The aim of the white paper summarised in this article is a preliminary assessment of what evidence exists for the efficacy of a smart insole to enhance mobility and thus mental health and social isolation, particularly in the elderly.
According to recent studies a smart insole that monitors gait and activity levels while providing personalised exercises, coaching, and access to an online community has the potential to significantly improve the quality of life (QoL) of older individuals.
Falls are a major issue for the elderly (see Falls in Elderly White Paper). Yearly, 30-40% of people >65 years of age will fall at least once with 32% of these resulting in serious injuries (Ambrose et al. 2015; Sterling et al. 2001). Falls can significantly undermine older adults’ confidence and independence. This can increase social isolation, a major issue in developed nations. For example, in the EU loneliness is common with 30-55% of older people in Central and Eastern Europe and 10-20% in Northwestern Europe feeling lonely (Hansen and Slagsvold 2016). Interestingly, loneliness can, in turn, increase fall risk with a 24% increase in falls noted in people with the least social contact compared with those with the most social contact (Bu et al. 2020).
Our product, IntellAge, are holistic smart insoles that tackle falls and social isolation in the elderly. IntellAge’s discrete sensors allow it to calculate our unique Fall Risk Index (FRI). Its complementary app displays gait, activity level, FRI, and AI-powered personalised exercise instructions based on FRI, age, and health status. Such balance training has been shown to reduce fall risk probability significantly with some reducing fall risk by over 50% (Gardner et al. 2000; Liu-Ambrose 2012). IntellAge’s app is also equipped with a community function to match elderly people with other people in their vicinity with similar interests so they can find exercise/walking/hobby partners as well as coaches to help them build meaningful connections.
What is Social Isolation?
Before discussing topics such as social isolation and loneliness, it is important to define these two terms. Although we recognise other definitions exist, this white paper will use the definitions set out in Gardiner et al. Loneliness, refers to the subjective feeling of being alone or more separate from others than desired. Social isolation is “the objective absence or paucity of contacts and interactions between a person and a social network” (Gardiner et al. 2018).
The world population aged >60 years is expected to reach 22% by 2050 (World Population Ageing 2007). Social isolation among the elderly is thus more relevant now than ever. Levels of social isolation/loneliness vary from country to country. A recent meta-analysis showed that the pooled prevalence of loneliness in those >65 is 28.5% with actual values varying from 11 to 55%(Chawla et al. 2021). Importantly, social isolation and loneliness can pose significant threats to the physical and mental wellbeing of older individuals (See - What are the Impacts of Social Isolation & Loneliness?).
What Can Cause Social Isolation?
Ageing alone does not cause social isolation however studies show that individuals who lack family contact are more likely to be socially isolated and to have higher rates of loneliness. Furthermore, those over 50 are more likely to have experiences that increase their risk of loneliness and social isolation (e.g. death of a loved one, worsening health and chronic illness, new sensory impairment, retirement, changes in income, etc.).
At-risk groups include immigrants and members of the LGBTQ+ community. A recent Canadian study has shown that both recent and long-term immigrants experience significantly greater levels of loneliness than their Canadian-born counterparts (Stick et al. 2021). This increased susceptibility to loneliness is present at almost all educational levels, age groups, income levels, and marital statuses (Stick et al. 2021).
Meanwhile, individuals identifying as LGBTQ+ report higher levels of social isolation than heterosexuals, with social isolation being associated with increased substance use and psychological distress in these populations (Bränström and Pachankis, 2018). Additionally, pre-existing mental health issues such as anxiety and depression can also increase the risk of isolation and loneliness (Evans et al. 2018).
Mobility, Frailty and Social Isolation.
According to studies, frailty, reduced mobility, and other physical disabilities can be major causes of social isolation.
NHS England describes frailty as “a loss of resilience that means people don't bounce back quickly after a physical or mental illness, an accident or other stressful event” and is quantified by a range of measures relating to physical, psychological, and social health (Xie et al. 2017). The most frequently reported components of frailty are mobility and balance, nutrition, and cognitive function (Xie et al. 2017). Analysis of the English Longitudinal Study of Ageing (ELSA) found that loneliness predicted frailty and social isolation (Gale et al., 2018). Fear of falling, a factor closely linked to frailty, is associated with poorer mental health and social isolation in those over 65 (Kumar et al., 2014; Esbrí-Víctor et al. 2017; Hajek et al. 2017).
Individuals who suffer from long-term illnesses or disabilities are 3.75 times more likely to say they feel lonely often or always (Wellbeing and Loneliness - Community Life Survey 2020/21). Studies such as Steptoe et al. confirm this finding showing that limiting longstanding illnesses such as chronic lung disease, arthritis, impaired mobility, and depressive symptoms are associated with social isolation (Steptoe et al. 2013).
What are the Impacts of Social Isolation?
Social isolation can have major impacts on both an individual’s psychological and physical health. Physically, social isolation and loneliness are associated with a range of health conditions/negative behaviours, including coronary heart disease, stroke, self-neglect, and clinical depression (Steptoe et al. 2013; Locher et al. 2005). Additionally, loneliness and social isolation are also associated with mortality (Steptoe et al. 2013).
Fixing Social Isolation.
A wide range of interventions has been carried out to tackle the issues of social isolation and loneliness. These include attempting to increase people’s interaction with their peers or others who are lonely, psychological therapies, health and social care provision, activities with animals, befriending interventions and hobby development (Gardiner et al. 2018).
As evidenced in this white paper, IntellAge has the potential to tackle multiple significant issues for the elderly including social isolation, loneliness, and mobility. Not only can IntellAge improve physical health by encouraging exercise and reducing fall risk via personalised balance exercises, but it can also protect against social isolation and loneliness via in-app coaches and community functions. As immobility, lack of physical activity levels, loneliness, and social isolation are all factors that contribute to premature ageing, health conditions, and mortality in the older population, IntellAge is a highly promising intervention for tackling a variety of issues in the elderly population.