Abstract
This study found that using information and communications technology has the potential to enhance opportunities for older adults’ social interaction, thereby improving the quality and quantity of social participation.
Research has shown that social participation among older adults is associated with reduced mortality (de Lima Silva et al., 2014) and increased healthy life expectancy (Matsuyama et al., 2022). Furthermore, social participation has been found to decrease the risk of loneliness (Newall et al., 2009) and cognitive decline (Tomioka et al., 2018) among this population. Dementia is a significant global health concern, with approximately 10 million new cases reported annually (World Health Organization [WHO], 2023). Furthermore, 1 in 4 older adults reports feelings of loneliness (WHO, 2024). Loneliness can be defined as a subjective negative feeling associated with a perceived lack of a wider social network or the absence of a specific desired companion (Valtorta & Hanratty, 2012). Loneliness has been identified as a significant risk factor for older adults’ developing dementia within 10 yr (Yin et al., 2019). Moreover, loneliness may serve as an early indicator of cognitive dysfunction and a modifiable target for the purpose of delaying the onset of dementia (Harrington et al., 2023). Social participation can be defined as a person’s involvement in activities providing interactions with others in community life and in important shared spaces, evolving according to available time and resources, and based on the societal context and what individuals want and find meaningful (Levasseur et al., 2022). The efficacy of social engagement as a means of combating loneliness and cognitive decline is contingent on the availability of time and resources, as well as the individual’s social and cultural background. It is therefore essential to consider these factors in conjunction with one another, because reducing loneliness through social participation in meaningful activities with people and in places that matter to them can help prevent cognitive decline and dementia.
When supporting the social participation of older adults, it is important to understand the physical and social environments surrounding the target population. Factors that inhibit older adults’ social participation include physical factors, such as the lack of places to meet and limited availability of public transportation, and social factors, such as the absence of social networks and supporters (Levasseur et al., 2020). In response to the aforementioned barriers to social participation, online social interaction through information and communication technologies (ICTs) has the potential to address the physical and social challenges older adults face. Indeed, studies have demonstrated that ICTs facilitate their social participation (Chen et al., 2022). In recent years, interest in using ICTs to encourage social participation among older adults has been increasing (Mulati et al., 2022), with their use also increasing among this population.
ICTs refer to a broad range of technologies that enable access to information through communication, including digital network technologies such as messaging services, online discussion groups, and social networking sites (Christensson, 2010). In Japan, an app called Kayoinoba has been developed with the objective of encouraging people to use ICTs to interact and engage with others even from home (National Center for Geriatrics and Gerontology, 2020). A growing body of evidence has associated ICTs with increased social participation and the expansion of social networks (Ibarra et al., 2020). The expansion of social networks has been demonstrated to increase satisfaction with (Rochelle, 2023) and the frequency of (Townsend et al., 2021) social participation by increasing the frequency of social interactions. Nevertheless, with only 40.8% of Japan’s older adults older than age 70 yr using these services, the intergenerational digital divide is becoming a significant concern (Ministry of Internal Affairs and Communications, 2021). Consequently, a significant proportion of older adults who engage in social participation do not use ICTs, which may influence the frequency of social interactions. However, the extent to which this is the case remains unclear.
Japan has implemented a policy aimed at providing opportunities for social participation for older adults, such as community gathering places located within elementary school districts or within walking distance from their homes, with the purpose of preventing the need for caregiving. These community gathering places are available in 93.0% of prefectures and municipalities throughout Japan, with a gathering frequency of approximately once a week (Ministry of Health, Labour and Welfare [MHLW], 2020). The primary passive activities among older adults are exercise (56.1%), hobbies (16.5%), social gatherings (tea parties; 15.4%), and dementia prevention activities (4%).
Although dementia is the most common disease causing older adults to transition to long-term care (MHLW, 2022), the problem is currently not being adequately addressed. In light of this, occupational therapists and other rehabilitation specialists are dispatched to assist community gathering places in providing effective preventive care. Occupational therapists can increase the frequency of social participation, help to prevent cognitive decline (De Coninck et al., 2017), and decrease loneliness (Collins et al., 2020). However, most existing studies have been conducted with populations gathered for research purposes. Therefore, there is insufficient evidence to support group-based interventions tailored to the needs of older adults, such as the government’s requirement for occupational therapists to work with older adults who are using community gathering places (Turcotte et al., 2018). To effectively promote social participation, interventions should consider various factors, such as the participant’s health status, the nature of the work involved in participation, and the environment in which participation occurs (Hashidate et al., 2021; Smallfield & Molitor, 2018). It is important to understand that social participation needs to be meaningful to older adults, not just more frequent. To promote social participation among older adults, occupational therapists should focus on both objective data and older adults’ own subjective evaluations. Moreover, as Levasseur et al. (2022) posited, the integration of informal and meaningful social participation is essential to enhance health outcomes, particularly for older adults. Occupational therapists should prioritize engaging with older adults who are socially active.
This study aimed to assess the effect of meaningful social participation, frequency of social engagement, use of ICT, and expansion of social networks on cognitive functioning and loneliness among socially engaged older adults in Japan. The results of this study will enable occupational therapists to intervene more effectively with the older adult population of Japan.
Method
Study Design and Procedure
This cross-sectional study used a questionnaire method over an 8-mo period from August 2022 to March 2023. The data were collected from older adults who met at community gathering places. Meetings at Japanese community gathering places occur voluntarily about once a week for exercise, hobby activities, and tea ceremonies. These groups do not usually attend ICT lectures. The participants included 113 older adults (M age = 78.6 yr, SD = 5.2; 92% female) from seven community gathering places located in western Japan, who met together for preventive care purposes. Written consent was obtained from the participants at the meetings before data collection. The meetings were conducted by the older adults, and their participation was voluntary. These meetings focused on increasing social participation and reducing loneliness and were held in locations that were accessible by foot. The participants were selected and recruited from a group of older adults who regularly attended community gathering places. Potential participants were recruited on the basis of the following inclusion criteria: being age 65 yr or older and having access to the meeting place where the preventive care programs were being conducted. The exclusion criterion was impaired communication skills because of severe cognitive or language impairments that would prevent participants from engaging in program activities.
Main Outcome Measure
We used the Mini-Cog, a brief and validated screening tool for cognitive impairment, to assess cognitive function (Borson et al., 2003). The Mini-Cog consists of a three-word recall test and a clock-drawing test. The total score ranges from 0 to 5, with lower scores indicating more severe cognitive impairment.
Descriptive Variables
Loneliness
Loneliness was assessed using the Japanese version of the Three-Item Loneliness Scale (TIL), a brief and reliable measure derived from the University of California, Los Angeles, Loneliness Scale (Hughes et al., 2004). The total score ranges from 3 to 9, with higher scores indicating higher levels of loneliness. This scale has been validated with older Japanese adults and demonstrated good reliability and validity (Igarashi, 2019).
ICT Use
We measured the older adults’ use of ICTs using a modified version of a questionnaire developed by Achdut and Sarid (2020). The questionnaire asked about the frequency of text messages (e.g., email, chat, bulletin boards, LINE, and Twitter) and phone and video calls (e.g., Facebook) in the past 3 mo. Respondents who used either text messages or phone and video calls were classified as ICT-based communication users (“yes”), and those who used little or no ICT for both were classified as nonusers (“no”).
Social Network
We used the Japanese version of the six-item Lubben Social Network Scale (LSNS–6), a validated measure of social isolation risk among older adults (Kurimoto et al., 2011). The scale consists of six questions about the frequency of contact with relatives and friends and the number of people contacted, with responses to each question made using a 6-point Likert scale. The total score ranges from 0 to 30, with lower scores indicating a higher risk of social isolation. The scale has been widely used in various countries and languages and has demonstrated good reliability and validity.
Meaningful Social Participation and Frequency of Social Participation
The assessment of meaningful social participation was conducted using the Canadian Occupational Performance Measure (COPM), a tool designed to evaluate self-perceptions of occupational performance across three domains: self-care, leisure, and productivity (Law et al., 1990). Participants are asked to identify the occupations in which they are currently engaged on a daily basis and to self-assess the importance, performance, and satisfaction associated with each. This instrument has been used with a diverse range of populations, including older adults, and has exhibited satisfactory reliability and validity (McColl et al., 2000). In this study, we identified work involvement as a significant aspect of social participation, because all participants were engaged in social activities on a daily basis. Furthermore, respondents indicated the duration of their involvement in each activity over the past month and the number of years they had been engaged in social activities.
Covariates
The covariates age, years of education, years of schooling, and depression, which are common dementia risk factors (WHO, 2023), were selected for analysis, as was loneliness (Cohen-Mansfield et al., 2016). These variables were also considered in a review on cognitive decline and loneliness (Harrington et al., 2023). Years of education were checked to ascertain whether the participants had less than 9 or more than 10 yr of compulsory education. Depression was assessed using the Center for Epidemiological Studies Depression Scale (CES–D; Lewinsohn et al., 1997).
Statistical Analyses
Descriptive statistics were computed using R (Version 4.2.2) software. Interrelationships between variables were estimated using the statistical modeling program Mplus (Version 8.9; Muthén & Muthén, 2010).
Bivariate correlations that included cognitive functioning and loneliness were computed for the entire sample. Structural equation modeling (SEM) assumes two statistical assumptions: the independence of the observed data and multiple normally distributed data. The initial assumption was satisfied; however, the latter was not. Because the data did not follow a normal distribution (assessed using a Kolmogorov–Smirnov test, SEM was then performed using the robust diagonal weighted least squares method (WLSMV) to assess the latent variables associated with social participation. The WLSMV method improves the computation of the inverse of the weighted least squares weight matrix, potentially yielding results with fewer samples compared with the maximum likelihood method (Beauducel & Herzberg, 2006). On the basis of the low amount of missing data and high covariance coverage, the data analysis estimates are reliable (Dong & Peng, 2013). Therefore, we used Mplus full information maximum likelihood estimation with a robust approach.
The model was modified on the basis of estimations and a goodness-of-fit check. The evaluation of model fit included reporting the χ2 value, degrees of freedom, and p value. A p > .05 conventionally indicates a good fit to the population data (Kline, 2011). The criteria for goodness-of-fit were a root mean square error of approximation (RMSEA) of less than .05 and a comparative fit index (CFI) and Tucker–Lewis index (TLI) of .95 or higher (Xia & Yang, 2019). The minimum sample size required to detect an effect of 0.3 was calculated with a desired power level of .8, two latent variables, 12 observed variables, and a probability level of .05 (Soper, 2024). The resulting minimum sample size was 90 individuals.
This study was conducted in accordance with the ethical standards of the Osaka Metropolitan University (Research Approval No. 2022-208), and all participants provided signed informed consent. The study adhered to the ethical principles set forth in the Declaration of Helsinki. This study adhered to the ethical principles of medical research involving human subjects, as outlined in the Declaration of Helsinki.
Results
Study consent was also obtained from representatives of the seven community gathering places in Osaka Prefecture (Table 1). On average, 16.1 (SD = 7.2) older adults per community gathering place engaged in the program. A total of 113 older adults (M age = 78.6, SD = 5.2 yr) cooperated in the study, leading to the termination of study recruitment. Of those who participated, 104 (92%) were female, 82 (73%) had an education beyond compulsory schooling, and 60 (55%) used ICTs. Normal distribution for each factor was not observed except for age. The kurtosis and skewness values were within the reference ranges in all cases, which allowed for SEM (Table 2).
Characteristics of the Study Participants
Descriptive Statistics for the Study Population
Note. p values were evaluated with the Kolmogorov–Smirnov test to confirm the normal distribution of the data.
The bivariate correlations are shown in Table 3 for the observed variables. First, we examined the goodness-of-fit of the measurement model for the latent variables (Figure 1). For social networks, both family (estimate = 0.532, standard error [SE] = 0.103, p = .00) and friendship (estimate = 0.710, SE = 0.101, p = .00) showed a good fit. Regarding meaningful social participation, the results for importance (estimate = 1.013, SE = 0.018, p = .00), performance (estimate = 0.807, SE = 0.034, p = .00), and satisfaction (estimate = 0.822, SE = 0.032, p = .00) indicated a good fit. The covariates were not statistically significant for age (estimate = −0.072, SE = 0.096, p = .453), years of education (estimate = 0.144, SE = 0.099, p = .146), depression (estimate = −0.152, SE = 0.087, p = .082), and loneliness (estimate = −0.042, SE = 0.092, p = .646). These variables did not show statistically significant relationships, indicating that they could be addressed by removing the variables.
Bivariate Correlations Between Observed Variables
Note. Standard deviations are in parentheses. ICT = information and communication technologies.
*p < .005. **p < .001.
Diagram illustrating Model 1.
The χ2 test of model fit resulted in χ2(23) = 28.291, p = .205. The nonsignificant p value indicates that the model fits the data well. The final model’s goodness-of-fit was within the criterion values for RMSEA (p = .045, 90% confidence interval [CI] [0.000, 0.094]), CFI (p = .995), and TLI (p = .993), indicating good model fit. The small χ2 value relative to the degrees of freedom further supports this conclusion. The indirect effect mediated by meaningful social participation was significant, and the direct effect paths from the use of ICT, social networks, and frequency of social participation were nondominant. For each path, the direct effect of the use of ICTs on social networks was 0.472 (SE = 0.106, p = .00), the effect of social networks on frequency of social participation was 0.324 (SE = 0.113, p = .01), and the effect of social networks on meaningful social participation was 0.381 (SE = 0.109, p = .00). Meaningful social participation and cognitive function showed an effect value of 0.237 (SE = 0.075, p = .00), and meaningful social participation and loneliness showed an effect value of −0.235 (SE = 0.075, p = .00).
Discussion
This study aimed to assess the effect of meaningful social participation, frequency of social engagement, use of ICTs, and expansion of social networks on cognitive functioning and loneliness among socially engaged older adults in Japan.
Using a cross-sectional design, this study measured the use of ICTs in seven meeting places, cognitive function using the Mini-Cog, loneliness using the Japanese version of the TIL, occupational association with social participation with the COPM, and social participation with the LSNS–6. The findings demonstrate that older adults who engaged in social interaction, ICTs, and expanded social networks to enhance social participation exhibited a favorable impact on cognitive function and that these activities were associated with a reduction in loneliness. Moreover, social participation with a high level of importance, satisfaction, and performance was found to be more strongly related to cognitive functioning and loneliness than the frequency of social participation, age, years of schooling, and depression, which have been identified as important influencing factors in many previous studies (Cohen-Mansfield et al., 2016; Harrington et al., 2023; WHO, 2023). To the best of our knowledge, this is the first study to report these findings. In this study, the use of ICTs as a mediating variable in social networks strengthened social participation and positively affected cognitive function while reducing loneliness. Previous research has found that ICT use moderates the negative relationship between social isolation and cognitive function, even after accounting for education, gender, economic status, and general computer use (Byrne & Ghaiumy Anaraky, 2022). Furthermore, ICT interventions have been demonstrated to reduce loneliness (Fu et al., 2022; Kamin et al., 2020). This study’s findings accord with the findings of these studies and provide further support for the conclusions. Additionally, exercise, education (Hersi et al., 2017), and social participation (Amieva et al., 2018) have been reported to be factors that reduce cognitive decline among older adults. However, this study found that, in terms of older adults participating in society, using ICT, expanding their social networks, and engaging in more meaningful social participation, these factors had a stronger impact on enhancing cognitive function. This is the first study to quantitively demonstrate that social participation with occupational association has a stronger impact than factors identified in previous studies.
In addition to the use of ICT, this study revealed a strong impact on cognitive function, owing to the strength of its association with social participation. The frequency and number of years of social participation have been found to be useful as general measures of social participation and the reduction in cognitive decline (Anatürk et al., 2018). Social participation requires not only objective assessment, such as the frequency of participation, but also subjective evaluations (Townsend et al., 2021). However, the literature is unclear regarding the relationship between cognitive function and subjective factors, such as satisfaction with social, emotional, and informational support as subjectively evaluated by older adults themselves in relation to social participation (Tomioka et al., 2018). In the current study, occupational therapy’s unique connection to social engagement was shown to have had a greater impact on cognitive functioning than the objective frequency of participation, age, years of schooling, or depression. For occupational therapists, these results are valuable, because they indicate that attempts to increase the engagement of older adults with social participation may reduce cognitive decline.
The limitations of this study include the relatively small sample size and the fact that the study population consisted of older adults who frequent community gathering places. Consequently, it is imperative to replicate this study with a larger and more diverse sample to generalize the findings. Additionally, cognitive function was evaluated using the Mini-Cog, a straightforward instrument for dementia screening. However, we should note that this tool is not designed to provide a comprehensive analysis of cognitive function.
As a direction for future study, it is essential to develop strategies that will enable occupational therapists to recommend ICT more effectively to maximize the potential benefits of ICT for older adults (Aboujaoudé et al., 2021). To this end, it is necessary to develop longitudinal programs and conduct intervention studies to identify how occupational therapists can use ICT to support social participation.
Implications for Occupational Therapy Practice
The findings of this study have the following implications for occupational therapy research and practice: ▪ The provision of support for occupational therapists’ use of ICT with older adults in community settings has the potential to enhance human interaction and improve the quality and quantity of social participation. ▪ When occupational therapists facilitate social participation, enhancing quality rather than quantity may diminish isolation and enhance cognitive function among older adults. ▪ This study examines the implications of occupational therapists providing ICT-based support to older adults in community settings. ▪ To facilitate social participation and encourage the evolution of intervention strategies, it is essential to prioritize quality over quantity. ▪ For older adults who engage in social activities, loneliness and cognitive function are inextricably linked, underscoring the significance of social participation as a source of support.
This study’s findings highlight for occupational therapists that ICT facilitates socially engaged older adults in preventing cognitive decline, reducing loneliness, expanding social networks, and extending social participation.
Conclusion
The use of ICTs is associated with the expansion of social networks and is related to the frequency and meaningfulness of social participation. The frequency of social participation was not found to be related to loneliness or cognitive function. However, meaningful social participation was found to be related to both. The findings of this study suggest that the utilization of ICTs and the provision of support for meaningful social participation may be beneficial in assisting community gathering places.
Footnotes
Acknowledgments
This study was supported by a grant from the Kansai University of Welfare Sciences and Innovation Support Program. We are deeply thankful to all those who contributed to this research project, including the members of the community gathering places and the staff at the Arontia Club health care facility. Their collaboration, insights, and support were invaluable to the progress and completion of this study.