Video Conferencing: An Intervention For Emotional Loneliness in Long-Term Care

Activities, Adaptation & Aging
ISSN: 0192-4788 (Print) 1544-4368 (Online) Journal homepage: http://www.tandfonline.com/loi/waaa20
Video Conferencing: An Intervention for Emotional

Loneliness in Long-Term Care
Mary T. Siniscarco, Cynthia Love-Williams & Sarah Burnett-Wolle
To cite this article: Mary T. Siniscarco, Cynthia Love-Williams & Sarah Burnett-Wolle (2017):
Video Conferencing: An Intervention for Emotional Loneliness in Long-Term Care, Activities,
Adaptation & Aging, DOI: 10.1080/01924788.2017.1326763
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Download by: [Pepperdine University] Date: 10 August 2017, At: 21:25

ACTIVITIES, ADAPTATION & AGING
https://doi.org/10.1080/01924788.2017.1326763
Video Conferencing: An Intervention for Emotional

Loneliness in Long-Term Care
Mary T. Siniscarcoa, Cynthia Love-Williamsb, and Sarah Burnett-Wolle c
a
Department of Health Studies, Utica College, Utica, NY; bDepartment of Nursing, Utica College, Utica,
NY; cDepartment of Aging Studies, Utica College, Utica, NY
ABSTRACT ARTICLE HISTORY

Residents in long-term care report high rates of emotional lone- Received 12 January 2016
liness. The following pilot study examined an intervention to Accepted 28 February 2017
Downloaded by [Pepperdine University] at 21:25 10 August 2017
address these feelings. A sample of eight residents used video- KEYWORDS

conferencing (Skype) to communicate with very close family/ assisted living; depression;
friends one or more times each week for two months. Wilcoxon emotional loneliness;
matched pairs tests suggested that the intervention was not nursing home; research
associated with significant changes in affective well-being. methods; videoconference
However, desirable changes in various aspects of social support
were evident and should be explored in future research that
includes a larger sample size. The logistics of implementing this
videoconferencing study were extensive and increasing the
sample size would necessitate changes in research methods.
Most notably, choice of the hardware as well as the availability
of assistance to operate the hardware and software are aspects
that need to be altered. Specific recommendations are made to
facilitate future research and practice.
Loneliness is a negative experience which results from individuals’ subjective

evaluation of their quantity or quality of social relationships as compared to a
cultural standard (de Jong-Gierveld & van Tilburg, 2010). It is often thought
of as a precursor to or synergistic with depression (Cacioppo, Hughes, Waite,
Hawkley, & Thisted, 2006; Drageset, Espehaug, & Kirkevold, 2012). In addi-
tion to depression, loneliness is associated with a wide range of medical
conditions including cardiovascular disease, decreased inflammatory control,
sleep disturbances, impaired motor function, cognitive impairments, and
cancer (Buchman et al., 2010; Cacioppo et al., 2002; Cacioppo, Hawkley,
Norman, & Berntson, 2011; Drageset, Eide, Dysvik, Furnes, & Hauge, 2015;
Hawkley, Thisted, Masi, & Cacioppo, 2010; Perissinotto, Stijacic Cenzer, &
Covinsky, 2012; Theeke, 2010; Wilson et al., 2007). Although the cause and
effect relationships between loneliness and these medical conditions are
unclear, the outcomes are not. Older adults who are lonely have more
functional impairments and use more health care resources, including phy-
sician visits and nursing home beds (Perissinotto et al., 2012; Theeke, 2010).
CONTACT Mary T. Siniscarco mtsinisc@utica.edu Department of Health Studies, Utica College, Utica, NY
13502.
© 2017 Taylor & Francis Group, LLC
2 M. T. SINISCARCO ET AL.
Most important, a nationally representative study and meta-analysis indicate

that loneliness appears to increase mortality and may do so by 26% (Holt-
Lunstad, Smith, Baker, Harris, & Stephenson, 2015; Perissinotto et al., 2012).
A very large (13,312-person) national study suggests that the prevalence of
loneliness among community-dwelling older adults is 17% (Theeke, 2010).
Long-term care residents are more likely to experience loneliness than those
living in the community and the incidence may be as high as 43% (Beal, 2006;
Couture, 2012; de Guzman et al., 2011; Lauder, Mummery, & Sharkey, 2006;
Tijhuis, de Jong-Gierveld, Feskens, & Kromhout, 1999). The difference
between community-dwelling and institutionalized older adults may be due
to the residential setting or confounding variables including advanced age,
female gender, non-married status, lower socioeconomic status, or declining
health (Drageset, Kirkevold, & Esephaug, 2010; Russell, Cutrona, de la Mora, &
Wallace, 1997; Scocco, Rapattoni, & Fantoni, 2006; Theeke, 2010; Tilvis,
Laitala, Routasealo, & Pitkala, 2011). Addressing loneliness among today’s
long-term care residents is critical to their well-being and doing so will become
increasingly important as the number of residents increases. In 2013, approxi-
mately 3.2 million people lived in assisted living, continuing care retirement
communities, or nursing homes and this figure is likely to rise to 10.4 million
by 2050 (Center for Disease Control and Prevention, 2013).
Loneliness has two forms, social and emotional (de Jong-Gierveld & van
Tilburg, 2010; Russell, Cutrona, Rose, & Yurko, 1984). The former refers to a
lack of social partners and the latter to feelings of detachment. Of these,
emotional loneliness appears to be the primary concern in institutionalized
settings as many people live and work in close proximity to one another, but
the quality of the relationships varies (de Guzman et al., 2011; Lauder et al.,
2006; Pinquart & Sorensen, 2001). Some long-term care residents become
very close friends with one another and report lower rates of loneliness
(Casey, Low, Jeon, & Brodaty, 2015; Fessman & Lester, 2000; Sefcik &
Abbott, 2014). However, relationships among residents often are superficial
and, in some cases, detrimental (Foltz-Gray, 1995; Herzberg, 1997; Kovack &
Robinson, 1996; Sefcik & Abbott, 2014). Most notably, some older adults
consciously refrain from forming close friendships with other residents to
avoid the heartache of losing the relationship (Sefcik & Abbott, 2014). Thus,
it is crucially important that long-term care residents have the opportunity to
connect with their close family members and friends.
Among the causes of relationship stress and dissolution in long-term care
are dementia and the short length of stay. Residents who have dementia have
difficulty recalling the details of one another’s lives, communicating, and
engaging in reciprocity, and thus are less able to form and maintain very
close friendships (Casey et al., 2015; Harris, 2013; Sefcik & Abbott, 2014).
Dementia is very common in long-term care. The incidence in assisted living
is 40% and in nursing homes is 50%, so it is likely to be very influential
ACTIVITIES, ADAPTATION & AGING 3
(Harris-Kojetin, Sengupta, & Park-Lee et al., 2016). In addition to cognitive

processes that underpin friendships, the affective bond or trust two people
share takes time to cultivate. Residents may not have the time to build very
close relationships with one another, the sort that are associated with social
support, because long-term care is fairly transitory (Adams, Blieszner, & de
Vries, 2000). The average length of stay in assisted living is 2.7 years and in
nursing homes it is 2.2 years (Jones, Dwyer, Bercovitz, & Strahan, 2009;
Khatutsky et al., 2016).
Socioemotional selectivity theory was used to guide the selection of an
intervention (Carstensen, 1991). The theory suggests that, in old age, emo-
tional support is the primary objective of social relationships and it is derived
from very close family members or friends (Lang, Staudinger, & Carstensen,
1998). Consequently, the intervention should promote these relationships.
Given the geographic distance that often separates residents from their very
close family and friends, videoconferencing technology was selected to bridge
this gap. The use of new technologies by the elderly population may sig-
nificantly contribute to better quality of life, particularly improving commu-
nication and participation in social life (Roupa et al., 2010).
Several studies indicate that videoconferencing may improve long-term
care residents’ affective well-being. For example, residents reported less
depression and more closeness after seeing their loved ones’ faces (Demiris
et al., 2008). The largest study, conducted in Taiwan, concluded that resi-
dents who used videoconferencing (n = 28) experienced a significant decline
in loneliness and an increase in emotional social support after one week and
after three months as compared to their baseline scores and a control group
(n = 21) (Tsai, Tsai, Wang, Chang, & Chu, 2010). This treatment group also
experienced a significant decline in depression after three months as com-
pared to baseline scores and a control group. Residents appeared to enjoy
being involved in family occasions such as watching football games, family
gatherings, seeing family photos, or meeting extended family members who
were unlikely to visit, such as a great-great niece or granddaughter’s boy-
friend (Demiris et al., 2008; Tsai & Tsai, 2010). Residents’ concerns about the
well-being of their family members was assuaged because they could see that
all was well (Demiris et al., 2008; Tsai & Tsai, 2010). Finally, using the
videoconferencing “added a sense of excitement and interest to their days”
and they “had fun with their family” (Tsai & Tsai, 2010, p. 1540).
Although the benefits appear numerous, all of the studies indicated that
medical conditions, ease of use, technical issues, or family members’ availability
hindered videoconferencing. Some residents had visual and hearing impair-
ments, which made it difficult to use the equipment (Mickus & Luz, 2002;
Tsai & Tsai, 2010). Ease of use issues included being intimidated by the
computer equipment or unfamiliar with its use such that interactions were
suboptimal (Mickus & Luz, 2002; Tsai & Tsai, 2010). Technical difficulties
included freezing images (Demiris et al., 2008; Mickus & Luz, 2002). Because of
the ease of use or technical difficulties, the videoconferences sometimes took
more time to complete than phone calls. Some family members were too busy, or
were assumed to be too busy by the residents, and they had difficulty coordinat-
ing schedules to videoconference (Demiris et al., 2008; Mickus & Luz, 2002; Tsai
et al., 2010). Tsai and colleagues (2010) resolved most of the aforementioned
issues by scheduling a weekly in-person meeting with the resident to initiate the
videoconference with the family members. However, 15% of the family declined
to participate in their study because they didn’t have the time. Some of the
scheduling obstacles are likely to be insurmountable.
Despite the difficulties, some residents continued to use videoconferen-
cing. It appeared to be beneficial for residents who experienced “isolation
and lack of a social network” (Demiris et al., 2008, p. 54). Residents who were
likely to be the best candidates for videoconferencing interventions had a

genuine need, valued the addition of the image, were physically and cogni-
tively able to operate the equipment, and were willing to troubleshoot
technical issues (Mickus & Luz, 2002). In particular, those who were dis-
tanced from family or unable to visit in person found the intervention very
beneficial (Mickus & Luz, 2002; Tsai & Tsai, 2010). In sum, videoconferen-
cing appears to hold promise as a means by which older adults living in long-
term care can maintain very close relationships and improve their affective
well-being but there are numerous obstacles to surmount.
Methods
Support for the study was secured from a multi-level long-term care facility,
which included an assisted living residence and a nursing home. The study plan
was approved by the facility and the Utica College Institutional Review Board
(IRB #529). To recruit residents, staff at the facility invited qualified people to an
informational program. Qualified residents included those who: (a) had access
to high-speed Internet service, (b) lived at the facility for at least three months,
(c) had decisional capacity defined as 24 or above on the most recent Mini
Mental State Exam, (d) had the ability to operate the Asus videoconferencing
machine independently or with minimal accommodations, and (e) had a very
close family member or friend who the resident would like to see more often. Of
the 12 residents contacted, eight participated in the study, a response rate of 67%.
The remaining four residents indicated that they were uncomfortable utilizing
the technology or felt their family members would be too busy to participate in
the study. Researchers met with participants to answer any questions and
complete study forms. To select the family/friend, residents were asked to
complete a modified version of the Social Convoy Questionnaire and select
someone who they defined as “very close, so close it would be hard to live
without them” (Lang & Carstensen, 1994, p. 317).
Researchers contacted the family/friends by phone as well as by formal

mailing. Those who met the following criteria participated in the study: (a)
access to high-speed Internet service, and (b) the ability to operate the Asus
videoconferencing machine independently. None of the family members/
close friends refused to participate in the study. The eight family members/
close friends included two daughters (25%), two close friends (25%), one wife
(12.5%), one son (12.5 %), one brother (12.5%), and one niece (12.5%).
A pre-experimental one group pre-test/post-test research design was used;
residents completed a survey before and after the intervention. Both surveys
included scales that were appropriate for their age group and had strong
reliability and validity. The initial survey included items that assessed demo-
graphic information (Burnett-Wolle, 2009; PROMIS Health Organization and
PROMIS Cooperative Group [PROMIS], 2008–2014); companionship
(PROMIS, 2008–2014); emotional loneliness (de Jong-Gierveld & van

Tilburg, 1999); social isolation (PROMIS, 2008–2014); opportunities of nur-
turance (Cutrona & Russell, 1987); emotional support (PROMIS, 2008–2014);
informational support (PROMIS, 2008–2014); and geriatric depression (Brink
et al., 1982). The follow-up survey included items that assessed emotional
loneliness (de Jong-Gierveld & van Tilburg, 1999); social isolation (PROMIS,
2008–2014); opportunities for nurturance (Cutrona & Russell, 1987); emo-
tional support (PROMIS, 2008–2014); informational support (PROMIS,
2008–2014); geriatric depression (Brink et al., 1982), and videoconferencing
use. All data were held in secure filing cabinets or computer files.
Tabletop videoconferencing hardware (Asus AiGuru SVIT) was selected
because it was relatively easy to use, was portable, was affordable, the Skype
service was free of charge, and it recorded the number of calls. The machines
were pre-programmed to call the family/friend or resident and distributed to
each dyad. All but one of the machines connected to the Internet via Wi-Fi.
The remaining machine was connected to the Internet via an ethernet port
because Wi-Fi wasn’t available in the resident’s room. Residents and family/
friends received training on how to use the videoconferencing hardware in
person and via written materials, respectively. At a minimum, the family/
friends called the residents at least once a week for approximately two months,
although the resident and family/friends were free to initiate calls more often.
Some of the residents had physical and cognitive disabilities that impacted
their ability to operate the videoconferencing hardware. Minor adaptations to
the buttons on the machines were made to enable two participants to operate
them. In one case, the spouse operated the hardware for the resident.
Results
The demographic profile of the eight residents in the sample included an
equal number of men and women; all were white and non-Hispanic; the
median age was 85.5 years (IQR = 13.25); the median education was
14.5 years (IQR = 5.5); most were not married (62.5%); and half were eligible
for Medicaid. Most of the residents lived in a nursing home (75%) and the
remainder in assisted living (25%). The facility had 320 nursing home and 80
assisted living beds so the response rates were 2% and 3% respectively. The
participants resided in these facilities for a median of 2.67 years (IQR = 1.96).
There was missing data from one respondent in one scale on the initial
survey. Since the respondent answered identical questions in the subsequent
survey, these scores were used to fill the missing data.
Given the small number of participants, the ability to calculate inferential
statistics was limited. However, Wilcoxon signed-rank tests of the scaled scores
were possible. Emotional support increased slightly, but did not change signifi-
cantly. Before the videoconferencing intervention, the Mdn = 3.00 (IQR = 7.25)
and, after the Mdn = 4.75 (IQR = 8.50), z = −0.8, p = .40. Informational support
increased slightly, but did not change significantly. Before the videoconferencing
intervention, the Mdn = 3.30 (IQR = 6.5) and, after the Mdn = 5.20 (7.25),
z = −1.13, p = .26. Social isolation decreased slightly, but did not change
significantly. Before the videoconferencing intervention, the Mdn = 4.70
(IQR = 6.75) and, after the Mdn = 4.17 (IQR = 14.25), z = −0.77, p = .44.
Emotional loneliness decreased slightly, but did not change significantly. Before
the videoconferencing intervention, the Mdn = 5.63 (IQR = 2.75) and, after the
Mdn = 3.38 (IQR = 3.50), z = −0.64, p = .52. Opportunity for nurturance did not
change significantly. Before the videoconferencing intervention, the Mdn = 4.00
(IQR = 3.75) and, after the Mdn = 4.00 (6.25), z = −0.34, p = .73. Unexpectedly,
geriatric depression increased slightly, but did not change significantly. Before
the videoconferencing intervention, the Mdn = 3.25 (IQR = 2.00) and, after the
Mdn = 4.00 (IQR = 2.50), z = −0.53, p = .60.
Several items were created to assess the videoconferencing experience.
Four-point Likert scales (anchored by strongly disagree and strongly agree)
were used to assess ease of use. Descriptive statistics suggested that most
respondents agreed that the machines were easy to operate (Mdn = 3.50,
IQR = 1.75), it was easy to hear the person on the call (Mdn = 4.00,
IQR = 1.00), it was easy to see the person on the call (Mdn = 4.00,
IQR = 1.00), and becoming disconnected was uncommon (Mdn = 1.00,
IQR = 1.50). In addition to the quantitative items, an open ended question
asked: “Is there anything else you would like to add about communicating
with your relative/friend by videophone?” Two researchers independently
identified themes in the open ended question and two emerged. First,
videoconferencing with close family/friends was pleasurable:
● It was great to see the person.

● I think it was a wonderful thing for the time that I used it. I loved being
able to see my daughter and make that kind of connection rather than
just hearing them on the phone. I love seeing her smile and seeing the
other members of the family. I thought it was absolutely wonderful. I
just wished I could have used it more.
● I loved being able to see my wife and talk to her at any time during
the day. “My wife loved it and she really liked being able to see me. She
had the grandchildren and great-grandchildren present and they were
able to see me too.
● Overall, I enjoyed using it and so did my brother. We could hear each
other well and it was lot of fun to communicate with each other. It was
like having him in the room with me. I could show him things right
there in my room. I also liked that my grandniece could see me during
her birthday party. I really enjoyed it. I got to sing happy birthday to
her. She could see me and I showed her the balloons I had in my room.
Second, several respondents indicated that using the videoconferencing

machine was, at times, difficult to use and they needed technical support:
● I am glad we had access to the researchers when there was a problem.

● I enjoyed having it but it was frustrating due to the technical issues.
● I did not like the disconnections that occurred from time to time. I also
had a tough time initiating the call to them.
Discussion
Demographically, the small sample varied by gender, socioeconomic status,
and level of care. It was uniform regarding ethnicity and tended to have
above-average education. Results of the Wilcoxon signed-rank tests suggested
that the intervention did not have a significant influence on affective well-
being. However, changes in emotional support, informational support, social
isolation, and emotional loneliness subscales were favorable and this trend is
consistent with the literature. Tsai and colleagues (2010) noted that loneliness
diminished after videoconferencing with family.
Participants frequently indicated that they enjoyed seeing and talking with
very close family/friends in the open ended question, which is consistent with
the literature (Demiris et al., 2008; Tsai & Tsai, 2010). Unexpectedly, geriatric
depression increased slightly, although not significantly, and this trend is
inconsistent with the literature (Demiris et al., 2008; Tsai et al., 2010). Thus,
the change in geriatric depression may be related to frustration related to
troubleshooting technical difficulties during or relinquishing the equipment
at the end of the study. Also, although emotional loneliness decreased
slightly, it did not change significantly. During the two-month period, time
was spent troubleshooting technical difficulties, which frustrated some of the
residents and may have contributed to the findings of the emotional
loneliness scores. Extending the study to three months, which is consistent

with the literature, (Tsai et al., 2010) and reducing technical difficulties
would have allowed the residents more quality time videoconferencing with
their family members/close friends; instituting such changes may have
decreased their sense of emotional loneliness. Future research should moni-
tor depression/loneliness to ensure that videoconference interventions don’t
have adverse outcomes.
Several quantitative items were written to assess the participants’ ability to
operate the videoconferencing hardware. The results suggested that the respon-
dents were able to operate the machinery with a moderate to high degree of
ease. However, responses to the open ended question indicated that the resi-
dents needed technical support and are consistent with the literature (Demiris
et al., 2008; Mickus & Luz, 2002; Tsai & Tsai, 2010; Tsai et al., 2010).
In addition to residents’ responses, the researchers noted technical diffi-

culties throughout the study. Issues with the internet signal, which resulted in
poor image or voice quality, were expected (Demiris et al., 2008; Mickus &
Luz, 2002). However, the inconsistency of Wi-Fi coverage within the facility
was unexpected. A few residents had weak Wi-Fi coverage such that, when
residents moved the videoconferencing machine around in their rooms,
disconnections would occur, resulting in frustration. In addition to trouble-
shooting connectivity issues, the researchers routinely met with residents to
teach them to receive and place calls. During conversations with the
researchers, residents reported feeling intimidated by the technology. This
echoes previous research (Mickus & Luz, 2002; Tsai & Tsai, 2010). Finally,
scheduling calls between residents and close family/friends was challenging
and is consistent with the literature (Demiris et al., 2008; Mickus & Luz,
2002; Tsai et al., 2010). In particular, some family/friends lived in different
time zones and the dyads struggled to find mutually convenient times to
videoconference.
Limitations
The most notable limitations of this study were the sample size and research
methods. Although a sample of eight was appropriate for a pilot study of a
logistically complex intervention, the small sample size may account for the
lack of significance in the results. Other researchers have used small sample
sizes. Demiris and colleagues (2008) and Mickus and Luz (2002) included
four and 10 residents respectively, but conducted qualitative research. A pair
of quantitative studies included larger treatment samples, 28 and 34 residents
respectively, but appeared to have extensive resources at their disposal (Tsai
& Tsai, 2010; Tsai et al., 2010). For example, recruitment strategies used by
Tsai and colleagues (2010) collected data at 12 nursing homes and solicited
154 family members for their sample. If the research methods can be
reconfigured such that technical support and participant education are man-
ageable, larger samples, which reflect real-world scenarios, may be feasible.
Implications for future research and practice

The use of videoconferencing to reduce loneliness appears to be promising
but logistical issues are numerous. The following recommendations may
improve the success of similar interventions in future research and practice:
● Select hardware that is portable and durable. Most important, the hard-
ware and the software must be easily accessible to the users. For exam-
ple, the Apple iPad Air 2 is very easy to use, has a large sharp image, has
loud speakers, and is very portable. Placing it in a drop-proof case with
handles will make the tablet durable and easy to hold. Finally, the
operating system includes FaceTime software, which is ideal for those
within the Apple ecosystem, and supports Skype, for those who are not.
● A reasonable strategy for implementing the intervention may be to
adopt a structure similar to residents receiving or making phone calls
at the nurses station. The unit staff (especially those in the Nursing,
Therapeutic Recreation, and Housekeeping departments) must commit
to participating in the intervention. One or two tablets could be placed
at the unit’s nursing station and made available to residents. When a
family/friend place a videoconference call to the unit, a staff member
could answer, take the tablet to the resident, and leave it with the
resident so he/she can converse independently and privately. The tablet
would be returned to the nursing station after the call. If a resident
wanted to videoconference a family/friend, the staff member would
place the call for the resident. During the call, the resident could choose
to find privacy in his/her room or remain close to the nursing station
where assistance is readily available.
● Smartphones and tablets (as well as computers) have become ubiquitous
and many people have used FaceTime and Skype applications such that
the amount of training unit staff and family/friends require would be
minimal. Residents could get assistance from nearly all of the staff so
they would need almost no training. Since very little new learning would
be required, residents with dementia would also be able to participate in
and benefit from the intervention.
● Additional benefits of using an iPad include a “do not disturb” setting
which can be used to disable the ringer at night, a wide range of
“accessibility” options which may improve residents’ experiences, and
a “find my iPhone” feature which prevents theft and misplacing tablets.
● Relying on family/friends to provide their own hardware and limiting
the facilities’ investment to one or two tablets per unit will reduce
equipment costs. Buying an insurance policy for each tablet may be a

wise precaution.
● High-speed Internet service that is adequate for videoconferencing is
essential. Signal strength throughout the facility may vary and the ability
and willingness of Information Technology personnel to troubleshoot
connectivity will play an important role in the success of the intervention.
● Scheduling videoconference calls is likely to be a persistent issue but it
may improve somewhat if mutually convenient times are identified prior
to starting the intervention. To this end, facilities may want to establish
a policy regarding when calls are discouraged, such as during meals or
shift changes, because staff tend to be very busy at those times. If
residents are indisposed, staff and family/friends should be prepared to
wait a few minutes while the residents are made presentable or to
reschedule the call for another time.

● The logistics associated with implementing videoconferencing interven-
tions are extensive. To avoid a sizable investment of time and money as
well as disruption in participants’ lives, a small pilot test that includes
the aforementioned recommendations is encouraged. Specifically, the
use of videoconferencing in a single unit for residents who have a high
degree of cognitive ability is suggested, since they are likely to need less
assistance from the staff. The frequency and type of logistical issues
should be monitored. If they can be resolved adequately, expanding the
intervention to other units may be justified.
● Finally, future research should include a larger sample, a time frame of
at least 3 months and a stronger study design that includes a control
group, a longitudinal design and include residents with dementia. Since
staff and family/friends’ involvement is essential to executing the inter-
vention, their experience should also be examined.
Conclusion
Loneliness is associated with high rates of morbidity and mortality.
Residents in long-term care report high rates of loneliness and, in parti-
cular, are likely to experience emotional loneliness. Socioemotional selec-
tivity theory suggests that fostering relationships with very close family
and friends may ease emotional loneliness. Residents who are distanced
from very close family or friends may benefit from communicating with
them via videoconference when in-person visits are limited or impossible.
This pilot study examined a videoconferencing intervention to address
emotional loneliness. A sample of eight residents used Skype to commu-
nicate with very close family/friends one or more times each week for
2 months. Wilcoxon matched pairs tests suggested that videoconferencing
did not have a significant effect on affective well-being. However, desirable
changes in emotional support, informational support, social isolation, and

emotional loneliness, as well as undesirable changes in depression, were
evident. The lack of statistical significance may be due to the small sample.
The logistics of implementing this study were very challenging and enlar-
ging the sample size would necessitate changing the research methods.
Most notably, the choice of hardware, as well as the availability of assis-
tance to operate the hardware and software, needs to be altered. Specific
recommendations were made to facilitate future research and practice.
Funding
We would like to extend our thanks to Utica College for their financial support regarding our
research project.
ORCID
Sarah Burnett-Wolle http://orcid.org/0000-0002-5335-5951
References
Adams, R. G., Blieszner, R., & de Vries, B. (2000). Definitions of friendship in the third age:
Age, gender, and study location effects. Journal of Aging Studies, 14(1), 117–133.
doi:10.1016/S0890-4065(00)80019-5
Beal, C. (2006). Loneliness in older women: A review of the literature. Issues in Mental Health
Nursing, 27(7), 795–813. doi:10.1080/01612840600781196
Brink, T. L., Yesavage, J. A., Lum, O., Heersema, P., Adey, M. B., & Rose, T. L. (1982).
Screening tests for geriatric depression. Clinical Gerontologist, 1, 37–44. doi:10.1300/
J018v01n01_06
Buchman, A. S., Boyle, P. A., Wilson, R. S., James, B. D., Leurgans, S. E., Arnold, S. E., &
Bennett, D. A. (2010). Loneliness and the rate of motor decline in old age: The rush
memory and aging project, a community-based cohort study. BMC Geriatric, 10(1), 77.
doi:10.1186/1471-2318-10-77
Burnett-Wolle, S. (2009). Applying socioemotional selectivity theory to nursing home recrea-
tion: Services which promote residents’ and family/friends affective well-being (Unpublished
doctoral dissertation). Penn State University, State College, PA. Retrieved from http://
gradworks.umi.com/33/74/3374461.html
Cacioppo, J. T., Hawkley, L. C., Crawford, L. E., Ernst, J. M., Burleson, M. H., Kowalewski,
R. B., … Berntson, G. C. (2002). Loneliness and health: Potential mechanisms.
Psychosomatic Medicine, 64, 407–417. doi:10.1097/00006842-200205000-00005
Cacioppo, J. T., Hawkley, L. C., Norman, G. J., & Berntson, G. G. (2011). Social isolation.
Annals of the New York Academy of Sciences, 1231(1), 17–22. doi:10.1111/j.1749-
6632.2011.06028.x
Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006).
Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and long-
itudinal analyses. Psychology and Aging, 21, 140–151. doi:10.1037/0882-7974.21.1.140
Carstensen, L. L. (1991). Selectivity theory: Social activity in lifespan context. Annual Review
of Gerontology and Geriatrics. 11, 195–217. Retrieved from https://scholar.google.com/
citations?view_op=view_citation&hl=en&user=hsKzGAwAAAAJ&citation_for_view=
hsKzGAwAAAAJ:Ug5p-4gJ2f0C
Casey, A. S., Low, L. F., Jeon, Y. H., & Brodaty, H. (2015). Residents perceptions of friendship
and positive social networks within a nursing home. The Gerontologist. Retrieved from
http://gerontologist.oxfordjournals.org/content/early/2015/11/23/geront.gnv146.abstract
Center for Disease Control and Prevention. (2013). Long-term care services. Retrieved from
http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf
Couture, L. (2012). Loneliness linked to serious health problems and death among elderly.
Activities Adaptation & Aging, 36(3), 266–268. doi:10.1080/01924788.2012.696234
Cutrona, C. E., & Russell, D. W. (1987). The provisions of social relationships and adaptation
to stress. Advances in Personal Relationships. 1, 37–67. Retrieved from http://depts.washing
ton.edu/uwcssc/sites/default/files/hw00/d40/uwcssc/sites/default/files/Social%20Provisions
%20Scale_0.pdf
de Guzman, A., Satuito, J., Satumba, M., Segui, D., Serquina, F., & Sevilla, M. (2011). Filipino
arts among elders in institutionalized care settings. Educational Gerontology, 37(3),
248–261. doi:https://doi.org/10.1080/03601270903534937
de Jong-Gierveld, J., & Van Tilburg, T., (1999). Manual of the loneliness scale 1999. Retrieved
from http://home.fsw.vu.nl/tg.van.tilburg/manual_loneliness_scale_1999.html
de Jong-Gierveld, J., & van Tilburg, T. (2010). The de Jong-Gierveld short scales for emo-
tional and social loneliness: Tested on data from 7 countries in the UN generations and
gender surveys. European Journal of Ageing, 7(2), 121–130. doi:10.1007/s10433-010-0144-6
Demiris, G., Parker Oliver, D., Hensel, B., Dickey, G., Rantz, M., & Skubic, M. (2008). Use of
videoconferencing for distant caregiving: An enriching experience for families in long-term
care. Journal of Gerontological Nursing, 34(7), 50–55. Retrieved from http://www.ncbi.nlm.
nih.gov/pubmed/18649824
Drageset, J., Eide, G., Dysvik, E., Furnes, B., & Hauge, S. (2015). Loneliness, loss, and social
support among cognitively intact older people with cancer, living in nursing homes—a mixed-
methods study. Clinical Interventions in Aging, 10, 1529–1536. doi:10.2147/CIA.S88404
Drageset, J., Espehaug, B., & Kirkevold, M. (2012). The impact of depression and sense of
coherence on emotional and social loneliness among nursing home residents without
cognitive impairment: A questionnaire survey. Journal of Clinical Nursing, 21, 965–974.
doi:10.1111/j.1365-2702.2011.03932.x
Drageset, J., Kirkevold, M., & Esephaug, B. (2010). Loneliness and social support among
nursing home residents without cognitive impairment: A questionnaire survey.
International Journal of Nursing Studies, 48(5), 611–619. doi:10.1016/j.ijnurstu.2010.09.008
Fessman, N., & Lester, D. (2000). Loneliness and depression among elderly nursing home
patients. International Journal of Aging and Human Development, 51(2), 137–141.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11140848
Foltz-Gray, D. (1995). Intimate strangers. When roommates clash, caregivers can ease the
tension—or make it worse. Contemporary Long-Term Care, 18(6), 34–37.
Harris, P. B. (2013). Dementia and friendship: The quality and nature of the relationships that
remain. The International Journal of Aging and Human Development, 76(2), 141–164.
Retrieved from http://ahd.sagepub.com/content/76/2/141.abstract
Harris-Kojetin, L., Sengupta, M., Park-Lee, E., Valverde, R., Caffrey, C., Rome, V., Lendon, J.
(2016). Long-term care providers and services users in the United States: Data from the
national study of long-term care providers, 2013–2014. National Center for Health
Statistics. Vital Health Statistics, 3(38), x–xii. (DHHS Publication No. 2016–1422).
Retrieved from http://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf
Hawkley, L. C., Thisted, R. A., Masi, C. M., & Cacioppo, J. T. (2010). Loneliness predicts
increased blood pressure: Five-year cross-lagged analyses in middle-aged and older adults.
Psychology and Aging, 25(1), 132–141. doi:10.1037/a0017805
Herzberg, S. R. (1997). The impact of the social environment on nursing home residents.
Journal of Aging and Social Policy, 9(2), 67–80. doi:10.1300/J031v09n02_06
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and
social isolation as risk factors for mortality: A meta-analytic review. Perspectives on
Psychological Science, 10(2), 227–237. doi:10.1177/1745691614568352
Jones, A. L., Dwyer, L. L., Bercovitz, A. R., & Strahan, G. W. (2009). The National Nursing
Home Survey: 2004 overview. National Center for Health Statistics. Vital Health Stat, 13
(167). Retrived from http://www.cdc.gov/nchs/data/series/sr_13/sr13_167.pdf
Khatutsky, G., Ormond, C., Wiener, J. M., Greene, A. M., Johnson, R., Jessup, E. A., …
Harris-Kojetin, L. (2016). Residential care communities and their residents in 2010: A
national portrait. (National Center for Health Statistics: DHHS Publication No. 2016-
1041). Retrieved from http://www.cdc.gov/nchs/data/nsrcf/nsrcf_chartbook.pdf
Kovack, S. S., & Robinson, J. D. (1996). The roommate relationship for the elderly nursing
home resident. Journal of Social and Personal Relationships, 13(14), 627–634.
Lang, F., & Carstensen, L. (1994). Close emotional relations in later life: Further support for
proactive aging in the social domain. Psychology and Aging, 9(2), 315–324. Retrieved from
https://www.researchgate.net/profile/Frieder_Lang/publication/15145427_Close_emo
tional_relationships_in_late_life_further_support_for_proactive_aging_in_the_social_
domain/links/5558bd9e08ae980ca61056a5.pdf
Lang, F., Staudinger, U., & Carstensen, L. (1998). Perspectives on socioemotional selectivity in
late life: How personality and social context do (and do not) make a difference. Journal of
Gerontology, 53B(1), 21–30. Retrieved from http://psychsocgerontology.oxfordjournals.org/
content/53B/1/P21.full.pdf
Lauder, W., Mummery, K., & Sharkey, S. (2006). Social capital, age and religiosity in people
who are lonely. Journal of Clinical Nursing, 15(3), 334–340. Retrieved from http://www.
ncbi.nlm.nih.gov/pubmed/16466483
Mickus, M. A., & Luz, C. C. (2002). Televisits: Sustaining long distance family relationships
among institutionalized elders through technology. Aging & Mental Health. 6, 387–396.
Perissinotto, C. M., Stijacic Cenzer, I., & Covinsky, K. E. (2012). Loneliness in older persons:
A predictor of functional decline and death. Archives of Internal Medicine, 172(14),
1078–1084. doi:10.1001/archinternmed2012.1993
Pinquart, M., & Sorensen, S. (2001). Influences on loneliness in older adults: A meta-analysis.
Basic and Applied Social Psychology, 23, 245–266. doi:10.1207/S15324834BASP2304_2
PROMIS. (2008-2014). Instruments available for use in assessment center. Retrieved from
https://www.assessmentcenter.net/documents/InstrumentLibrary.pdf
Roupa, Z., Nikas, M., Gerasimou, I., Zafeiri, V., Giasyrani, L., Kazitori, E., & Sotiropoulou, P.
(2010). The use of technology by the elderly. Health Science Journal, 4(2), 118–126.
Retrieved from http://www.hsj.gr/medicine/the-use-of-technology-by-the-elderly.pdf
Russell, D. W., Cutrona, C. E., de la Mora, A., & Wallace, R. B. (1997). Loneliness and
nursing home admission among rual older adults. Psychology and Aging, 12(4), 574–589.
Russell, D. W., Cutrona, C. E., Rose, J., & Yurko, K. (1984). Social and emotional loneliness:
An examination of Weiss’s typology of loneliness. Journal of Personality and Social
Psychology, 46(6), 1313–1321. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/
6737214
Scocco, P., Rapattoni, M., & Fantoni, G. (2006). Nursing home institutionalization: A source
of eustress or distress for the elderly? International Journal of Geriatric Psychiatry, 21(3),
281–287. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16477582
Sefcik, J. S., & Abbott, K. M. (2014). Right back to square one again: The experience of
friendship among assisted living residents. Activities, Adaptation & Aging, 38(1), 11–28.
Retrieved from http://scholar.google.com/citations?view_op=view_citation&hl=en&user=
7TG6oFoAAAAJ&citation_for_view=7TG6oFoAAAAJ:UeHWp8X0CEIC
Theeke, L. A. (2010). Sociodemographic and health-related risks for loneliness and outcome
differences by loneliness status in a sample of U.S. older adults. Research in Gerontological
Nursing, 3(2), 113–125. doi:10.3928/19404921-20091103-99
Tijhuis, M. A., De Jong-Gierveld, J., Feskens, E. J., & Kromhout, D. (1999). Changes in and
factors related to loneliness in older men. The Zutphen Elderly Study. Age and Ageing, 28
(5), 491–495. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10529046
Tilvis, R. S., Laitala, V., Routasealo, P. E., & Pitkala, K. H. (2011). Suffering from loneliness
indicates significant mortality risk of older people. Journal of Aging Research, 534781.
doi:10.4061/2011/534781
Tsai, H. H., & Tsai, Y. F. (2010). Older nursing home residents’ experiences with videocon-
ferencing to communicate with family members. Journal of Clinical Nursing, 19,
1538–1543. doi:10.1111/j.1365-2702.2010.03198.x
Tsai, H. H., Tsai, Y. F., Wang, H. H., Chang, Y. C., & Chu, H. H. (2010). Videoconference
program enhances social support, loneliness, and depressive status of elderly nursing home
residents. Aging & Mental Health, 14(8), 947–954. doi:10.1080/13607863.2010.501057
Wilson, R. S., Krueger, K. R., Arnold, S. E., Schneider, J. A., Kelly, J. F., Barnes, L. L., …
Bennett, D. A. (2007). Loneliness and risk of Alzheimer disease. Archives of General
Psychiatry, 64(2), 234–240. Retrived from http://www.ncbi.nlm.nih.gov/pubmed/17283291

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Activities, Adaptation & Aging

ISSN: 0192-4788 (Print) 1544-4368 (Online) Journal homepage: http://www.tandfonline.com/loi/waaa20

Video Conferencing: An Intervention for Emotional

Mary T. Siniscarco, Cynthia Love-Williams & Sarah Burnett-Wolle

To link to this article: http://dx.doi.org/10.1080/01924788.2017.1326763

Published online: 15 Jun 2017.

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Download by: [Pepperdine University] Date: 10 August 2017, At: 21:25

Video Conferencing: An Intervention for Emotional

ABSTRACT ARTICLE HISTORY

address these feelings. A sample of eight residents used video- KEYWORDS

Loneliness is a negative experience which results from individuals’ subjective

Most important, a nationally representative study and meta-analysis indicate

(Harris-Kojetin, Sengupta, & Park-Lee et al., 2016). In addition to cognitive

likely to be the best candidates for videoconferencing interventions had a

Researchers contacted the family/friends by phone as well as by formal

(PROMIS, 2008–2014); emotional loneliness (de Jong-Gierveld & van

● It was great to see the person.

Second, several respondents indicated that using the videoconferencing

● I am glad we had access to the researchers when there was a problem.

loneliness scores. Extending the study to three months, which is consistent

In addition to residents’ responses, the researchers noted technical diffi-

Implications for future research and practice

equipment costs. Buying an insurance policy for each tablet may be a

reschedule the call for another time.

changes in emotional support, informational support, social isolation, and

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