Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Living Alone During COVID-19: Social Contact and Emotional Well-being Among Older Adults

Living Alone During COVID-19: Social Contact and Emotional Well-being Among Older Adults Objective: The COVID-19 outbreak and associated physical distancing measures altered the social world for most older adults, but people who live alone may have been disproportionately affected. The current study examined how living alone was associated with daily social contact and emotional well-being among older adults during the pandemic. Method: Adults (N = 226) aged 69+ completed a brief survey assessing their living situation, social contact with different social partners (in person, by phone, electronically), and emotions during the morning, afternoon, and evening the prior day. Results: Older adults who live alone were less likely to see others in person or to receive or provide help. Living alone was associated with more positive emotions concurrent with in-person contact. In contrast, phone contact was associated with higher levels of negative affect among those living alone, but not among those who live with others. Older adults who live alone were more likely to have contact with friends (rather than family). Discussion: Findings suggest older adults who live alone may be more reactive to social contact during the COVID-19 out- break than older adults who reside with others. In-person contact may confer distinct benefits not available via telephone contact, suggesting that possible interventions during the pandemic may work best with safe forms of in-person contact, possibly with nonfamily members. Keywords: COVID-19, Loneliness, Social isolation, Social support, Stay at home order In spring 2020, to curtail the spread of COVID- Living with social partners, by definition, affords more 19, public health initiatives encouraged limiting in-person contact, and in-person contact may have advan- face-to-face contact, maintaining a distance of 6 feet tages over other modalities of contact (e.g., telephone, text, from others, and remaining at home as much as pos- social media). For example, a national study found that sible. Older adults who live alone may have experi- among older adults, in-person contact was associated with enced greater isolation during the pandemic than older lower levels of depression, but this was not the case for tele- adults living with others (Armitage & Nellums, 2020). phone or electronic contact (Teo et al., 2015). Furthermore, Approximately 34% of women and 21% of men aged nearly a third of older adults lack access to the internet 60+ in the United States live alone (Ausubel, 2020) (Armitage & Nellums, 2020; Fingerman, Birditt, et al., 2020; and are at heightened risk factor of social isolation Hülür & Macdonald, 2020) and depend on in-person or (Klinenberg, 2016). phone contact. © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. e116 For permissions, please e-mail: journals.permissions@oup.com. Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 e117 if participants could not be reached, we contacted a social The Current Study partner (for whom information was provided at Wave 1) to The current study examines how daily positive and neg- help us reach the participant). We attempted to reach partici- ative emotions vary based on whether people live alone pants by phone, letter, or email (if email address was available). during the pandemic. Analysis of Twitter feeds at the outset Loss of original participants reflected: lack of contact informa- of the pandemic revealed increased mention of gratitude tion (n = 21), deceased (n = 13), monolingual Spanish (n = 8), (e.g., for good health, job), though negative emotions were illness or crisis (n  =  6), and cognitive impairment (n  =  4). still heavily present (Lwin et  al., 2020). In general, older Response rate was 80% of eligible participants (n = 226 out adults seem to report less stress and negative emotion than of 281). Participants (N = 226) differed from the 2016 who younger adults during the pandemic (Birditt et al., in press). did not participate (n  =  107) with regard to being: younger It is not clear whether social distancing practices influ- (t  =  −3.41, p < .001), better educated (t  =  4.39, p < .001), ence levels of loneliness. A study conducted at the start of healthier (t  =  4.73, p < .001), and less likely to be racial or the pandemic in the United States found that older adults ethnic minorities (χ  = 22.52, p < .001). Participants received listed lack of social contact as their biggest challenge due to $15 gift cards for completing the study. To recruit a few re- the pandemic (Heid et al., 2020). Another study, however, maining participants at the end of the study, we increased in- including a U.S. national longitudinal sample that was con- centive to $30 with IRB permission. ducted prior to and during the early phases of the pandemic found that older adults living alone reported more loneli- ness than older adults living with others in February 2020, Measures but no increase in loneliness during the stay-at-home orders Background characteristics (Luchetti et  al., 2020). Likewise, a large study examined Several demographic variables were gathered in Wave 1: daily loneliness using an internet survey during the initial age (+4 years = approximate current age); gender: 1 (male) COVID outbreak in Germany, and found that older adults and 0 (female); education: 1 (no formal education) to 8 (ad- reported less loneliness than younger adults. Importantly, vanced degree); and ethnic and racial identities: 1 (ethnic that study found no association between number of house- or racial minority) and 0 (non-Hispanic White). We did hold members and loneliness, though it is not clear whether not include data from 2016 regarding sociability, daily ex- living alone might pose special risks in late life (Buecker periences, or well-being for two reasons: (a) the 4-year gap et al., in press). As such, it is worth considering the role of precludes understanding baseline well-being immediately social contact among older adults who live alone. prior to the COVID-19 outbreak, and (b) methods of data Individuals who live alone must engage with social collection were different at the two waves. In 2016, we col- partners outside their household to see others in person. lected reports of social contacts and well-being every 3 hr Married individuals most likely have in-person contact throughout the day. This was not possible during the pan- with a spouse, but widowed, divorced, or never married demic, and we relied on survey methodology of morning, individuals are more likely to live alone (Cudjoe et  al., afternoon, and evening the prior day; surveys were com- 2020). Those who live alone may seek contact with grown pleted by phone, the internet, or paper and pencil. children, siblings, friends, or others. In the current data collection, participants rated their We included covariates that might shape these experi- physical health from 1 (poor) to 5 (excellent; Ware & ences, including race, gender, and education (Carr, 2019). Sherbourne, 1992). Marital status of nine participants had Black and Hispanic adults are disproportionately affected changed since 2016 (i.e., eight widowed one divorced). by COVID-19 (Hooper et  al., 2020), and are less likely Being married was highly correlated with living with others to live alone than are non-Hispanic White older adults (r = .78, p < .001); we did not examine marital status sepa- (Cudjoe et  al., 2020). Likewise, older adults in poorer rately. Ten participants indicated their living situation had health have higher risk of contracting COVID-19 (Cohen, changed since the pandemic started. Current living situa- 2020; Lian et al., 2020), and may avoid other people. We tion was coded 1 (alone) and 0 (with other). included feeling depressed in general, given associations be- tween daily affect and mental health (Charles et al., 2013). COVID-19 experiences In addition, social activity and negative affect may vary Participants reported COVID experiences: symptoms (e.g., throughout the day, with social contact peaking in the af- fever, shortness of breath), loved one had COVID-19, fi- ternoon among older adults (Tucker et al., 2012). nancial circumstances worse, and whether they socially distanced, 1 (yes) or 0 (no). Participants also indicated Method changes in contact with (a) family members and (b) friends, neighbors, and acquaintances since the pandemic started. Data collection occurred during May and June 2020. Participants (N = 226; M = 77.28 years, SD = 6.23) in the age Austin area had previously participated in the Daily Experiences Daily experiences and Well-being Study (DEWS) in 2016 (Fingerman, Huo, et al., Research using the Day Reconstruction Method (DRM) 2020). We used prior contact information for the participants; has shown adults accurately report experiences from the e118 Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 prior day (Kahneman et al., 2004; Oerlemans et al., 2011). (contentment, gratitude) when they saw someone in person To prevent fatigue, we asked questions about three broad than people who did not have in-person contact (Table 2). periods: morning (waking until noon), afternoon (noon Phone contact was not associated with positive affect. until 5 pm), and evening (5 pm until bedtime). Individuals who live alone experienced more negative emo- tions (loneliness, sadness, and stress) when they talked to someone on the phone compared to people (a) who lived Social engagement alone but did not talk with others on the phone or (b) who For each time period, participants indicated whether they live with others regardless of phone contact (see Figure 1). engaged with social partners: (a) in person, (b) via phone, We repeated analyses for each type of emotion separately and (c) electronically, and if so, with whom. They also in- (contentment, gratitude, loneliness, sadness, and stress). dicated 1 (yes) or 0 (no) whether they provided or received Findings were significant for contentment and gratitude, help from another person. indicating that positive emotions broadly may increase after in-person contact. But only loneliness was significant Emotions among negative emotions (Supplementary Table 3). Participants rated five emotions, 1 (not at all) to 5 (a great We also considered the types of social partners with deal), at each time period (morning, afternoon, and eve- whom older adults had contact (Supplementary Table 2). ning), generating a subscale for positive emotions, gratitude Unsurprisingly, older adults who lived with others were more and contentment (α = .71), and negative emotions, loneli- likely to see a spouse in person (.04 live alone and .78 lives ness, sadness, and stress (α = .70). with others, t = −15.79, p <. 001). But those who lived alone were more likely to see a friend (.31 live alone and .08 with others, t  =  3.27, p <. 01) or service provider (.21 live alone Results and .07 with others, t = 2.18, p <. 05). Likewise, we observed Descriptive and Bivariate Statistics differences in telephone contact. Older adults who lived alone Eighty-one older adults lived alone, and 145 lived with were less likely to talk with a sibling (.04 live alone and .15 spouse/romantic partner only (n = 95), grown child only with others, t = −2.47, p <. 05), but more likely to talk with a (n = 21), or spouse and others (e.g., grown child, grand- friend (.70 live alone and .40 with others, t = 3.68, p <. 01). child, or other; n  =  29). Only 5% of the sample had experienced symptoms of COVID. Socially, 83% self- Discussion isolated, but 95% reported they had necessary support during the outbreak. Most participants reported con- Social distancing may have placed older adults who live tact with family was about the same or more frequent, alone at increased risk for lower levels of well-being but living alone was associated with increased contact (Brooke & Jackson, 2020; Klinenberg, 2016). This study with friends and acquaintances (χ (2) = 4.19, p < .05; assessed this risk in a community-dwelling sample in daily Table 1). life. Consistent with national data, two-thirds of partici- Bivariate comparisons revealed that older adults who pants resided with other people, usually with spouses and live alone were less likely to see social partners in person, to grown children (Ausubel, 2020), and 5% had experienced provide help throughout the day, less likely to receive help symptoms of COVID-19. Compared to those living with in the afternoon or evening, or communicate electronically others, older adults living alone reported less in-person in the afternoon (Supplementary Table 1). contact, but contrary to expectations they did not report more time on the phone or electronic communication. Overall, findings suggest that in-person contact is im- Residential Status, Social Encounters, and portant for older adults’ positive emotional well-being, Emotional Experiences particularly for those who live alone. In addition, physical We asked whether social encounters throughout the day presence appears to confer key benefits (Teo et al., 2015), exert a greater effect on emotional well-being among older as telephone contact did not increase positive affect. In fact, adults who live alone. Regressions included main effects telephone contact among those who lived alone was asso- and interaction terms for Living arrangement × Mode of ciated with higher levels of negative affect, and specifically contact at each period of the day as well as covariates. with loneliness. Talking to others by phone may remind Findings were similar at different times of day; for parsi- people of their feelings of being alone during the pandemic. mony, we present significant models using afternoon data It is not clear whether this effect was evident prior to the (Supplementary Table 1). COVID-19 outbreak, when phone contact might have sup- The interaction terms for in-person contact and tele- plemented (rather than substituted) for in-person contact. phone contact were significant. When participants reported Nor do we know whether electronic contact (e.g., video- in-person encounters, mean positive affect was similar re- conferencing) might mitigate effects of social isolation, and gardless of living status. Simple slope analyses revealed indi- many older adults continue to lack access or ability to use viduals who live alone experienced more positive emotions internet communications (Xie et al., 2020). Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 e119 Table 1. Background Characteristics and Social Experiences of Older Adults Who Live Alone or With Others Lives alone (n = 81) Lives with others (n = 145) Mean/proportion SD Mean/proportion SD Significant differences Age 78.27 6.18 76.73 6.21 Education 6.19 1.52 6.10 1.38 Health 3.48 0.98 3.41 0.96 Life satisfaction 7.33 1.88 7.25 2.03 Loneliness past week 1.43 0.54 1.31 0.41 Depression past week 1.33 0.57 1.24 0.46 Female 0.77 – 0.43 – χ (1) = 23.95*** Married 0.04 – 0.85 – χ (1) = 136.02*** Racial/ethnic minority 0.17 – 0.28 – Change in social contacts since March With family Less than before 0.05 – 0.08 – Same as before 0.63 – 0.62 – More than before 0.32 – 0.30 – With friends, acquaintances neighbors χ (2) = 4.19* Less than before 0.28 – 0.38 – Same as before 0.44 – 0.46 – More than before 0.27 – 0.16 – Social experiences in the afternoon In-person contact 0.62 – 0.90 – t (218) = −4.70*** Contact by phone 0.67 – 0.67 – Electronic communication 0.51 – 0.65 – t (220) = −2.12* Provided help 0.11 – 0.27 – t (222) = −3.21** Received help 0.14 – 0.29 – t (220) = −2.86** Emotions in the afternoon Positive emotion subscale 3.86 1.05 3.91 0.90 Gratitude 3.96 1.21 3.92 1.09 Contentment 3.77 1.13 3.90 0.98 Negative emotion subscale 1.49 0.63 1.38 0.63 Loneliness 1.46 0.82 1.23 0.58 t (220) = 2.17* Sadness 1.38 0.70 1.41 0.80 Stress 1.59 0.92 1.51 0.83 Notes: 1 (no formal education), 2 (elementary school), 3 (some high school), 4 (high school), 5 (some college/vocational school), 6 (college graduate), 7 (post col- b c d lege), and 8 (advanced degree). 1 (poor) to 5 (excellent). 1 (not at all satisfied) to 10 (completely satisfied). Average of three items rated 1 (hardly ever), 2 (some e f g of the time), and 3 (often). 1 (hardly ever), 2 (some of the time), and 3 (often) Average of gratitude and contentment,1 (not at all) to 5 (a great deal). Average of loneliness, sadness, and stress, 1 (not at all) to 5 (a great deal). *p < .05. ** p < .01. *** p < .001. being alone, with others, and in telephone communica- Notably, friends play an important role for older adults tion across a broader timespan. Moreover, we could not who live alone. These older adults reported increased con- compare experiences before and after the COVID-19 out- tact with friends since the start of the outbreak, and had break. A national study reported that adults who live alone more in-person and more telephone contact with friends were lonelier than those who live with others before the than did older adults who live with others. We had antici- U.S.  pandemic, but did not increase in loneliness during pated that older adults who live alone (e.g., widows, di- the pandemic (Luchetti et  al., 2020). Those findings sug- vorced) might also have increased contact with grown gest these patterns may not be unique to social distancing. children or siblings, but those who lived with others talked Despite these limitations, findings reinforce the impor - more often with their siblings. This study is consistent with prior research that has found contact with friends improves tance of social partners for daily well-being. Further, the daily well-being (Ng et al., 2021). Here, that was true for study suggests that in-person contact may confer unique in-person contact among older adults who live alone. benefits to positive emotional well-being and technolog- These findings, however intriguing, have limitations. ically mediated communication cannot replace the phys- We did not compare how the same person experienced ical presence of others. e120 Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 Table 2. Linear Regressions Predicting Emotion Subscales in the Afternoon From Participants’ Living Situation: Social Contacts as Moderators a b Positive emotions Negative emotions Parameter B SE B SE Intercept 2.01* 0.82 1.11* 0.44 Live alone −0.53 0.28 −0.23 0.12 In-person contact 0.06 0.25 – – c d Live alone × In-person contact 0.82** 0.31 – – Phone contact – – −0.01 0.08 c d Live alone × Phone contact – – 0.41** 0.14 Covariates Gender −0.23 0.12 −0.09 0.07 Age 0.01 0.01 −0.00 0.01 Education 0.09 0.04 −0.02 0.02 Minority status 0.59*** 0.15 −0.05 0.08 Health 0.25*** 0.07 −0.00 0.04 Depression −0.35** 0.12 0.64*** 0.06 F 8.37*** 15.48*** Adjusted R .26 .38 Notes: Participant reports on contact and afternoon emotions n = 226. a b c Average of gratitude and contentment, 1 (not at all) to 5 (a great deal). Average of loneliness, sadness, and stress, 1 (not at all) to 5 (a great deal). Live alone 1 d e f g (yes) and 0 (no). Any contact 1 (yes) and 0 (no). 1 (male) and 0 (female). 1 (no formal education) to 8 (advanced degree). 1 (racial or ethnic minority) and 0 h i (non-Hispanic White). 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). 1 (hardly ever), 2 (some of the time), and 3 (often). *p < .05. **p < .01. ***p < .001. Supplementary Table 1. Participants’ reported social ex- periences and emotions at different times of day. Supplementary Table 2. Types of social partners with whom participants had in person or phone contact in the afternoon. Supplementary Table 3. Significant linear regressions predicting individual emotions in the afternoon from par- ticipants’ living situation: social encounters as moderators. Funding This study was supported by grants R01AG046460 and P30AG066614 from the National Institute on Aging (NIA) and grant P2CHD042849 awarded to the Population Research Center (PRC) at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Conflict of Interest None declared. Figure 1. Living situation and social contact predicting positive and negative emotions in the afternoon. References Armitage, R., & Nellums, L. B. (2020). COVID-19 and the conse- quences of isolating the elderly. The Lancet Public Health, 5(5), Supplementary Material e256. doi:10.1016/S2468-2667(20)30061-X Supplementary data are available at The Journals of Ausubel, J. (2020, March 10). Older people are more likely to live Gerontology, Series B: Psychological Sciences and Social alone in the U.S.  than elsewhere in the world. Pew Research Sciences online. Center. https://www.pewresearch.org/fact-tank/2020/03/10/ Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 e121 older-people-are-more-likely-to-live-alone-in-the-u-s-than- Kahneman,  D., Krueger,  A.  B., Schkade,  D.  A., Schwarz,  N., & elsewhere-in-the-world/ Stone, A. A. (2004). A survey method for characterizing daily life Birditt,  K.  S., Turkelson,  A., Fingerman,  K.  L., Polenick,  C., & experience: The day reconstruction method. Science (New York, Oya, A. (in press). Age differences in COVID-19 related stress, N.Y.), 306(5702), 1776–1780. doi:10.1126/science.1103572 life changes, and social ties during the COVID-19 pandemic: Klinenberg, E. (2016). Social isolation, loneliness, and living alone: Implications for psychological well-being. The Gerontologist. Identifying the risks for public health. American Journal of Public doi:10.1093/geront/gnaa204 Health, 106(5), 786–787. doi:10.2105/AJPH.2016.303166 Brooke,  J., & Jackson,  D. (2020). Older people and COVID-19: Lian, J., Jin, X., Hao, S., Cai, H., Zhang, S., Zheng, L., Jia, H., Hu, J., Isolation, risk and ageism. Journal of Clinical Nursing, 29(13– Gao, J., Zhang, Y., Zhang, X., Yu, G., Wang, X., Gu, J., Ye, C., Jin,  C., Lu,  Y., Yu,  X., Yu,  X., … Yang,  Y. (2020). Analysis of 14), 2044–2046. doi:10.1111/jocn.15274 Buecker, S., Horstmann, K. T., Krasko, J., Kritzler, S., Terwiel, S., Kaiser, T., epidemiological and clinical features in older patients with co- ronavirus disease 2019 (COVID-19) outside Wuhan. Clinical & Luhmann, M. (in press). Changes in daily loneliness during the first four weeks of the Covid-19 lockdown in Germany. Social Science and Infectious Diseases, 71(15), 740–747. doi:10.1093/cid/ciaa242 Luchetti, M., Lee, J. H., Aschwanden, D., Sesker, A., Strickhouser, J. E., Medicine. doi:10.1016/j.socscimed.2020.113541 Carr, D. (2019). Golden years? Social inequality in later life. Russell Terracciano, A., & Sutin, A. R. (2020). The trajectory of lone- liness in response to COVID-19. The American Psychologist, Sage Foundation. Charles,  S.  T., Piazza,  J.  R., Mogle,  J., Sliwinski,  M.  J., & 75(7), 897–908. doi:10.1037/amp0000690 Lwin, M. O., Lu, J., Sheldenkar, A., Schulz, P. J., Shin, W., Gupta, R., Almeida,  D.  M. (2013). The wear and tear of daily stressors on mental health. Psychological Science, 24(5), 733–741. & Yang, Y. (2020). Global sentiments surrounding the COVID- 19 pandemic on Twitter: Analysis of Twitter trends. JMIR Public doi:10.1177/0956797612462222 Cohen,  S. (2020). Psychosocial vulnerabilities to upper respiratory Health and Surveillance, 6(2), e19447. doi:10.2196/19447 Ng,  Y.  T., Huo,  M., Gleason,  M.  E., Neff,  L.  A., Charles,  S.  T. & infectious illness: Implications for susceptibility to corona- virus disease 2019 (COVID-19). Perspectives on Psychological Fingerman, K. L. (2021). Friendships in old age: Daily encounters and emotional well-being. The Journals of Gerontology, Series Science. doi:10.1177/1745691620942516 Cudjoe,  T.  K.  M., Roth,  D.  L., Szanton,  S.  L., Wolff,  J.  L., B: Psychological Sciences and Social Sciences, 76, 549–560. doi:10.1093/geronb/gbaa007 Boyd, C. M., & Thorpe, R. J. (2020). The epidemiology of so- cial isolation: National Health and Aging Trends Study. The Oerlemans, W. G., Bakker, A. B., & Veenhoven, R. (2011). Finding the key to happy aging: a day reconstruction study of happiness. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 75(1), 107–113. doi:10.1093/geronb/gby037 The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 66(6), 665–674. doi:10.1093/geronb/gbr040 Fingerman, K. L., Birditt, K. S., & Umberson, D. (2020). Mobile technologies and social connection in late life. Commissioned Teo, A. R., Choi, H., Andrea, S. B., Valenstein, M., Newsom, J. T., Dobscha, S. K., & Zivin, K. (2015). Does mode of contact with paper, Steering Committee for Mobile Technology for Adaptive Aging, National Academies of Sciences, Engineering, different types of social relationships predict depression in older adults? Evidence from a Nationally Representative Survey. and Medicine. Fingerman, K. L., Huo, M., Charles, S. T., & Umberson, D. J. (2020). Journal of the American Geriatrics Society, 63(10), 2014–2022. doi:10.1111/jgs.13667 Variety is the spice of life: Social integration and activity in late life. The Journals of Gerontology, Series B: : Psychological Tucker, A. M., Feuerstein, R., Mende-Siedlecki, P., Ochsner, K. N., & Stern, Y. (2012). Double dissociation: Circadian off-peak times Sciences and Social Sciences, 75, 377–388. doi:10.1093/geronb/ gbz007 increase emotional reactivity; aging impairs emotion regulation via reappraisal. Emotion (Washington, D.C.), 12(5), 869–874. Heid, A. R., Cartwright, F., Wilson-Genderson, M., & Pruchno, R. (2020). Challenges experienced by older people during the in- doi:10.1037/a0028207 Ware,  J.  E. Jr, & Sherbourne,  C.  D. (1992). The MOS 36-item itial months of the COVID-19 pandemic. The Gerontologist. doi:10.1093/geront/gnaa138 Short-Form Health Survey (SF-36). I.  Conceptual frame- work and item selection. Medical Care, 30(6), 473–483. Hooper,  M.  W., Nápoles,  A.  M., & Pérez-Stable,  E.  J. (2020). COVID-19 and racial/ethnic disparities. Journal of the doi:10.1097/00005650-199206000-00002 Xie,  B., Charness,  N., Fingerman,  K., Kaye,  J., Kim,  M.  T., & American Medical Association, 323(24), 2466–2467. doi:10.1001/jama.2020.8598 Khurshid,  A. (2020). When going digital becomes a necessity: Ensuring older adults’ needs for information, services, and social Hülür, G., & Macdonald, B. (2020). Rethinking social relationships in old age: Digitalization and the social lives of older adults. The American inclusion during COVID-19. Journal of Aging & Social Policy, 32(4-5), 460–470. doi:10.1080/08959420.2020.1771237 Psychologist, 75(4), 554–566. doi:10.1037/amp0000604 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Pubmed Central

Living Alone During COVID-19: Social Contact and Emotional Well-being Among Older Adults

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences , Volume 76 (3) – Nov 16, 2020

Loading next page...
 
/lp/pubmed-central/living-alone-during-covid-19-social-contact-and-emotional-well-being-JLx3x0wCHQ

References (53)

Publisher
Pubmed Central
Copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ISSN
1079-5014
eISSN
1758-5368
DOI
10.1093/geronb/gbaa200
Publisher site
See Article on Publisher Site

Abstract

Objective: The COVID-19 outbreak and associated physical distancing measures altered the social world for most older adults, but people who live alone may have been disproportionately affected. The current study examined how living alone was associated with daily social contact and emotional well-being among older adults during the pandemic. Method: Adults (N = 226) aged 69+ completed a brief survey assessing their living situation, social contact with different social partners (in person, by phone, electronically), and emotions during the morning, afternoon, and evening the prior day. Results: Older adults who live alone were less likely to see others in person or to receive or provide help. Living alone was associated with more positive emotions concurrent with in-person contact. In contrast, phone contact was associated with higher levels of negative affect among those living alone, but not among those who live with others. Older adults who live alone were more likely to have contact with friends (rather than family). Discussion: Findings suggest older adults who live alone may be more reactive to social contact during the COVID-19 out- break than older adults who reside with others. In-person contact may confer distinct benefits not available via telephone contact, suggesting that possible interventions during the pandemic may work best with safe forms of in-person contact, possibly with nonfamily members. Keywords: COVID-19, Loneliness, Social isolation, Social support, Stay at home order In spring 2020, to curtail the spread of COVID- Living with social partners, by definition, affords more 19, public health initiatives encouraged limiting in-person contact, and in-person contact may have advan- face-to-face contact, maintaining a distance of 6 feet tages over other modalities of contact (e.g., telephone, text, from others, and remaining at home as much as pos- social media). For example, a national study found that sible. Older adults who live alone may have experi- among older adults, in-person contact was associated with enced greater isolation during the pandemic than older lower levels of depression, but this was not the case for tele- adults living with others (Armitage & Nellums, 2020). phone or electronic contact (Teo et al., 2015). Furthermore, Approximately 34% of women and 21% of men aged nearly a third of older adults lack access to the internet 60+ in the United States live alone (Ausubel, 2020) (Armitage & Nellums, 2020; Fingerman, Birditt, et al., 2020; and are at heightened risk factor of social isolation Hülür & Macdonald, 2020) and depend on in-person or (Klinenberg, 2016). phone contact. © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. e116 For permissions, please e-mail: journals.permissions@oup.com. Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 e117 if participants could not be reached, we contacted a social The Current Study partner (for whom information was provided at Wave 1) to The current study examines how daily positive and neg- help us reach the participant). We attempted to reach partici- ative emotions vary based on whether people live alone pants by phone, letter, or email (if email address was available). during the pandemic. Analysis of Twitter feeds at the outset Loss of original participants reflected: lack of contact informa- of the pandemic revealed increased mention of gratitude tion (n = 21), deceased (n = 13), monolingual Spanish (n = 8), (e.g., for good health, job), though negative emotions were illness or crisis (n  =  6), and cognitive impairment (n  =  4). still heavily present (Lwin et  al., 2020). In general, older Response rate was 80% of eligible participants (n = 226 out adults seem to report less stress and negative emotion than of 281). Participants (N = 226) differed from the 2016 who younger adults during the pandemic (Birditt et al., in press). did not participate (n  =  107) with regard to being: younger It is not clear whether social distancing practices influ- (t  =  −3.41, p < .001), better educated (t  =  4.39, p < .001), ence levels of loneliness. A study conducted at the start of healthier (t  =  4.73, p < .001), and less likely to be racial or the pandemic in the United States found that older adults ethnic minorities (χ  = 22.52, p < .001). Participants received listed lack of social contact as their biggest challenge due to $15 gift cards for completing the study. To recruit a few re- the pandemic (Heid et al., 2020). Another study, however, maining participants at the end of the study, we increased in- including a U.S. national longitudinal sample that was con- centive to $30 with IRB permission. ducted prior to and during the early phases of the pandemic found that older adults living alone reported more loneli- ness than older adults living with others in February 2020, Measures but no increase in loneliness during the stay-at-home orders Background characteristics (Luchetti et  al., 2020). Likewise, a large study examined Several demographic variables were gathered in Wave 1: daily loneliness using an internet survey during the initial age (+4 years = approximate current age); gender: 1 (male) COVID outbreak in Germany, and found that older adults and 0 (female); education: 1 (no formal education) to 8 (ad- reported less loneliness than younger adults. Importantly, vanced degree); and ethnic and racial identities: 1 (ethnic that study found no association between number of house- or racial minority) and 0 (non-Hispanic White). We did hold members and loneliness, though it is not clear whether not include data from 2016 regarding sociability, daily ex- living alone might pose special risks in late life (Buecker periences, or well-being for two reasons: (a) the 4-year gap et al., in press). As such, it is worth considering the role of precludes understanding baseline well-being immediately social contact among older adults who live alone. prior to the COVID-19 outbreak, and (b) methods of data Individuals who live alone must engage with social collection were different at the two waves. In 2016, we col- partners outside their household to see others in person. lected reports of social contacts and well-being every 3 hr Married individuals most likely have in-person contact throughout the day. This was not possible during the pan- with a spouse, but widowed, divorced, or never married demic, and we relied on survey methodology of morning, individuals are more likely to live alone (Cudjoe et  al., afternoon, and evening the prior day; surveys were com- 2020). Those who live alone may seek contact with grown pleted by phone, the internet, or paper and pencil. children, siblings, friends, or others. In the current data collection, participants rated their We included covariates that might shape these experi- physical health from 1 (poor) to 5 (excellent; Ware & ences, including race, gender, and education (Carr, 2019). Sherbourne, 1992). Marital status of nine participants had Black and Hispanic adults are disproportionately affected changed since 2016 (i.e., eight widowed one divorced). by COVID-19 (Hooper et  al., 2020), and are less likely Being married was highly correlated with living with others to live alone than are non-Hispanic White older adults (r = .78, p < .001); we did not examine marital status sepa- (Cudjoe et  al., 2020). Likewise, older adults in poorer rately. Ten participants indicated their living situation had health have higher risk of contracting COVID-19 (Cohen, changed since the pandemic started. Current living situa- 2020; Lian et al., 2020), and may avoid other people. We tion was coded 1 (alone) and 0 (with other). included feeling depressed in general, given associations be- tween daily affect and mental health (Charles et al., 2013). COVID-19 experiences In addition, social activity and negative affect may vary Participants reported COVID experiences: symptoms (e.g., throughout the day, with social contact peaking in the af- fever, shortness of breath), loved one had COVID-19, fi- ternoon among older adults (Tucker et al., 2012). nancial circumstances worse, and whether they socially distanced, 1 (yes) or 0 (no). Participants also indicated Method changes in contact with (a) family members and (b) friends, neighbors, and acquaintances since the pandemic started. Data collection occurred during May and June 2020. Participants (N = 226; M = 77.28 years, SD = 6.23) in the age Austin area had previously participated in the Daily Experiences Daily experiences and Well-being Study (DEWS) in 2016 (Fingerman, Huo, et al., Research using the Day Reconstruction Method (DRM) 2020). We used prior contact information for the participants; has shown adults accurately report experiences from the e118 Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 prior day (Kahneman et al., 2004; Oerlemans et al., 2011). (contentment, gratitude) when they saw someone in person To prevent fatigue, we asked questions about three broad than people who did not have in-person contact (Table 2). periods: morning (waking until noon), afternoon (noon Phone contact was not associated with positive affect. until 5 pm), and evening (5 pm until bedtime). Individuals who live alone experienced more negative emo- tions (loneliness, sadness, and stress) when they talked to someone on the phone compared to people (a) who lived Social engagement alone but did not talk with others on the phone or (b) who For each time period, participants indicated whether they live with others regardless of phone contact (see Figure 1). engaged with social partners: (a) in person, (b) via phone, We repeated analyses for each type of emotion separately and (c) electronically, and if so, with whom. They also in- (contentment, gratitude, loneliness, sadness, and stress). dicated 1 (yes) or 0 (no) whether they provided or received Findings were significant for contentment and gratitude, help from another person. indicating that positive emotions broadly may increase after in-person contact. But only loneliness was significant Emotions among negative emotions (Supplementary Table 3). Participants rated five emotions, 1 (not at all) to 5 (a great We also considered the types of social partners with deal), at each time period (morning, afternoon, and eve- whom older adults had contact (Supplementary Table 2). ning), generating a subscale for positive emotions, gratitude Unsurprisingly, older adults who lived with others were more and contentment (α = .71), and negative emotions, loneli- likely to see a spouse in person (.04 live alone and .78 lives ness, sadness, and stress (α = .70). with others, t = −15.79, p <. 001). But those who lived alone were more likely to see a friend (.31 live alone and .08 with others, t  =  3.27, p <. 01) or service provider (.21 live alone Results and .07 with others, t = 2.18, p <. 05). Likewise, we observed Descriptive and Bivariate Statistics differences in telephone contact. Older adults who lived alone Eighty-one older adults lived alone, and 145 lived with were less likely to talk with a sibling (.04 live alone and .15 spouse/romantic partner only (n = 95), grown child only with others, t = −2.47, p <. 05), but more likely to talk with a (n = 21), or spouse and others (e.g., grown child, grand- friend (.70 live alone and .40 with others, t = 3.68, p <. 01). child, or other; n  =  29). Only 5% of the sample had experienced symptoms of COVID. Socially, 83% self- Discussion isolated, but 95% reported they had necessary support during the outbreak. Most participants reported con- Social distancing may have placed older adults who live tact with family was about the same or more frequent, alone at increased risk for lower levels of well-being but living alone was associated with increased contact (Brooke & Jackson, 2020; Klinenberg, 2016). This study with friends and acquaintances (χ (2) = 4.19, p < .05; assessed this risk in a community-dwelling sample in daily Table 1). life. Consistent with national data, two-thirds of partici- Bivariate comparisons revealed that older adults who pants resided with other people, usually with spouses and live alone were less likely to see social partners in person, to grown children (Ausubel, 2020), and 5% had experienced provide help throughout the day, less likely to receive help symptoms of COVID-19. Compared to those living with in the afternoon or evening, or communicate electronically others, older adults living alone reported less in-person in the afternoon (Supplementary Table 1). contact, but contrary to expectations they did not report more time on the phone or electronic communication. Overall, findings suggest that in-person contact is im- Residential Status, Social Encounters, and portant for older adults’ positive emotional well-being, Emotional Experiences particularly for those who live alone. In addition, physical We asked whether social encounters throughout the day presence appears to confer key benefits (Teo et al., 2015), exert a greater effect on emotional well-being among older as telephone contact did not increase positive affect. In fact, adults who live alone. Regressions included main effects telephone contact among those who lived alone was asso- and interaction terms for Living arrangement × Mode of ciated with higher levels of negative affect, and specifically contact at each period of the day as well as covariates. with loneliness. Talking to others by phone may remind Findings were similar at different times of day; for parsi- people of their feelings of being alone during the pandemic. mony, we present significant models using afternoon data It is not clear whether this effect was evident prior to the (Supplementary Table 1). COVID-19 outbreak, when phone contact might have sup- The interaction terms for in-person contact and tele- plemented (rather than substituted) for in-person contact. phone contact were significant. When participants reported Nor do we know whether electronic contact (e.g., video- in-person encounters, mean positive affect was similar re- conferencing) might mitigate effects of social isolation, and gardless of living status. Simple slope analyses revealed indi- many older adults continue to lack access or ability to use viduals who live alone experienced more positive emotions internet communications (Xie et al., 2020). Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 e119 Table 1. Background Characteristics and Social Experiences of Older Adults Who Live Alone or With Others Lives alone (n = 81) Lives with others (n = 145) Mean/proportion SD Mean/proportion SD Significant differences Age 78.27 6.18 76.73 6.21 Education 6.19 1.52 6.10 1.38 Health 3.48 0.98 3.41 0.96 Life satisfaction 7.33 1.88 7.25 2.03 Loneliness past week 1.43 0.54 1.31 0.41 Depression past week 1.33 0.57 1.24 0.46 Female 0.77 – 0.43 – χ (1) = 23.95*** Married 0.04 – 0.85 – χ (1) = 136.02*** Racial/ethnic minority 0.17 – 0.28 – Change in social contacts since March With family Less than before 0.05 – 0.08 – Same as before 0.63 – 0.62 – More than before 0.32 – 0.30 – With friends, acquaintances neighbors χ (2) = 4.19* Less than before 0.28 – 0.38 – Same as before 0.44 – 0.46 – More than before 0.27 – 0.16 – Social experiences in the afternoon In-person contact 0.62 – 0.90 – t (218) = −4.70*** Contact by phone 0.67 – 0.67 – Electronic communication 0.51 – 0.65 – t (220) = −2.12* Provided help 0.11 – 0.27 – t (222) = −3.21** Received help 0.14 – 0.29 – t (220) = −2.86** Emotions in the afternoon Positive emotion subscale 3.86 1.05 3.91 0.90 Gratitude 3.96 1.21 3.92 1.09 Contentment 3.77 1.13 3.90 0.98 Negative emotion subscale 1.49 0.63 1.38 0.63 Loneliness 1.46 0.82 1.23 0.58 t (220) = 2.17* Sadness 1.38 0.70 1.41 0.80 Stress 1.59 0.92 1.51 0.83 Notes: 1 (no formal education), 2 (elementary school), 3 (some high school), 4 (high school), 5 (some college/vocational school), 6 (college graduate), 7 (post col- b c d lege), and 8 (advanced degree). 1 (poor) to 5 (excellent). 1 (not at all satisfied) to 10 (completely satisfied). Average of three items rated 1 (hardly ever), 2 (some e f g of the time), and 3 (often). 1 (hardly ever), 2 (some of the time), and 3 (often) Average of gratitude and contentment,1 (not at all) to 5 (a great deal). Average of loneliness, sadness, and stress, 1 (not at all) to 5 (a great deal). *p < .05. ** p < .01. *** p < .001. being alone, with others, and in telephone communica- Notably, friends play an important role for older adults tion across a broader timespan. Moreover, we could not who live alone. These older adults reported increased con- compare experiences before and after the COVID-19 out- tact with friends since the start of the outbreak, and had break. A national study reported that adults who live alone more in-person and more telephone contact with friends were lonelier than those who live with others before the than did older adults who live with others. We had antici- U.S.  pandemic, but did not increase in loneliness during pated that older adults who live alone (e.g., widows, di- the pandemic (Luchetti et  al., 2020). Those findings sug- vorced) might also have increased contact with grown gest these patterns may not be unique to social distancing. children or siblings, but those who lived with others talked Despite these limitations, findings reinforce the impor - more often with their siblings. This study is consistent with prior research that has found contact with friends improves tance of social partners for daily well-being. Further, the daily well-being (Ng et al., 2021). Here, that was true for study suggests that in-person contact may confer unique in-person contact among older adults who live alone. benefits to positive emotional well-being and technolog- These findings, however intriguing, have limitations. ically mediated communication cannot replace the phys- We did not compare how the same person experienced ical presence of others. e120 Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 Table 2. Linear Regressions Predicting Emotion Subscales in the Afternoon From Participants’ Living Situation: Social Contacts as Moderators a b Positive emotions Negative emotions Parameter B SE B SE Intercept 2.01* 0.82 1.11* 0.44 Live alone −0.53 0.28 −0.23 0.12 In-person contact 0.06 0.25 – – c d Live alone × In-person contact 0.82** 0.31 – – Phone contact – – −0.01 0.08 c d Live alone × Phone contact – – 0.41** 0.14 Covariates Gender −0.23 0.12 −0.09 0.07 Age 0.01 0.01 −0.00 0.01 Education 0.09 0.04 −0.02 0.02 Minority status 0.59*** 0.15 −0.05 0.08 Health 0.25*** 0.07 −0.00 0.04 Depression −0.35** 0.12 0.64*** 0.06 F 8.37*** 15.48*** Adjusted R .26 .38 Notes: Participant reports on contact and afternoon emotions n = 226. a b c Average of gratitude and contentment, 1 (not at all) to 5 (a great deal). Average of loneliness, sadness, and stress, 1 (not at all) to 5 (a great deal). Live alone 1 d e f g (yes) and 0 (no). Any contact 1 (yes) and 0 (no). 1 (male) and 0 (female). 1 (no formal education) to 8 (advanced degree). 1 (racial or ethnic minority) and 0 h i (non-Hispanic White). 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). 1 (hardly ever), 2 (some of the time), and 3 (often). *p < .05. **p < .01. ***p < .001. Supplementary Table 1. Participants’ reported social ex- periences and emotions at different times of day. Supplementary Table 2. Types of social partners with whom participants had in person or phone contact in the afternoon. Supplementary Table 3. Significant linear regressions predicting individual emotions in the afternoon from par- ticipants’ living situation: social encounters as moderators. Funding This study was supported by grants R01AG046460 and P30AG066614 from the National Institute on Aging (NIA) and grant P2CHD042849 awarded to the Population Research Center (PRC) at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Conflict of Interest None declared. Figure 1. Living situation and social contact predicting positive and negative emotions in the afternoon. References Armitage, R., & Nellums, L. B. (2020). COVID-19 and the conse- quences of isolating the elderly. The Lancet Public Health, 5(5), Supplementary Material e256. doi:10.1016/S2468-2667(20)30061-X Supplementary data are available at The Journals of Ausubel, J. (2020, March 10). Older people are more likely to live Gerontology, Series B: Psychological Sciences and Social alone in the U.S.  than elsewhere in the world. Pew Research Sciences online. Center. https://www.pewresearch.org/fact-tank/2020/03/10/ Journals of Gerontology: SOCIAL SCIENCES, 2021, Vol. 76, No. 3 e121 older-people-are-more-likely-to-live-alone-in-the-u-s-than- Kahneman,  D., Krueger,  A.  B., Schkade,  D.  A., Schwarz,  N., & elsewhere-in-the-world/ Stone, A. A. (2004). A survey method for characterizing daily life Birditt,  K.  S., Turkelson,  A., Fingerman,  K.  L., Polenick,  C., & experience: The day reconstruction method. Science (New York, Oya, A. (in press). Age differences in COVID-19 related stress, N.Y.), 306(5702), 1776–1780. doi:10.1126/science.1103572 life changes, and social ties during the COVID-19 pandemic: Klinenberg, E. (2016). Social isolation, loneliness, and living alone: Implications for psychological well-being. The Gerontologist. Identifying the risks for public health. American Journal of Public doi:10.1093/geront/gnaa204 Health, 106(5), 786–787. doi:10.2105/AJPH.2016.303166 Brooke,  J., & Jackson,  D. (2020). Older people and COVID-19: Lian, J., Jin, X., Hao, S., Cai, H., Zhang, S., Zheng, L., Jia, H., Hu, J., Isolation, risk and ageism. Journal of Clinical Nursing, 29(13– Gao, J., Zhang, Y., Zhang, X., Yu, G., Wang, X., Gu, J., Ye, C., Jin,  C., Lu,  Y., Yu,  X., Yu,  X., … Yang,  Y. (2020). Analysis of 14), 2044–2046. doi:10.1111/jocn.15274 Buecker, S., Horstmann, K. T., Krasko, J., Kritzler, S., Terwiel, S., Kaiser, T., epidemiological and clinical features in older patients with co- ronavirus disease 2019 (COVID-19) outside Wuhan. Clinical & Luhmann, M. (in press). Changes in daily loneliness during the first four weeks of the Covid-19 lockdown in Germany. Social Science and Infectious Diseases, 71(15), 740–747. doi:10.1093/cid/ciaa242 Luchetti, M., Lee, J. H., Aschwanden, D., Sesker, A., Strickhouser, J. E., Medicine. doi:10.1016/j.socscimed.2020.113541 Carr, D. (2019). Golden years? Social inequality in later life. Russell Terracciano, A., & Sutin, A. R. (2020). The trajectory of lone- liness in response to COVID-19. The American Psychologist, Sage Foundation. Charles,  S.  T., Piazza,  J.  R., Mogle,  J., Sliwinski,  M.  J., & 75(7), 897–908. doi:10.1037/amp0000690 Lwin, M. O., Lu, J., Sheldenkar, A., Schulz, P. J., Shin, W., Gupta, R., Almeida,  D.  M. (2013). The wear and tear of daily stressors on mental health. Psychological Science, 24(5), 733–741. & Yang, Y. (2020). Global sentiments surrounding the COVID- 19 pandemic on Twitter: Analysis of Twitter trends. JMIR Public doi:10.1177/0956797612462222 Cohen,  S. (2020). Psychosocial vulnerabilities to upper respiratory Health and Surveillance, 6(2), e19447. doi:10.2196/19447 Ng,  Y.  T., Huo,  M., Gleason,  M.  E., Neff,  L.  A., Charles,  S.  T. & infectious illness: Implications for susceptibility to corona- virus disease 2019 (COVID-19). Perspectives on Psychological Fingerman, K. L. (2021). Friendships in old age: Daily encounters and emotional well-being. The Journals of Gerontology, Series Science. doi:10.1177/1745691620942516 Cudjoe,  T.  K.  M., Roth,  D.  L., Szanton,  S.  L., Wolff,  J.  L., B: Psychological Sciences and Social Sciences, 76, 549–560. doi:10.1093/geronb/gbaa007 Boyd, C. M., & Thorpe, R. J. (2020). The epidemiology of so- cial isolation: National Health and Aging Trends Study. The Oerlemans, W. G., Bakker, A. B., & Veenhoven, R. (2011). Finding the key to happy aging: a day reconstruction study of happiness. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 75(1), 107–113. doi:10.1093/geronb/gby037 The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 66(6), 665–674. doi:10.1093/geronb/gbr040 Fingerman, K. L., Birditt, K. S., & Umberson, D. (2020). Mobile technologies and social connection in late life. Commissioned Teo, A. R., Choi, H., Andrea, S. B., Valenstein, M., Newsom, J. T., Dobscha, S. K., & Zivin, K. (2015). Does mode of contact with paper, Steering Committee for Mobile Technology for Adaptive Aging, National Academies of Sciences, Engineering, different types of social relationships predict depression in older adults? Evidence from a Nationally Representative Survey. and Medicine. Fingerman, K. L., Huo, M., Charles, S. T., & Umberson, D. J. (2020). Journal of the American Geriatrics Society, 63(10), 2014–2022. doi:10.1111/jgs.13667 Variety is the spice of life: Social integration and activity in late life. The Journals of Gerontology, Series B: : Psychological Tucker, A. M., Feuerstein, R., Mende-Siedlecki, P., Ochsner, K. N., & Stern, Y. (2012). Double dissociation: Circadian off-peak times Sciences and Social Sciences, 75, 377–388. doi:10.1093/geronb/ gbz007 increase emotional reactivity; aging impairs emotion regulation via reappraisal. Emotion (Washington, D.C.), 12(5), 869–874. Heid, A. R., Cartwright, F., Wilson-Genderson, M., & Pruchno, R. (2020). Challenges experienced by older people during the in- doi:10.1037/a0028207 Ware,  J.  E. Jr, & Sherbourne,  C.  D. (1992). The MOS 36-item itial months of the COVID-19 pandemic. The Gerontologist. doi:10.1093/geront/gnaa138 Short-Form Health Survey (SF-36). I.  Conceptual frame- work and item selection. Medical Care, 30(6), 473–483. Hooper,  M.  W., Nápoles,  A.  M., & Pérez-Stable,  E.  J. (2020). COVID-19 and racial/ethnic disparities. Journal of the doi:10.1097/00005650-199206000-00002 Xie,  B., Charness,  N., Fingerman,  K., Kaye,  J., Kim,  M.  T., & American Medical Association, 323(24), 2466–2467. doi:10.1001/jama.2020.8598 Khurshid,  A. (2020). When going digital becomes a necessity: Ensuring older adults’ needs for information, services, and social Hülür, G., & Macdonald, B. (2020). Rethinking social relationships in old age: Digitalization and the social lives of older adults. The American inclusion during COVID-19. Journal of Aging & Social Policy, 32(4-5), 460–470. doi:10.1080/08959420.2020.1771237 Psychologist, 75(4), 554–566. doi:10.1037/amp0000604

Journal

The Journals of Gerontology Series B: Psychological Sciences and Social SciencesPubmed Central

Published: Nov 16, 2020

There are no references for this article.