THE EFFECTIVENESS OF TECHNOLOGY-BASED NON-CLINICAL COMMUNITY INTERVENTIONS TO REDUCE LONELINESS IN THE ELDERLY: A LITERATURE REVIEW

Introduction: The condition of the elderly who experience various declines in biological and psychological functions can affect mobility and social contact, one of which is a sense of loneliness (loneliness). The purpose of this study was to identify the effect of Digital Information Technology-based interventions in reducing loneliness in the elderly. Methods: A systematic review using three electronic databases (Scopus, PubMed, and Web of Science) from the last 7 years (2014-2021). The research used quasi-experiments and Randomized Control Trials (RCT). The data analysis used is descriptive analysis with a narrative approach. Results: There were 8 articles that met the inclusion criteria in the review. All selected studies discuss the effect of Digital Technology-based interventions on reducing loneliness in the elderly. Other interventions are needed such as technological interventions (eg, digital applications (apps), online social networks and social robots) to enhance emotional support and social interaction. Conclusions: This systematic review concluded that the evidence for the effectiveness of technology-based interventions for reducing loneliness in the elderly is uncertain. Basically, technology is not a solution to reduce loneliness in the elderly, but a tool that helps them stay connected with family members, friends, neighbors, etc. and get access to information and resources.


INTRODUCTION
The aging process is a natural process for a person who has gone through three stages of life which include childhood, adulthood, and old age. When starting old age means also starting to experience a setback physically and psychologically. The condition of the elderly who experience various declines or setbacks in both biological and psychological functions can affect mobility and social contact, one of which is a sense of loneliness (Mubarak et al., 2009). Elderly people who experience loneliness often feel bored and bored with their lives, so they hope that death will come to pick them up soon (Bini'Matillah et al., 2018). This is because he does not want to trouble his family and the people around him. Lonely conditions can indeed lead to many psychological problems. Some of them are depression, anxiety, chronic stress, and insomnia.
Loneliness is an unpleasant experience experienced when there is a lack of quantity or quality of social relationships. Loneliness is increasingly considered a public health problem, especially among the elderly. The number of elderly people in Indonesia in 2025 is expected to increase to 11.09% of the total population (22,277,700 people) with a life expectancy of 70-75 years, so that Indonesia is ranked 3rd in the world after China, India and America in an elderly population. As the number of elderly people increases, the number of lonely people is getting bigger, it is estimated that 50% of the elderly are now suffering from loneliness. This is also supported by the research of Johnson et al. (1993) in the National Council on Aging and Older People (2004), reported that the prevalence of loneliness in America is quite high, namely 62% of the elderly. Research by Wardiyah (2007) elderly who experience loneliness in the community, namely 66.67% with moderate loneliness, 23.33% mild loneliness, and 10% severe loneliness (Fahrudiana & Kusbaryanto, 2019).
Loneliness is a feeling of being left out, isolated from other people because you feel different from other people, left out from your group, feeling unnoticed by the people aaround you, isolated from your environment, and not having someone to share your feelings and experiences (Domènech-Abella et al., 2017). This condition creates feelings of helplessness, lack of confidence, dependency, and neglect. Someone who claims to be lonely tends to see himself as a worthless individual, uncared for, and unloved. The feeling of loneliness will be increasingly felt by the elderly who were previously someone who was active in various activities that presented or connected with many people (Bini'Matillah et al., 2018). The elderly will also experience depression such as feeling sad, depressed, feeling empty, isolated, feeling bored, anxious, feeling ashamed of themselves, and feeling afraid. When the elderly experience these things and without support or limited social support, loneliness is something that is very feared by the elderly. Individuals who experience feelings of loneliness really need social support.
Social and technology-based interventions may be ways primary care practitioners can refer patients to non-clinical community-based sources of support. The adoption of technology, especially information and communication technology, to reduce loneliness in the elderly has attracted increasing attention worldwide. Technologybased solutions, for example, the use of video calls and online group chats, are believed to have the potential to maintain social relationships and reduce loneliness in the elderly (Jin et al., 2021). Some experts suggest that technology can increase the interaction of the elderly with family, relatives, and friends, enabling them to connect socially without faceto-face communication so as to reduce loneliness (Shah et al., 2021;Yuan, 2021). However, not all researchers agree with technology-based interventions in the elderly because of some problems in the elderly, such as the ability to use technology and it takes a relatively long time to learn it. Considering the controversial opinion about the effect of technology-based interventions to reduce loneliness in the elderly, it is necessary to carry out a systematic review to find more reliable evidence. In addition, recent evidence on the effectiveness of technology in reducing loneliness is especially important from the perspective of the elderly and their families and other stakeholders such as health and social service providers.

MATERIALS AND METHODS
The method used in this paper is to use a Literature review. Literature search used 3 databases namely Scopus, PubMed and Web of Science (WOS). The question format for finding study results is using PICOS (P = population, I = intervention, C = comparison, O = results, S = type of study), PICOS is used to formulate research questions. The literature study was searched using three groups of keywords based on Medical Subject Heading (MeSH) and combined with the Boolean operators AND, OR and NOT. so that the search keywords obtained are "Intervention Based-Technology" AND Loneliness AND (Elderly OR "Older Adult). Search results are limited to cross-sectional studies, Quasyexperiments and Randomized Control Trials (RCT), published from the last 5 years (2014-2021) using English and taking open access journals.

Study selection
Two hundred and ten articles (210) were found from searching 3 databases. Then limit the year of publication (N=82), open access records (N=51), delete duplications (N=14) from the results and leave a total of 37, evaluate and filter titles (N=37), filter abstracts (N=22), full and appropriate text (N=8). Eight complete texts have been found and are eligible for literature review. During the literature screening process, the investigator defined general reasons for the exclusion criteria, including irrelevant study type, lack of full explanation of the prevention of risky sexual behavior in adolescents, and an inappropriate sample.

Picture 1. Diagram PRISMA flow Data extraction and analysis
Two hundred and ten articles (210) were found from searching 3 databases. Then limit the year of publication (N=82), open access records (N=51), delete duplications (N=14) from the results and leave a total of 37, evaluate and filter titles (N=37), filter abstracts (N=22), full and appropriate text (N=8). Eight complete texts have been found and are eligible for literature review. During the literature screening process, the investigator defined general reasons for the exclusion criteria, including irrelevant study type, lack of full explanation of the prevention of risky sexual behavior in adolescents, and an inappropriate sample.

Characteristic Study
All included studies were RCTs (6 studies) and Quasy Experiments (2 studies) published in peer-reviewed journals. The entire study was conducted in Taiwan, China, the United States and United Kingdom between 2014 and 2021. Study sample sizes ranged from 30 to 234, and follow-up duration ranged from 3 to 12 months. Each of the eight included studies compared a technology-based intervention is Digital Technology Information (DTI).
DTI includes social internet-based activities, i.e. social activities through social websites (1 study), video conferencing (2 studies), customized computer platforms with simplified touch screen interfaces (1 study), personal reminder information, and social management systems (1 study). 1 study), and social media such as Line, Whatsapp group and Facebook (3 studies). Enrolled participants are aged 60 and over who are in a Nursing Home with basic cognitive abilities and have wireless internet access on their residential floor. The entire study recruited older adults who lived independently and had cognitive function. All studies report outcomes of loneliness. Loneliness is a personal thing and will be responded to differently by each person, for some people loneliness is acceptable normally but for some people loneliness can become a deep sadness. The Facebook groups showed a significant increase in the combined size of updating, a factor executive function associated with a complex working memory task, compared to no significant change in the control group. Other measures of cognitive function and social support did not show any distinct improvement within the Facebook group.

DISCUSSION
The results of this study are one way to address the potential for technology-based interventions to prevent or reduce loneliness, and subjective negative feelings that can exacerbate the physical and psychological wellbeing of the elderly. The elderly trend to be less familiar with communication technology. This creates a lack of contact with the family. Restrictions on physical distance can lead to restrictions on emotional contact and affection if this is not handled properly (Hind et al., 2014). They will feel confined, confused, and even afraid. It is at this time that the elderly must try to learn to use communication tools to contact with relatives to reduce loneliness (Larsson et al., 2016;Hsiu-hsin Tsai et al., 2020).
Various conveniences due to technological developments that occur in the digital era, to affect human behavior. By introducing older adults to electronic devices, technology-based interventions are designed to help increase social connection and reduce loneliness (Czaja et al., 2018;Jarvis et al., 2019;Morton et al., 2018). Future studies or reviews should focus on seniors who are at high risk of experiencing loneliness in everyday life, especially those living at home or in nursing homes far from their families. In terms of intervention methods, the main intervention methods are smartphone-based video calls, computer-based training, and internet use (Jin et al., 2021). Exploring technology-based interventions more broadly could help identify more evidence about the role of technology in reducing loneliness in the elderly. The elderly also needs effective communication with other people, especially with people they miss. Unfortunately, there is a stereotype which states that the elderly is often considered less effective in communicating because of the minimal communication process carried out by the elderly, not only face-to-face communication but also communication using mass media including the internet.
Digital technology is a communication tool that can be used by the elderly. Even though there are limitations for the elderly in accessing technology, the use of the internet, especially social media, has a positive impact on the elderly in communicating, especially in providing social support to them. Digital Technology Information (DTI) is a technologybased communication plan in care where events and interactions are designed therapeutically to increase social support, build self-confidence and increasing self-esteem in the elderly, and making the elderly feel valuable. However, the findings of several studies contradict the general view that digital technology can solve the problem of loneliness, especially in the elderly. Nonetheless, digital technologies can provide tools and means that facilitate social interaction, which can help reduce loneliness for a limited period of time because the effects of DTI are short-lived (Hsiu-hsin Tsai et al., 2020). This is probably because digital technology does not provide real human interaction and cannot replace human contact (Anderson & Thayer, 2018;Shah et al., 2021). But by doing so, they do not reduce real-life social disconnection in the long term because communication technologies can be used at any time.

CONCLUSSION
This systematic review concluded that the evidence for the effectiveness of technology-based interventions for reducing loneliness in the elderly is uncertain. Although some of the results of this review indicate that technology-based interventions have little or no difference in reducing loneliness in the elderly. According to existing research, minimal use of technology does not hurt the elderly who experience loneliness and desire social relationships. For practical purposes, attention should be paid to the abilities, conditions, needs and resources of the elderly to determine whether technology-based interventions are an appropriate approach to reducing loneliness. Basically, technology is not a solution to reduce loneliness in the elderly, but a tool that helps them stay connected with family members, friends, neighbors, etc. and get access to information and resources.