Abstract
Technology has been integrated into every aspect of life for interpersonal support and connections and social isolation has become a hotspot topic for health promotion in nursing among various populations, but little attention has been paid to immigrant older adults using technology to overcome social isolation. The purpose of this narrative review is to comprehend the role of technology use in the context of social isolation, including the predisposing factors, encountered by immigrant older adults to support their psychosocial wellbeing. By studying relevant peer-reviewed articles published in professional databases from 2013 to 2024, 26 articles met the criteria and were accessed for this narrative review, despite an unexpected participant selection preference of older Asian immigrants living in a North American context among these eligible papers. It is discovered that technology use has improved the mental health of socially-isolated immigrant older adults. However, the benefits of technology use for these individuals are constrained by cultural and linguistic differences as well as educational backgrounds. Therefore, technology adaptation should be promoted in this population through a collaborative partnership with healthcare practitioners, educators, researchers and policymakers. There should be further exploration of the interrelationships between technology use and psychosocial support and continuous striving for the most suitable approach for social isolation prevention among immigrant older adults.
Context
Canada is one of the largest immigrant-receiving countries in the world. During the last twenty years, it has witnessed a 121% increase in first generation immigrants belonging to racialized communities (Hou et al., 2023). The percentage of older adults who are immigrants is expected to surpass 55% by 2055 in Canada (Statistics Canada, 2022). The largest percentage of immigrant older adults in Canada comes from East and South Asia (Statistics Canada, 2022).
Social isolation, as a concept, indicates a lack of frequent or quality contact with others (Koehn et al., 2022). Social isolation is more common/prevalent among older adults, and this is especially more so among immigrant older adults in Canada whose primary language is neither English nor French (Johnson et al., 2021). Social isolation among immigrant older adults is exacerbated by cultural differences, the migration journey and process, and many other social determinants of health, such as a person's income and education level (Johnson et al., 2021; Salma & Salami, 2020).
The literature suggests that personal networks, family support, social services, and the use of technology are effective approaches to combatting or even preventing these negative experiences (Guruge et al., 2015; Li et al., 2017; Sidani et al., 2022). Furthermore, loneliness is often associated with social isolation as it emphasizes individuals’ subjective experience of suffering because of being alone (Koehn et al., 2022; Sidani et al., 2022). Loneliness can be social loneliness, which highlights the exclusion from group associations, and emotional loneliness, which embodies a lack of a secure attachment with a single person (Weiss, 1973; Wolfers et al., 2022). Researchers commonly use the De Jong Gierveld Loneliness Scale to differentiate these two sub-categories in the literature (Liu & Rook, 2013; Weiss, 1973; Wolfers et al., 2022).
Considerable literature exists on the interventions to address social isolation and loneliness. As one example, the COVID-19 pandemic highlighted the importance of technology use in addressing social isolation (Hajek & König, 2022). There is an emerging interest in and attention to the use of technology to address social isolation and loneliness among immigrant older adults. Specifically, a major change brought on by the pandemic was the macro-transition into a virtual lifestyle because people of different ages had to satisfy various aspects of living needs with the imposed restrictions of quarantine and social distancing (Hajek & König, 2022). Immigrant older adults are more likely to be left behind by the new information age, concerning the normal aging process (Choi et al., 2021) and the potential challenges with digital literacy and access. Meanwhile, the technology use among immigrant older adults may be impacted simultaneously by language barriers and cultural differences in their receiving countries (Chen et al., 2022). In a systematic literature review (n = 12 sources) of immigrant older adults’ use of intelligent homecare services, adopted technology for home-based activity and health support, a shorter period of schooling and limited language proficiency were found to be the most direct barriers to smart home constructions for this population (Chen et al., 2022). Among the studies conducted in the United States (US), Australia, and the United Kingdom (UK), researchers also discovered a positive influence on study participants’ initial acceptance and final benefits from ethnocultural integration, especially the interventions addressing language barriers and cultural preferences, in home technology-based applications such as electronic self-management tools (Chen et al., 2022). In a study of 91 older Chinese immigrants living with type 2 diabetes in New York, US, researchers conducted a cross-sectional survey and subsequently discovered a low rate of technology use for illness management despite a high rate of smart device ownership (Hu et al., 2022). Most participants had limited English proficiency (n = 78) and a high school education or less (n = 58) (Hu et al., 2022).
Overall, there is a significant knowledge gap in the concepts and interrelationships of social isolation and loneliness with technology use for older adults living outside of their country of origin. This paper presents a narrative review of what is currently known on the use of technology in addressing social isolation in immigrant older adults. It aims to further discuss the determinants and psychological impacts of technology use on immigrant older adults who experience social isolation by reviewing available literature on this topic. For the purposes of this review, older adults are defined as being adults over 65 years of age and first-generation immigrants to Canada.
Article Selection Process
The article selection process was guided by a narrative review of the literature. Keyword searching was conducted in several databases (PubMed, ProQuest, Taylor & Francis, ScienceDirect and Cambridge Core) to identify scholarly and peer-reviewed articles written in English and released between 2013 and 2024. Both original research and literature reviews were considered. Other types of articles, such as commentaries and book chapters, were excluded, as well as papers not published in English, due to the additional work and expenses required for translation. The Medical Subject Headings (MeSH) terms included “social isolation,” “older immigrants,” “psychological/mental health,” and “technology use.” When searching all the four keywords together, this yielded only 16 applicable articles. However, we yielded 139 articles when the first two key terms were explored with “psychological/mental health,” and 41 articles were obtained when the first two key terms were explored with “technology use.” All of these papers underwent title and abstract screening, then full text review by two independent team members to determine eligibility for inclusion in this narrative review. Additionally, any associated articles on “loneliness” and “depression” were also examined for relevance for inclusion. In total, 26 articles met the criteria and were accessed for this review. Most of the articles focused on older Asian immigrants within a North American context, even though all contexts and cultural representations were considered.
Narrative Review of Relevant Literature
The first section will present how technology adoption changes the psychological wellbeing of socially-isolated immigrant older adults and then explore the interconnections between technology and social support with the development of social isolation. The second section will discuss the root causes of the mental health manifestations identified in the target population.
Immigrant Older Adults and the Impact of Technology Use
There is extensive literature on how external resources influence immigrant older adults’ lives in their receiving countries. However, most of the research examines the social support received by immigrant older adults whereas fewer than ten articles explored both the impact of technology use on immigrant older adults and its effects on their mental health. One study could be located using digital interventions to address loneliness experienced by older adult Chinese immigrants during the COVID-19 pandemic (Chiu et al., 2022). This cross-sectional survey received a total of 173 valid responses in Auckland, New Zealand, and the results showed that the utility of technology was moderately linked with both classes of loneliness, with social loneliness obtaining a higher mean score than emotional loneliness. Other papers have independent sections for technology adoption and psychological conditions among older adults while assessing the topics of social services and healthcare access simultaneously. A cross-sectional survey of 209 Korean older immigrants in Texas, reported that participants who were able to utilize technology for medical-related information and communication had lower computer anxiety (Jun et al., 2021). This helped them with smoother acquisition of positive health concepts and attitudes and easier fulfilment of health prevention and interventions (Jun et al., 2021). Another study, but longitudinal in nature, on Korean immigrant women applying technology and health resources found that an older age significantly affected non-English speaking participants’ access to the medical system (Chae et al., 2021). Despite the shrinking in participant size from 560 at the initial stage of data collection to 157 in their last follow-up twelve months later, the study found that older Korean immigrant women preferred printed information or face-to-face interactions with healthcare professionals, over digital resources related to self-care. When their preferred methods to receive health information were not available, they faced limitations in accessing information to learn about and participate in healthcare practices, which directly and indirectly hindered their pursuit of overall wellbeing in the long run (Chae et al., 2021).
The Combined Impacts of Social Support and Technology Use on Immigrant Older Adults
Although limited digital applications can hinder social participation, technology use, as one of the potential approaches toward social support, is often examined in combination with this concept regarding the health and life quality of immigrant older adults. The associations between depression and the interactions of technology utilization and social support are much stronger than those detected between loneliness and the mutual effects of technology and social assistance (Jun et al., 2021; Lee et al., 2021). An inference can be made that the application of information and communication technologies mitigated some negative psychological impacts of social isolation for the target population. This could be explained by the interdependence and collectivistic culture that was highly valued by the older generations from non-western cultures, who tend to possess established forms of socialization with more influence from their original country than their country of immigration destination (Salma & Salami, 2020). Thus, in the shortage of physical interactions, digital devices can offer immigrant older adults some form of connection to the outside world (Li et al., 2017). In a qualitative study by Salma and Salami (2020), 67 Muslim older adults in Canada shared that they found social media helpful in preserving their social network in their homeland when real-life contact was unattainable owing to medical conditions or financial constraints in their new country. Similar observations were recognized in Korea among over 10,000 Korean older adults; socially-isolated older adults obtained more benefits from technology use than those who had frequent access to their interpersonal relationships when it came to depressive symptoms (Lee et al., 2021). While looking at the experiences of older Korean immigrants in the US, participants’ physical and mental health, as well as their level of life satisfaction, improved following their migration to North America because digital applications supported them to get over multiple socioeconomic inequities during acculturation into American society, stay in touch with their social support networks back in Korea, and make friends in their new surroundings (Jun et al., 2021). Nonetheless, no other studies could be found that have investigated the combined effects of technology use and external support access on the psychosocial wellbeing of immigrant older adults, nor is there any research explicitly analyzing the experience of loneliness in this context.
The Leading Factors of Social Isolation Among Immigrant Older Adults
To some extent, all the studies conducted on this topic that have been included in this narrative review attributed the development of loneliness and depression to three key demographic factors: language proficiency, academic background, and socioeconomic status. De Jong Gierveld et al. (2015) claimed that larger cultural and linguistic disparities from the place of origin to the host country predicted an intensified feeling of loneliness in newcomers. As common languages used in an ethnic group are a powerful symbol of their culture, English fluency became a significant factor for the settlement of older adult Arabic, Chinese, and Punjabi immigrants in Toronto (Li et al., 2017). The level of education indirectly shaped participants’ pathway of acculturation (Li et al., 2017). This is because schooling offers individuals a standardized approach to expand their knowledge reservoirs, including digital literacy, and allows most people to develop adaptable and holistic thinking throughout the process. All these aspects enable individuals with such education to seek help in a new setting with multiple approaches, such as through their friends’ circle, community support, and online assistance. Moreover, Salma and Salami (2020) asserted that longer-term immigrants, compared to their freshly-arrived counterparts, were less likely to suffer from social isolation and loneliness due to their established interpersonal ties, no matter in the virtual or physical world, of their host country.
To overcome these linguistic and cultural barriers, newcomers frequently choose to reside in co-ethnic neighbourhoods. They, thus, require governmental support to develop tailored, multi-modal services, and through hiring bilingual and bi-cultural citizens to deliver such services (Lai et al., 2020). However, the actualization of these programs was largely undermined by economic obstacles at the individual level (Li et al., 2017; Salma & Salami, 2020). Since most immigrant older adults came to Canada without secure social insurance, their ability to pay for various community resources, electronic applications, and healthcare visits was dictated by their financial status, in which an initial period of scarcity predisposed this population to loneliness and mental illnesses.
Current literature does not place much emphasis on the impact of other demographic factors, such as employment status, age, and gender. While retirement or unemployment exacerbated immigrant older adults’ financial insecurity (Guruge et al., 2015), advanced age hindered immigrant older adults’ social connectivity by impairing their functional health and causing them to experience the loss of significant others or friends (Sidani et al., 2022). Memory and cognitive decline during the normal ageing process also decrease immigrant older adults’ ability to learn new technology and maintain the same level of competence for a long time. Among the Arabic-, Mandarin-, and Punjabi-speaking populations, single immigrant women from these three communities were more prone than men to mental health issues in Canada (Guruge et al., 2015). Similarly, negative emotional consequences had been noticed by Salma and Salami (2020) in older adult Muslim women, who were more vulnerable to encountering discrimination from both mainstream society and immigrant communities due to many religious customs restricting their behaviours and appearances. These constraints isolated immigrant older adult women from useful resources, up-to-date technologies, and even necessary information and approaches towards surrounding social support and digital applications.
In the case of the interactions between technology use and social support accessibility, there are several predetermined personal factors that can lower the risk of depression development. According to Jun et al. (2021), older adults under 70 years of age who possessed solid academic qualifications and held affluent status were most likely to take advantage of digital applications for their biopsychosocial health after resettling in a foreign country. Additionally, the acceptance and utilization of technology products in daily life were generally poorer in immigrant older adult women, which were predictive of the manifestations of depressive symptoms (Sidani et al., 2022; The role of information, 2015). As a result, further research is needed to better understand the demographic profiles of immigrant older adults who relocate to Canada (Guruge et al., 2015). Policymakers and program executors should also consider the accessibility and affordability of immigrant-related services, as well as maximize the use of appropriate technology to enhance the outcomes of their services.
Implications
For healthcare professionals, the findings of this narrative review demonstrate that having entry into the healthcare system is essential for the mental health and wellbeing of immigrant older adults who choose to settle in Canada. Considering this, nurses, settlement workers, and health service professionals in all practice settings should collaborate, if it is not yet currently the standard of practice, to screen all immigrant older adults for social isolation and depression to provide culturally-sensitive health education to enhance their mental health literacy. Particularly, they should connect this population to appropriate outreach support in the community. Modern information technology should be incorporated into traditional nursing and settlement practices to overcome the healthcare inaccessibility caused by immigrant older adults’ individualized difficulties and improve the outcomes of medical and behavioural interventions for depression (The role of information, 2015). Furthermore, participants’ accessibility to and proficiency in technology use should be evaluated in advance and addressed correspondingly to alleviate the adverse effects of social isolation.
For nursing education, ensuring the importance of assessing and evaluating the risk for social isolation in susceptible populations, like immigrant older adults, is incorporated in nursing curricula is vital. This strategy can ensure nurses are well-equipped to enhance mental health and wellbeing in this population. If there is an opportunity to teach about interprofessional collaboration and person/population-centred care, both caring models can underscore the importance of working in close partnership with patients to learn about their lived experiences and involve them in care plan development. For nurses who are already practising, offering such training through in-services and online simulations could be an excellent strategy.
For research, further quantitative studies can be conducted to identify ways that technology use can impact on alleviating immigrant older adults’ social isolation. Meanwhile, further qualitative studies can be conducted to provide deeper insights into the lived experiences of this population and their ability to share their voice. This is extremely important considering the topic under investigation is social isolation. Conducting research from both perspectives can produce a comprehensive understanding of effective and targeted interventions that can be employed to support this population. Future research can also focus on studying other cultural groups of immigrant older adults, such as immigrant older adults of Eastern European origin, to see if their experiences are similar. Exploring the experiences of immigrant older adults in other countries, outside of the North American context, can be another option to extend this work further.
For policy development, the insights from this paper can be used to enhance organizational policies by providing assessments of and support for these populations. Community service providers and legislators should proactively evaluate the availability and proficiency of technology use among immigrant older adults in each neighbourhood (Jun et al., 2021; Salma & Salami, 2020). Specialized programs should be constructed to emphatically encourage positive social interactions for participants with advanced age, lower educational background, and/or language barriers while enhancing their digital literacy (Jun et al., 2021). In addition, it is imperative to provide funding to improve accessibility to technology and digital literacy skills to older adults. By improving access to technology or providing culturally and linguistically tailored training programs to older adults to effectively use technology, they can participate in social engagement and improve their sense of connectedness. It is imperative to advocate for an upstream or preventative approach that addresses the root cause of social isolation as opposed to focusing on the provision of remediation for people who already are presenting with symptoms of social isolation.
Finally, there are implications for the host society; as different cultures coexist peacefully in one country, immigrant older adults should be supported and encouraged to participate in mainstream activities and build connections with individuals from different backgrounds (Salma & Salami, 2020). Local governments should collaborate with community leaders to gain trust of diverse populations to maintain a safe and inclusive environment. The selected leaders play an important role in bridging the societal integration of immigrant older adults as early as possible while preserving their cultural identities in their current country of residence (Salma & Salami, 2020). These programs should be initiated in nearby ethnocultural organizations and expanded to health, education, civil, and judicial institutions so that immigrant older adults can make more contributions and have a stronger voice in mainstream society. Moreover, it is important to address social isolation and loneliness among older immigrants and their families due to the increasing political tensions and changing immigration policies in countries such as the United States and Europe. Previous literature has found such shifting immigration policies to have a dire impact on the mental health of immigrants, such as increased rates of depression, anxiety, posttraumatic stress disorder (PTSD), and substance use (Martinez et al., 2015; Ornelas et al., 2020). As these political climates evolve and immigrants face mass deportation, immigrants are at an increased risk to experience social isolation and loneliness, further exacerbating their mental health challenges. Host countries and nurses providing care for this vulnerable population play a crucial role in identifying and addressing these issues. Nurses must recognize signs of social isolation and provide education on resources that are available to connect the individual with a supportive community. Host countries must implement policies that promote inclusive environments for older immigrants that protect their mental wellbeing and make certain they are not at risk to experience further marginalization.
Conclusions
This narrative review has demonstrated the benefits of technology use in immigrant older adults in relation to their experiences with social isolation. The results underscore that lack of technology access and application are more associated with social loneliness than emotional loneliness among the target population, whereas inadequate societal support predicts both loneliness and depression, albeit to varying degrees across the literature. Technology use could also counteract the negative influence of social isolation and keep immigrant older adults from developing depression. It is imperative to create culturally-sensitive, age-appropriate community support and health promotion programs in order to improve the mental health literacy, interpersonal networks, and overall quality of life of immigrant older adults. Policymakers should prioritize primary health promotion protocols that address social isolation and various mental health complications while adopting appropriate information technology and the WHO's strategies on Healthy Ageing with immigrant older adults residing in their country. Further research into the intersectionality of immigrant older adults, including factors such as age, gender, ethnicity, and employment status will be important to unveil the nuances and complexities of psychological well-being and to provide culturally appropriate interventions.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The larger Inclusive Communities for Older Immigrants (ICOI) partnership project is funded by the Social Sciences and Humanities Research Council Partnership Grant 2020–2027.
Social Sciences and Humanities Research Council of Canada, (grant number Partnership Engage Grant).
