In 2017, Ontario’s Chief Medical Officer of Health proclaimed loneliness to be a major societal challenge that needs to be addressed. “Loneliness and social isolation are serious public health problems that cost us all. They affect our productivity, health and well-being – even how long we live.”
Loneliness is a particularly important issue for older adults to pay attention to because it is common and linked to negative health outcomes.
But what is loneliness?
Social isolation is the objective lack of social resources. Loneliness, on the other hand, is the subjective perceived lack of social resources; a discrepancy between a person’s preferred and actual social contact. It is distinct from social isolation because someone can have little social contact and not feel lonely, or have many resources but still feel alone.
According to research by Sinai Health’s own Staff Geriatrician Dr. Nathan Stall, loneliness affects three dimensions. First, it affects emotions that leads to feelings of desperation, boredom and self-deprecation. Second, it leads older adults to have negative attitudes towards themselves and others. Third, it leads older adults to become self-absorbed and passive.
Additionally, loneliness can lead to other negative health outcomes among older adults. Among older age groups, loneliness can lead to depressive symptoms, functional limitations, dementia progression and increased nursing home admissions. It is common among older adults, with 40% experiencing loneliness, and is associated with a 45% increased risk of death. Older adults who are not married, less educated, and live with worsening finances are at greater risk of experiencing loneliness.
Fortunately, older Torontonians are less likely than millennials to feel the most socially isolated. The recent National Institute on Ageing co-sponsored Toronto Social Capital Study demonstrated that “older adults exhibit among the highest levels of social capital of those surveyed. Older Torontonians were more likely to have a close friend in their neighbourhood, and to be satisfied with the frequency of contact with family and friends.”
However, for older adults who are lonely, they often desire increased social contact and interaction, but for whatever reason, are not able to achieve it. As a result, as Dr. Stall also points out, loneliness can be an important contributor to health care use, with lonely older adults tending to make more frequent appointments to boost their social interactions. It should, however, be noted that loneliness driven social interactions in the health care system is not the primary drivers of increased healthcare utilization, rather the fact that our older population will double in size between 2010 and 2030 is.
Now, to better address loneliness in older adults, health care practitioners are starting to consider a practice aimed at increasing their social interactions: social prescribing. Often co-created with patients to complement clinical treatments, social prescribing considers a patient’s strengths and interests, as well as their health needs. In order to avoid ‘downstream’ services, such as emergency department visits and hospital admissions, the approach directs patients to ‘upstream’ community supports.
A ‘social prescription’ is typically made by a patient’s primary care provider, after carefully considering their needs and whether social prescribing will benefit them. This begins a process that involves a navigator who helps connect the patient to appropriate resources and supports the patient to fulfill their social prescription.
In Ontario, a network of 11 community health centres has undertaken a pilot project to promote social prescribing to its clients, called Rx: Community. The health centres connect older adults to non-clinical supports and interventions, such as volunteering opportunities, museum visits, breakfast clubs, park and nature walks, bereavement support groups, yoga and meditation. The project, which brings together Ontario-based community health centres from Ottawa, Guelph, Thunder Bay, Temiskaming, and Belleville, has found social prescribing to be a low-cost feasible intervention that addresses real health issues in the community.
The practice has also been trialed in the United Kingdom. In that time, health care providers have found that social prescribing contributes to improved self-esteem, mood, opportunities for social contact, self-efficacy, transferrable skills and confidence. All of these outcomes are positive in and of themselves, but social prescribing can also lead to enhanced engagement in other health-related activities. In the UK, researchers also found that social prescribing resulted in overall per-patient cost reductions due to fewer appointments and admissions to hospital.
Staying socially connected to friends and family members is becoming increasingly recognized as a good strategy to help us age independently in our communities and remain as healthy as possible. Better understanding that social isolation and loneliness are growing issues for our ageing population will be the first step in understanding the actions we can take to create more well-connected communities as we age where eventually social prescribing may become a key prescription to enable healthy ageing.
Date modified: 2020-01-22
