The COVID-19 pandemic has disproportionately harmed older adults and subsequently heightened their social isolation and loneliness (SIL) [1,2] and suicidal vulnerability [3-5]. Long-term care facilities (LTCFs) are the most profoundly affected sector with the highest mortality rate of 81% [6,7]. Apart from being the hardest hit during the pandemic, residents have already been experiencing long-lasting SIL before the beginning of the COVID-19 pandemic [8]. To address this SIL, information and communication technologies (ICTs) have become key resources for families to maintain a socio-emotional connection with their loves secluded in LTCFs [9]. Families remain LTCF residents’ strongest support system. The Canadian Institutes for Health Information contends that the majority (82%) of older adults need family involvement in their instrumental activities of daily living [10-12].

Systematic [13] and Cochrane [14] reviews undertaken before the COVID-19 pandemic were inconclusive with regard to the effect of ICT in reducing SIL in older adults. However, the pandemic has confirmed the importance of ICT’s applications worldwide to provide remote chatting conferencing—a feature that maintains vital interactions between families and their loved ones. Owing to stringent public health restrictions on physical access to LTCFs, ICT has been the only alternative to maintaining social capital and subsequently reducing SIL among seniors in LTCFs [15]. Residents in these settings are more fraught with SIL, varying from 40% [16] to 71.6% [17]. As noted by Abbasi [18], during the current COVID-19 pandemic, SIL resulted in an uptake of antidepressants, antipsychotics, and anxiolytics in LTCF residents. Along with being physically and psychologically separated from the community, many older adults find that relocation to a LTCF itself is a stressful life event. The literature clearly contends that the majority of older adults are reluctant to be relocated [19-21]. Many older adults are widowed, under guardianship or tutorship, and an unknown proportion—4% in the Canadian general population in 2018 [22]—sel-identify as lesbian, gay, bisexual, transgender, questioning, or two-spirit [23]. These vulnerable older adults often become further isolated once admitted into a LTCF and experience greater levels of SIL [24], which underlines the necessity for providing interactive connections with others.

SIL negatively affects quality of life and is associated with an increase in all-cause mortality, an effect that is slightly stronger in men than in women [25-27]. Owing to the public health restrictions imposed during the COVID-19 pandemic, LTCF residents had limited contact with staff and were often secluded in their rooms and no longer able to partake in communal meals, in-person activities, or family visits. The threat of infection and the loss of contact with loved ones has contributed to SIL and has likely exaggerated subsequent negative outcomes in older people. Nevertheless, SIL in LTCFs has just started being considered in the literature. With an increasing incidence of COVID-19, the use of ICT applications has skyrocketed to facilitate social communication [15], providing a necessary support for older people in long-term care [28].

The use of ICT to reduce SIL has been extensively studied, including the effects of internet-based interventions [29-33] and Humanoid Robot approaches [34-36]. Methods currently used in LTCFs to connect older adults with their families and friends range from the conventional telephone to web-based platforms such as Skype, FaceTime, Zoom, or Google Meet (for a review see Banskota et al [37] or Chen and Schulz [38]). Zamir et al [39] employed an intercare home group “Skype” to reduce SIL in 3 care homes and found that video calls reduced feelings of loneliness in residents seemed acceptable and was a feasible, low-cost model, especially during times of public crisis such as during the COVID-19 pandemic.

This review intends to assess the effect of ICT interventions implemented in LTCFs to address SIL among residents during the COVID-19 pandemic. The following objectives will be considered to address this research question:

Older adults have been relying on family members to monitor their “health, well-being, and safety” through virtual visits during the COVID-19 pandemic [40]. SIL in older people has been identified as a risk factor for premature mortality [27] for both poor physical (eg, cardiovascular and obesity) [41-43] and psychiatric health (eg, depression and anxiety) [44]. The significance of communication technology has been featured prominently in local and national news outlets that have highlighted the stories of residents and families being connected via various ICT applications during the pandemic [45]. Liotta et al [46] explained how increased social connectedness was a powerful tool for nursing home residents that it decreased SIL during the pandemic. Thus, innovative use of digital tools can provide a method to address this urgent public health matter on a long-term basis [47]. As opportunities offered by ICT applications have the potential for long-term solutions for the COVID-19 pandemic and postpandemic period, this systematic review will help inform policy and practice interventions in this area.

The proposed systematic review is also necessary to shed light on the pre–COVID-19 pandemic literature on the impact of ICT on SIL. Systematically examining the evidence on the association between ICT and SIL will help establish up-to-date knowledge to develop best practices and support evidence-based policy decision-making.

This systematic review will be conducted following the Cochrane Collaboration methods [48] and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist to ensure the completeness of this protocol. We will consult the Synthesis Without Meta-analysis (SWiM) guidelines to guide the use of alternative synthesis methods. The review is registered with the OSF registries [49]. The search will be performed in English, French, and Chinese. A pilot exploratory search on Ovid MEDLINE will be undertaken to create a robust string that is well calibrated in order to improve the likelihood of retrieving articles that are as relevant as possible. This interactive process will include both free vocabulary and descriptors. Beyond the traditional approach that emphasizes on French or English search strings, this review will be enhanced by searching on Chinese databases. Tables 1 and 2 exhibit the search strategies in English for the Ovid MEDLINE database and in Chinese for the China National Knowledge Infrastructure (CNKI) database. The final search strategy involved the following databases: PsycINFO, Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, Communication & Mass Media Complete, Association for Computing Machinery (ACM) Digital Library, IEEE Xplore, CNKI, WanFang, Weipu (VIP), and SinoMed. Two review authors, the principal investigator (IB) and a PhD student (JZ), who is a native Mandarin speaker and writer, will canvas all the titles and abstracts; a third review author (DS) will resolve the conflicts. A pilot test will be implemented using a pilot-tested algorithm, which is shown in Figure S1 in Multimedia Appendix 1.

All retrieved articles will be uploaded into Rayyan Intelligent Systematic Review [50]. After the removal of duplicates, 2 reviewers will independently screen the titles and abstracts identified by the literature search for inclusion. By April 30, 2022, the full text of potentially relevant articles will be screened to determine final inclusion, followed by a data extraction phase. To increase the reliability of screening by the two independent reviewers, a random sample of articles will be screened on the basis of the eligibility criteria in a pilot test phase. For the screening, a structured algorithm that was previously validated by IB, SD, and ETN will be used.

A standardized data extraction grid that has been developed and piloted will be employed to extract data from all full texts. This includes the following: authors, year of publication, language, design, objectives, participants’ characteristics, ICT intervention, outcomes, population, setting, and the fields of the AMSTAR checklist. The K statistic will then be calculated to determine the intrarater agreement for study inclusion [51]. Studies excluded during the screening phase will be recorded along with the reason for exclusion by each reviewer. As we intend to complete the review by October 2022, an updated search will be run shortly before this time in order to capture any recent peer-reviewed publications.

Given the potential heterogeneity in study designs, IB and JZ will independently assess the methodological quality of studies using the design-specific appraisal tool the Cochrane risk-of-bias (RoB 2) for randomized clinical trials, or the Newcastle-Ottawa Scale also used in nonobservational cohort and case-control studies.

Inclusion and exclusion criteria will be based on the Population, Interventions, Comparators and designs, Outcomes (PICO) framework, summarized below.

Extracted data from all included studies will be summarized in tabular format. Data will be categorized and aggregated by type of intervention and type of setting (eg, nursing homes or assisted living arrangements). A narrative synthesis will be completed. Significant as well as nonsignificant results will be collected, analyzed, and discussed within the relevant outcome category. We plan to run a subgroup narrative analysis. A meta-analysis is planned on the basis of the quality and quantity of data, and heterogeneity will be measured through I² statistics. All the limitations will be discussed.

The data sets generated and analyzed during this study, which would be necessary to interpret, replicate, and build on the findings reported in the review article will be made publicly available as requested by the funding institution. All requests should be addressed to the corresponding author as these data will be stored on a secured server of the Université de Saint-Boniface.

As this systematic review is part of a “Social isolation and loneliness project,” we received ethical approval from the Ethics Committees for Research of the University of Ottawa (H-08-21-7314) the University of Moncton (dossier 2021-073) and the Research Ethics Board of the Primary Care and Population Health Research Sector of the CIUSSS of the Capitale-Nationale (2021-2303, _SPPL).

No patients will be involved. Patients will not be invited to comment on the study protocol design and were not consulted as to how this work may inform patient-relevant outcomes or how a patient might interpret results. However, findings will be disseminated to the public and health care professional networks via conferences, publications, and presentations.