Anthea Tinker

Background: Loneliness is a critical issue among older adults and constitutes a significant risk factor for a range of physical and mental health conditions. However, current assessment methods primarily rely on self-report questionnaires and clinical evaluations, which are susceptible to recall bias and social desirability bias, highlighting the need for more objective and continuous assessment approaches. Recent studies have reported associations between physiological and behavioral indicators and the experience of loneliness in older adults. While these technologies have demonstrated correlations between physiological and behavioral sensor data and the experience of loneliness, their implementation has been limited. Most systems rely on fixed-location sensors or smartphone apps, with little attention given to the integration of these tools into users’ daily routines. To date, no published studies have applied smart textile technology, which integrates sensing capabilities directly into garments or furniture, as a medium for loneliness detection. This study addresses that gap by exploring the usability, experiential acceptability, and ethical considerations of smart textile-based monitoring systems. Objective: This study aims to assess the perceived usability, acceptability, and emotional resonance of a smart loneliness monitoring system integrating sensing garments, furniture, and a mobile app and identify design implications to guide future improvement and promote sustained engagement among older adults. Methods: Building on earlier conceptual research, a functional prototype system was developed and evaluated through 2 immersive in-person workshops with older adults (N=10). A mixed methods approach was applied, combining structured questionnaires, sensory ethnographic observations, focus group discussions, and experience-based co-design. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically to explore user perceptions related to system usability, emotional response, lifestyle compatibility, and ethical considerations. Results: Quantitative data indicated high user satisfaction in dimensions such as comfort, ease of use, and feedback clarity. However, trust in long-term monitoring and willingness to use the system regularly varied. Thematic analysis revealed 4 main areas influencing acceptance, including wearability, usability, and daily integration; trust, privacy, and data control; perceptions of loneliness and the limits of detection; and adoption, applicability, and ethical futures. Participants emphasized the need for discretion, personalization, and human oversight in system feedback and data-sharing mechanisms. Conclusions: The resulting prototype was positively received, demonstrating the potential of smart systems for passive and personalized loneliness monitoring among older adults. However, adoption is influenced by perceptions of autonomy, emotional sensitivity, and contextual integration. Future development should focus on modularity, transparency, and integration within care infrastructures to ensure ethical and sustainable deployment.

BACKGROUND Loneliness is a critical issue among older adults and constitutes a significant risk factor for a range of physical and mental health conditions. However, current assessment methods primarily rely on self-report questionnaires and clinical evaluations, which are susceptible to recall bias and social desirability bias, highlighting the need for more objective and continuous assessment approaches. Recent studies have reported associations between physiological and behavioral indicators and the experience of loneliness in older adults. While these technologies have demonstrated correlations between physiological and behavioral sensor data and the experience of loneliness, their implementation has been limited. Most systems rely on fixed-location sensors or smartphone apps, with little attention given to the integration of these tools into users’ daily routines. To date, no published studies have applied smart textile technology, which integrates sensing capabilities directly into garments or furniture, as a medium for loneliness detection. This study addresses that gap by exploring the usability, experiential acceptability, and ethical considerations of smart textile-based monitoring systems. OBJECTIVE This study aims to assess the perceived usability, acceptability, and emotional resonance of a smart loneliness monitoring system integrating sensing garments, furniture, and a mobile app and identify design implications to guide future improvement and promote sustained engagement among older adults. METHODS Building on earlier conceptual research, a functional prototype system was developed and evaluated through 2 immersive in-person workshops with older adults (N=10). A mixed methods approach was applied, combining structured questionnaires, sensory ethnographic observations, focus group discussions, and experience-based co-design. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically to explore user perceptions related to system usability, emotional response, lifestyle compatibility, and ethical considerations. RESULTS Quantitative data indicated high user satisfaction in dimensions such as comfort, ease of use, and feedback clarity. However, trust in long-term monitoring and willingness to use the system regularly varied. Thematic analysis revealed 4 main areas influencing acceptance, including wearability, usability, and daily integration; trust, privacy, and data control; perceptions of loneliness and the limits of detection; and adoption, applicability, and ethical futures. Participants emphasized the need for discretion, personalization, and human oversight in system feedback and data-sharing mechanisms. CONCLUSIONS The resulting prototype was positively received, demonstrating the potential of smart systems for passive and personalized loneliness monitoring among older adults. However, adoption is influenced by perceptions of autonomy, emotional sensitivity, and contextual integration. Future development should focus on modularity, transparency, and integration within care infrastructures to ensure ethical and sustainable deployment.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Loneliness is a negative emotional state which is common in later life. The accumulative effects of loneliness have significant impact on physical and mental health of older adults. Automatic methods for detection and prediction are an emerging field to support early identification of loneliness. Objectives: We aim to qualitatively explore the thoughts and preferences of people aged 65 and over regarding technologies to detect feelings of loneliness in later life. Methods: We conducted 60 semi-structured interviews with people aged 65 and over between September 2022 and August 2023. Data were analysed using a reflective thematic approach on NVIVO software. Results: Three themes were identified representing what older adults considered important in a system able to detect loneliness. 1) Interest and Control of Data, which was a priority for older adults; 2) Perceived Usefulness to Address Loneliness, which related to the importance of providing recommendations to reduce feelings of loneliness after detection; and 3) Personalisation as a Priority, which included the level of loneliness for which an alert was sent and selection of relevant individuals who would be sent a loneliness alert. Conclusion: Findings from this in-depth qualitative study provide important perspectives from people with lived-experience of loneliness on the context in which a sensor-based loneliness detection system would be most useful and acceptable to older adults. Future research will include such perspectives in the design of innovative technologies enabling the early detection of loneliness and access to timely interventions to tackle loneliness in later life.

Background: Loneliness in later life has been widely associated with poor mental and physical health. However, despite many reviews, current evidence does not provide a clear picture of how to tackle loneliness in older adults through interventions. Research examining the contexts and mechanisms for reducing loneliness through interventions is required to identify how, why, and for who interventions work or do not work. Methods: A critical interpretive synthesis, a review method designed to rigorously and reflexively re-examine existing literature, was conducted to re-consider and identify what matters in interventions. This was enacted through a broad search strategy incorporating database searches, contacting experts, reference-chaining, and team discussions, enabling a flexible and iterative review able to generate new theory. Results: 274 papers were included in the analysis. We identified four dimensions to whether and how interventions worked. Intended outcome mirrored different theoretical perspectives on how to reduce loneliness. Four intended outcomes were identified: cognitive change; improved social connections; physiological change; and a more meaningful life. The second dimension was the level of an intervention - whether it intended to intervene at a micro, meso, or macro level. Thirdly, 13 positive features of interventions were noted to have been evidenced to lead to or constitute more effective interventions. These were interventions that are organised, adaptable, have good staff/volunteers, provide support to attend, routinised, built on shared interests/identities, personalised, culturally aware, co-produced, involve active participation, strengths-based, lasting, and targeted at the appropriate people. Lastly, nine emotions that represent less loneliness were identified: a feeling of reciprocated interactions; emotional and social support; belonging; perspective; self-efficacy; mattering; pride; purpose; and empowerment. Conclusions: Interventions and evaluations should look beyond comparing activities to see which are best and recognise that multidimensionality and variation is vital for individuals and communities with different needs. Identifying what the intended outcome of an intervention is, what level of society it intends to impact, and whether it actions the positive features identified in this study, can be employed to better target the variety of emotions that represent less loneliness.

Background: Previous studies have explored how sensor technologies can assist in in the detection, recognition, and prevention of subjective loneliness. These studies have shown a correlation between physiological and behavioral sensor data and the experience of loneliness. However, little research has been conducted on the design requirements from the perspective of older people and stakeholders in technology development. The use of these technologies and infrastructural questions have been insufficiently addressed. Systems generally consist of sensors or software installed in smartphones or homes. However, no studies have attempted to use smart textiles, which are fabrics with integrated electronics. Objective: This study aims to understand the design requirements for a smart textile loneliness monitoring system from the perspectives of older people and stakeholders. Methods: We conducted co-design workshops with 5 users and 6 stakeholders to determine the design requirements for smart textile loneliness monitoring systems. We derived a preliminary product concept of the smart wearable and furniture system. Digital and physical models and a use case were evaluated in a focus group study with older people and stakeholders (n=7). Results: The results provided insights for designing systems that use smart textiles to monitor loneliness in older people and widen their use. The findings informed the general system, wearables and furniture, materials, sensor positioning, washing, sensor synchronization devices, charging, intervention, and installation and maintenance requirements. This study provided the first insight from a human-centered perspective into smart textile loneliness monitoring systems for older people. Conclusions: We recommend more research on the intervention that links to the monitored loneliness in a way that addresses different needs to ensure its usefulness and value to people. Future systems must also reflect on questions of identification of system users and the available infrastructure and life circumstances of people. We further found requirements that included user cooperation, compatibility with other worn medical devices, and long-term durability.

BACKGROUND Previous studies have explored how sensor technologies can assist in in the detection, recognition, and prevention of subjective loneliness. These studies have shown a correlation between physiological and behavioral sensor data and the experience of loneliness. However, little research has been conducted on the design requirements from the perspective of older people and stakeholders in technology development. The use of these technologies and infrastructural questions have been insufficiently addressed. Systems generally consist of sensors or software installed in smartphones or homes. However, no studies have attempted to use smart textiles, which are fabrics with integrated electronics. OBJECTIVE This study aims to understand the design requirements for a smart textile loneliness monitoring system from the perspectives of older people and stakeholders. METHODS We conducted co-design workshops with 5 users and 6 stakeholders to determine the design requirements for smart textile loneliness monitoring systems. We derived a preliminary product concept of the smart wearable and furniture system. Digital and physical models and a use case were evaluated in a focus group study with older people and stakeholders (n=7). RESULTS The results provided insights for designing systems that use smart textiles to monitor loneliness in older people and widen their use. The findings informed the general system, wearables and furniture, materials, sensor positioning, washing, sensor synchronization devices, charging, intervention, and installation and maintenance requirements. This study provided the first insight from a human-centered perspective into smart textile loneliness monitoring systems for older people. CONCLUSIONS We recommend more research on the intervention that links to the monitored loneliness in a way that addresses different needs to ensure its usefulness and value to people. Future systems must also reflect on questions of identification of system users and the available infrastructure and life circumstances of people. We further found requirements that included user cooperation, compatibility with other worn medical devices, and long-term durability.

Reports of Covid-19 pandemic related day centre closures impacting negatively on their attenders and family carers have fuelled a resurgence of interest in day centres, a common, but often ‘invisible’, preventive service. The absence of detailed descriptions of these services from the literature limits the evidence base since outcomes data without context are less meaningful. This descriptive article aims to further understanding of these diverse and multi-faceted settings for potential collaborators and social care and health professionals, particularly in the context of rising social prescribing initiatives in England with their focus on linking older people to asset-based community resources. Using data from documentation provided by managers of four purposively selected English day centres for older people, interviews with 23 centre managers, staff and volunteers, and notes made during 56 full-day visits, this article presents a rich, contemporary, non-interpretative, pre-Covid pandemic picture of four purposively selected English day centres for older people.This baseline data will support conversations concerning optimisation of such services in the post-pandemic recovery period and beyond: how buildings may be regarded as valuable community assets with potential, and how other parts of the health and care system may better interact with day services to improve older people’s, carers’ and others’ health and wellbeing, and to benefit of staff working elsewhere in health and care.

Background: Day centres are a substantial element of community-based support for older people in many countries. However, assumptions that they are an outdated or costly service model have resulted in many centre closures in England. The perspectives of 42 people attending, providing, making referrals to or purchasing places at four diverse day centres for older people were collected in interviews. Using these data, we explore day centres’ relevance to social workers’ efforts to promote person-centred support for older people enabling them to maintain or improve their well-being. These are explored from the perspectives of choice, control and person-centredness and local authority responsibilities for shaping the care market under the Care Act 2014. Findings: Attenders highly valued centres’ congregate nature and the continuity they offered which contributed to the development of person-centred relationships. Attenders exercised choice in attending day centres. Social work staff were more positive about day centres’ relevance to personalisation than those responsible for making decisions about the shape of local care services. Applications: With social isolation recognised as a serious risk of old age, the value of togetherness in group environments may need highlighting. Enactment of personalisation policies need not necessarily lead to individualisation; day centres may be community-based assets for some. Those shaping the care market may be encouraged to acknowledge wider outcomes, and frontline social workers may benefit from hearing positive experiences that may help in the development of effective care plans for older people who would like to benefit from day centre participation.

Background: Social prescribing is encouraged to promote well-being, reduce isolation and loneliness. Traditional, generalist day centres for older people could be suggested by social prescribing, but little is known about their clientele or their outcomes. As part of a larger study of the role, outcomes and commissioning of generalist English day centres for older people, the characteristics of attenders at 4 day centres, their reasons for attendance and outcomes were explored.Methods: This mixed-methods study used qualitative interviews and standardised tools within an embedded multiple-case study design. Semi-structured interviews with older day centre attenders (n = 23, 62% of eligible attenders) of 4 day centres in south-east England, recruited purposively to reflect organisational differences, were analysed.Results: Participants reported non-elective withdrawal from socialisation following health or mobility decline, or losses. Apart from living arrangements and marital status, attenders’ profiles differed between centres. Access had been mostly facilitated by others. Day centre attendance enhanced quality of life for this group of socially isolated people with mobility restrictions and at risk of declining independence and wellbeing. The positive impact on attenders’ social participation and involvement and on meaningful occupation was significant (p-value < 0.001, 99% CI), with an average ASCOT gain score of 0.18. Ten outcome themes were identified.Conclusion: Outcomes of day centre attendance are those targeted by social care and health policy. Centres were communities that ‘enabled’ and offset loss or isolation, thus supporting ageing in place through wellbeing and contributed something unique to their attenders’ lives. By monitoring attenders’ health and wellbeing and providing practical support, information and facilitating access to other services, centres offered added value. Attendance needs to be set in the context of other social engagement and care provision which may not overlap or duplicate centre support. Professionals may wish to explore the benefits of social prescriptions to day centres but should map local centres’ provision, engage with their organisers, and seek information on attenders, who may differ from those in this study.