Evidence
Alert

Virtual quizzes involving several care homes are feasible and might reduce loneliness and social isolation

Simple low-cost video technology allowed residents in different care homes to enjoy taking part in virtual quizzes. Staff support was needed but new research found that the sessions were feasible and low-cost.

This is the first study to trial connecting care homes virtually via quiz sessions. Interviews revealed that residents felt more connected with each other, and with other care homes. They re-gained a sense of self and purpose and felt less lonely. Care home staff were eager to continue with the sessions, but they outlined barriers such as lack of staff support or time.

Unlike previous research into virtual socialising, this study included residents with dementia. It found that they benefited and remembered faces and conversations.

Loneliness and isolation in care home residents are long-standing issues which are likely to have intensified during the COVID-19 lockdowns. Virtual interventions are particularly relevant during lockdown but are also valuable for care homes in other times.

What’s the issue?

Many older people in care homes report feeling lonely and socially isolated. Loneliness can have a negative impact on health outcomes and can lead to depression and increased confusion and memory loss (cognitive decline).

The internet, and video technologies such as Skype, FaceTime, or Zoom, can connect people to loved ones, or allow new social ties. But older people in care homes may be unfamiliar with the technology.

Many care homes run quizzes as a form of entertainment and mental stimulation. This research looked at virtual quizzes involving several care homes to improve socialisation. It explored whether the quizzes were feasible and beneficial.

What’s new?

Twenty-two care home residents, from three homes, volunteered to take part. Residents with dementia, signs of cognitive decline, and hearing or visual impairments were included. Some residents were non-verbal, or had limited mobility, and some had no prior experience of video calls.

Care home staff helped to plan and facilitate eight video quizzes. Most used Skype TV, with the video projected onto a big TV screen showing a group of residents. A separate small webcam was moved between residents when they wanted to speak.

Each of the quizzes lasted about one hour. They began with 15 minutes’ general chat and then there were about 20 straightforward questions, for example, ‘what year did the second world war end in?’ or ‘is iron a metal?’.

Afterwards, staff and residents provided feedback on the benefits and feasibility of the sessions.

Staff reported that the competitive element was important in engaging participants, as was the opportunity for peer interactions. Participants talked about ‘our home’s pride’ and ‘top star’ residents who could answer questions. Many residents participated in multiple sessions and some who initially observed took part in later sessions.

Four themes emerged from interviews with staff and residents:

  1. Residents with moderate-advanced dementia remembered faces and conversations but could not recall having seen the technology before. They expressed happiness when remembering conversations with people ‘outside’ of their care home, and answering questions in a ‘game’. They could recall details such as the gender or clothing of people who had spoken.
  2. Residents felt more connected with others. Within the same care home, residents learnt more about each other’s backgrounds and interests, and spoke fondly about their ‘teammates’. Across care homes, residents enjoyed comparing features of their environments.
  3. Residents re-gained a sense of self by sharing their stories and remembering their pasts with people of a similar age. One resident said the sessions were encouraging her to regain an interest in technology, but two expressed some insecurities, worrying that others may not like their image, and that ‘just anyone’ could see. However, the residents acknowledged that everyone on the calls had been friendly, and that they could move away from the screen if they wished.
  4. The virtual quizzes provided relief from loneliness or boredom. Most residents said the video calls helped them to ‘pass the time’ and gave them ‘something to do’. Residents said the quizzes encouraged them to get to know others within the same home more than passive activities, such as watching TV. Across care homes, residents were surprised that there were so many people with similar interests or professions, or who had grown up in the same area as they had.

Staff were keen to run virtual quizzes following the end of the study but said a lack of available staff and support could be a barrier. They saw positive effects on residents and enjoyed the competitive nature of the quiz themselves. They liked being able to get to know staff from other homes, and felt that the quizzes could help care homes connect with each other.

Why is this important?

This is the first study to trial connecting two or more care homes virtually over a long period. The quiz sessions were feasible and acceptable, with both residents and staff enjoying the competition and the socialising.

This is also one of the first studies to include residents living with dementia, who enjoyed and could remember details of the event. This indicates that residents with dementia should not be overlooked in virtual socialising.

Many residents reported being able to relate to those in other homes as they had similar interests and experiences. In previous work, some residents had video calls with school pupils and felt they had to filter their conversations more. This suggests that virtual socialising may be more successful when participants have more in common.

This work is particularly relevant to lockdown measures during the COVID-19 pandemic. But loneliness and social isolation are deep-rooted issues. Many residents do not ordinarily leave their homes; virtual socialising could provide an important opportunity, at low cost, for them to meet new people.

What’s next?

Residents and staff wanted to continue with regular virtual quiz sessions. One activity coordinator was eager to set up a regional competition with rewards for the winning care homes. Another was keen to extend use of the technology to other environments, such as calls with relatives, or with other organisations such as church on Sundays.

However, the care staff also noted that the activities relied heavily on the availability of staff. The researchers say that organisational issues within care homes will need to be overcome for these activities to continue.

In future work, established scales of loneliness, isolation, and well-being should be used to monitor changes before and after virtual activities. Further research could identify the most beneficial aspects of sessions: the competition, new friendships with people in other homes, or improved bonding with their fellow residents. This knowledge will inform the design of future interventions to increase wellbeing and socialisation.

Lockdown measures during the COVID-19 pandemic have accelerated society’s use of technology. Care home staff, family members, and residents are more likely to be familiar with virtual platforms, which means that virtual socialising is likely to become easier to coordinate.

You may be interested to read

The full study: Zamir S, and others. Intergroup ‘Skype’ Quiz Sessions in Care Homes to Reduce Loneliness and Social Isolation in Older People. Geriatrics. 2020;5:90

Research by the same group looking at the barriers and facilitators of video-calls for care home residents with their relatives or friends: Zamir S, and others. Video-calls to reduce loneliness and social isolation within care environments for older people: an implementation study using collaborative action research. BMC Geriatrics. 2018;18:62

Funding

This research was partially funded by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (CLAHRC SW).

Commentaries

Study author

The lack of social contact and any permitted visits to care homes by loved ones and friends has added to the issue of loneliness and isolation in older people living in care, including those with dementia.

Connecting care homes through video calls to reduce feelings of loneliness seems acceptable, feasible, and low cost. Many care homes already have the equipment, and also have sister homes, so it’s just a matter of agreeing to the activity. Reducing loneliness and social isolation should be a part of the duty of care given to all residents.

This could easily be embedded as a short weekly activity. There needs to be enough staff available to run such activities, and unfortunately many homes have a lack of staff.

Personally, setting up and running these quiz sessions was incredibly enjoyable and rewarding as I was able to see residents socialise and make meaningful connections.

Sonam Zamir, Researcher at the School of Nursing and Midwifery, University of Plymouth

Care home manager

This was an amazing innovative initiative which all care homes should now get on board with. It worked a lot better this time round compared to last year I think because the staff now … they got the hang of it. It does take a bit of time but it’s worthwhile. Only problem I can see it … not with the technology we can use it now … not with the residents even the families are getting on board … they like the activity. But it’s just staff to support this. Families need us to focus on the care, the physical care and even then we are low on staff. Maybe if we had some more support even external support I can see this continuing.

Care home manager interviewed as part of the study

Care home resident

I couldn’t believe [resident]! He was on fire that time answering everything we didn’t have the need for anything thinking …[resident] was very knowledgeable usually very quiet to himself never shared but I guess no one asked him before this. Probably other residents who I don’t know much about also.

Resident interviewed as part of the study

Nurse

This paper shows the importance of social interaction for care home residents, not only for those who already join in organised sessions. This new type of interaction encouraged isolated residents to try out a new experience. It should never be assumed that residents prefer to remain alone in their rooms if they do not jump at the chance to attend existing activities. They should be offered a range of events on an ongoing basis. This paper also shows that residents (and staff) may not know much about their fellow residents and may welcome the opportunity to find people to engage with.

The study indicates that often care homes do not network with other providers, and it shows how important this can be to allow both residents and staff to share ideas, solutions and awareness of common issues.

The research findings might help care home managers to see the advantages of supporting these activities in their care homes, and make them more likely to support these activities, by investing in additional equipment and giving staff the time to run the sessions. They could involve external volunteers to support these sessions alongside staff.

Carol Singleton, Queen’s Nurse, University of Sunderland

Conflicts of Interest

None declared.