive results (63.6%) regarding the use of social media to minimize the perception of loneliness and/or social isolation in the older adults. Conclusion: the scientific evidence shows that the use of digital social media can reduce the perception of loneliness and/or isolation in older adults. Furthermore, the internet can favor greater contact between the older adults and family members and can serve as a source of support, provide a greater sense of belonging in the community and reduce loneliness.


Introduction
The increase in the older adult population is no longer an exclusive phenomenon of globalized and developed nations, but also of developing countries, such as Brazil (1) .
In 2008, the population aged 65 and over represented 6.53% of the total Brazilian population, with estimates of exceeding 22.71% by the year 2050. For the same period, life expectancy will increase from 72.78 years to 81.29 years (2) .
With the increase in the older adult population, it is necessary to adopt specific government policies and actions to ensure aging with minimal impairment (1) .
The magnitude of the phenomenon of population aging is increasing and influenced by different factors, being related to unequal and contradictory ways of aging, with social interaction as a marker for quality of life (3) . The World Health Organization (4) warns that the non-inclusion of older adults in human development strategies can cause suffering and result in processes of exclusion and abandonment.
Therefore, the aging process makes older adults more susceptible to situations that impact mental health (5) . These factors are considered risk factors for the occurrence of loneliness and social isolation in older adults (6) .
Loneliness can be defined as the cognitive perception that existing social relationships in life are insufficient or inadequate, generating an affective reaction of sadness and emptiness (7) . In older adults, loneliness is related to inadequate social contact and low socioeconomic status, being a predictor of morbidity and mortality, cognitive decline and risk for depressive symptoms (8)(9) .
There are different patterns of relationships established among human beings, given that there are people who prefer to spend most of their time without the company of other people and with a reduced social network, without implying that they feel alone.
This phenomenon is characterized as active isolation.
Loneliness differs from these patterns, as it implies a discrepancy between personal preferences for social involvement and the person's real social network, which is called passive isolation (10) .
Social isolation is defined (11) from the objective perspective of separation, typically physical, from people, such as in those who live alone or live in isolated environments. In a review study (3) , it was possible to identify a more general concept about social isolation in older adults, linked, in an objective way, to the scarcity of human relationships and regular contacts with people, whether they are family members, friends or members of the community In these cases, the person, in their daily life, interacts with a smaller number of people than they would like, their social network is reduced and they have insufficient social, emotional, informational and instrumental support. It relates to the life history and the context of the social organization. From this perspective, isolation does not refer to those who are voluntarily disconnected, but to those with possible barriers that hinder or prevent social integration.
Considering this scenario, it is necessary to recognize the scientific evidence and carry out a critical reflection on the subject, as well as to provide information for the professionals who work in the care of older adults regarding the use of resources and strategies that promote their integration into society (10) .

Accordingly, new technologies have been
transforming communication practices in contemporary times. It is increasingly common to find people accessing these new technologies and social media (12) . Recent literature review studies have shown that the use of social media has good adherence among older adults, with it facilitating communication, information exchange, sharing and access to materials of interest (13)(14)(15) .
Social media can be described as places that "allow conversations". They can be websites constructed to allow social interaction and the sharing of information in various formats: photos, messages, icons, among others. Their main characteristic is the active participation of the user community, in the connection and sharing of information.
Therefore, these sites of relationships between people are called social media (12) .
The integration of the older adult population into the digital world makes it possible for them to maintain their social roles, and exercise citizenship, autonomy and active participation in a complex society, which promotes the maintenance of a more active life (16) . With a positive emphasis on friendly relationships and social integration, this results in a healthy learning environment, with the promotion of well-being and health in the older adult population (17)(18)(19) .
In this way, the importance of investigating the current social scenario transformed by digital technological changes and the inclusion of older adults is highlighted. Accordingly, the present study aimed to synthesize knowledge about the use of social media and the perception of loneliness and/or social isolation in older adults. It is believed that the results of the study may provide support for planning interprofessional care, contributing to and combining efforts to improve care for older adults.

Method Study type
This integrative review (IR) of the literature was developed in six stages following a proposed model (20) , (5) interpretation of the results; and (6) presentation of the review/synthesis of knowledge (20) .
In the first step, the research question was

Data collection and instrument
The data collection (23) from the studies included

Data analysis
To assess the methodological rigor of the included    Rev. Latino-Am. Enfermagem 2022;30:e3526.

Discussion
The  The smartphone video conferencing intervention reduced feelings of loneliness in the older adult residents at 1, 3, and 6 months. The IG was older than the CG. The decrease in feelings of loneliness scores from baseline to 6 months was significantly greater in the IG than in the CG. The videoconference intervention did not improve the residents' depressive symptoms at any time, however, it had positive effects on vitality at 6 months, in addition, it had positive effects on QoL indicators for pain, vitality and physiological dimensions of health at 6 months, but not on physical function.
It was suggested that allowing older residents to use these communication and information technologies improves their overall outlook, as well as them reporting that they "felt young" or "became members of the modern generation". findings suggested that its use for communication and information was associated with the improvement of mental well-being, contributing to the older adults having greater opportunities to live independently (36) .
However, some studies included in this IR did not find a positive effect of the use of social media on loneliness and/or social isolation in older adults. One study (25) , in which the use of social networking sites showed no relationship with loneliness and/or or mental health, indicated that this association cannot be automatically assumed in older adults living in the community (25) . In another study, there was also no perceived improvement in relation to depressive symptoms (35) . Therefore, it is necessary to seek digital inclusion strategies for older adults, in addition to emphasizing the identification of symptoms related to depression, loneliness and social isolation, so that the use of social media is employed effectively and efficiently, allowing the older adults to present better results in their interaction and social participation.
In the United Kingdom, older adults who participated in group computer learning sessions showed a greater tendency for reduced loneliness when compared to those in individual sessions (26) . It should be emphasized that the older adults felt safer in the sessions with teachers who were also older, as there was recognition and encouragement for the study participants (26) .
Among the most used technologies and with better results, video calls were highlighted (29) , as they also allow visual contact, in addition to providing a greater possibility of reducing loneliness when compared to phone calls or written correspondence. Body language influences both the expression and receptivity of social cues, reducing perceived social distance. These expressions can be seen as an active social engagement system that decreases psychological distance and can influence the perception of other people's engagement, therefore reducing feelings of loneliness and social isolation (29,37) . Particularly in modern society, when face-to-face communication has decreased, it becomes necessary to create alternative methods to maintain satisfactory communication (29) .
However, it is necessary to consider the particularities of the older adult population. In the study (28)  The study (29) that used a cell phone on a structure with wheels, presented criticism due to its peculiar design, being considered a barrier for use by older adult residents in LSIEs, with the instability of the internet connection, the anxiety in handling a screen with small dimensions and the lack of interest of the team of caregivers in helping the participants to manipulate the cell phone leading to a lack of interest in participating in the dynamics of social interaction of the older adults.
As a means of controlling situations such as this, researchers (36) (26,28) . Many older adults are digitally excluded for several reasons, including the cost of access and lack of knowledge regarding the use, among other factors that worsen with increasing age.
Technology and the use of the internet present important results for combating social isolation and  (32) . In a study (38) carried out in Brazil, following 1,593 older adults, researchers found that strengthened social relationships play a mediating role in survival. However, it is known that it is necessary to adapt measures to strengthen these relationships and, in a context of social isolation, the internet and social media can be great facilitators for greater interaction with family and friends.
Although this IR was developed with scientific rigor, some limitations were identified. The first one refers to the inclusion of only articles available for free, which may have It is therefore recommended to carry out further reviews including the years of the pandemic, which could probably include new evidence to better understand the results in situations of mandatory social isolation.
Accordingly, studies on loneliness and social isolation in older adults must be evaluated by the family and healthcare providers, with it being up to each person responsible to identify the social media available to each population and guide them in each situation. What must be considered is that social media are already part of society's daily life and that we have a commitment to support those who need assistance in their daily lives, aiming to help older adults minimize the perception of loneliness and social isolation.

Conclusion
This IR presented the synthesis of available knowledge regarding the use of digital social media in relation to loneliness and social isolation in older adults.
The scientific evidence shows that the use of digital