Adoption and feasibility of a communication app to enhance social connectedness amongst frail institutionalized oldest old: an embedded case study

The risks of social isolation and loneliness are becoming emergent issues for older adults (aged 65+) in industrialized countries, particularly for oldest old people (80+) who are frail and institutionalized. Socially isolated and lonely older people are more likely to experience depression, social disengagement, cognitive and physical decline, morbidity, and early mortality. In response to these significant negative health and socioeconomic costs, research suggests using new technologies to enhance opportunities for social connectedness as a strategy to help alleviate both social isolation and loneliness. In this context, following a participatory design method, we developed an accessible communication app with and for frail institutionalized older adults. To test the adoption of this innovative technology and its feasibility to address social isolation and loneliness, we conducted a two-month deployment of the app in a long-term care home with five oldest old and their relatives. Due to access, recruitment, and ethical challenges, the oldest old are a specially understudied group. Using an embedded case study (based on interviews, psychometric scales, field observations, and usability and accessibility testing) and a recursive approach to technology studies, our findings show that technology adoption is based on a complex set of interrelated factors: social, attitudinal, physical, digital literacy, and usability. We also discuss the feasibility of the app to enhance perceived social connectedness amongst our target population, provided that at least one strong tie is involved and communication norms and expectations across generations are considered.