ccsmh: first clinical guidelines an ‘important step forward’ in treating social isolation and loneliness in older adults
canadian health care and social service professionals now have access to clinical tools and resources to better support older adults who may be at risk of, or already experiencing, social isolation and loneliness.
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“the impacts of social isolation and loneliness can be mitigated with the right knowledge, training and resources,” says dr. david conn, a geriatric psychiatrist and co-chair of ccsmh.
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the canadian coalition for seniors’ mental health (ccsmh) has good news for older adults who are struggling with social isolation and loneliness. the national organization has unveiled the canadian clinical guidelines on social isolation and loneliness in older adults, a vital undertaking believed to be the first of its kind. the project, developed in conjunction with an interdisciplinary team of experts, is intended to help healthcare and social service professionals provide support to some of the most vulnerable members of society. a valuable addition to existing resources for older adults and care partners, the guidelines are critical to understanding the health implications of social isolation and loneliness.
it couldn’t come at a better time: recent research indicates that 41 per cent of canadians aged 50 and older are at risk of social isolation, while as many as 58 per cent have experienced loneliness. the two mental health issues are associated with a range of health problems in this age group, including an increased risk of cancer mortality, stroke and dementia. living with social isolation and loneliness is so detrimental to one’s health, it has been compared to smoking 15 cigarettes a day.
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even more concerning, says dr. suzanne dupuis-blanchard, director of the centre d’études du vieillissement at the université de moncton in new brunswick, is the fact that social isolation is much more common than the numbers show, pointing out that the part of the population affected by isolation is not the one that responds to surveys.
“social isolation is not trivial, it’s not just someone saying, ‘i don’t want to leave the house,'” explains dupuis-blanchard, who is also a member of the working group for the guidelines. “this is a public health crisis.”
the guidelines offer 17 evidence-based recommendations that have been divided into prevention, screening, assessment and interventions. they are supported by an extensive review of relevant literature and informed by surveys of older adults and healthcare and social service professionals. “the impacts of social isolation and loneliness can be mitigated with the right knowledge, training and resources,” says dr. david conn, a geriatric psychiatrist and co-chair of ccsmh. “these guidelines are an important step forward in that direction.”
an ounce of prevention
a key part of addressing social isolation and loneliness in older adults is ensuring that healthcare and social workers understand the long list of factors involved. some of these risks, which include advanced age, low income and poor health status, have only been exacerbated by the pandemic. “it’s important to not just identify older adults who may be socially isolated or lonely but to anticipate any possible changes in their life circumstances that can put them at risk,” conn says. “major life transitions are really critical and that’s something that might, in some cases, be anticipated.”
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this involves adding social isolation and loneliness to the curriculum taught to future healthcare and social service professionals and encouraging them to spread this information far and wide. “we should use our role as agents of change to help inform and educate patients, clients and the general public about the association between social isolation and loneliness and poor mental and physical health,” he adds.
identifying those in need
according to the guidelines, it’s important to use evidence-based screening tools to identify individuals who are most at risk. this means understanding that stigma is a serious issue that may prevent patients from sharing their real concerns.
“some people may be less open to discussing loneliness or being labelled as lonely and that certainly came through in our survey of older adults,” says conn. “some respondents said they would not want to talk about this with their doctor or other health care provider. we need to bear that in mind.”
it also means recognizing that being alone isn’t necessarily a bad thing. “solitude often gets left out of this discussion but it’s important to know that virtually all of us enjoy a certain amount of time on our own. it’s very important to respect that and not assume that everyone needs to be as socially connected as possible.”
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the root of the problem
once a patient has been identified, the guidelines call for a thorough clinical assessment to explore the causes of their social isolation and loneliness. this helps identify any underlying health conditions that might be contributing factors and, ideally, leads to a plan that addresses their unique needs.
“it also says in our guidelines that utilizing a strength-based approach can help identify an individual’s positive attributes and protective factors while avoiding stigmatization,” says conn. “even though we’re performing a typical assessment, it’s important to look at a person’s strengths.”
a helping hand
the first of a long list of potential interventions included in the guidelines is a relatively new concept known as social prescribing. this is where the health sector offers recommendations to individuals who are suffering from social isolation or loneliness and helps them make connections within their communities.
“we think this is an excellent approach that needs to be carefully considered,” he says. “bearing in mind, of course, that the resources available are going to vary dramatically from community to community. organizations should consider developing social prescribing strategies and community organizations should consider developing relationships and partnerships with clinical organizations.”
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other recommended interventions include encouraging patients to engage in social and physical activities, cognitive behavioural therapy and even animal ownership.
“if you have a dog, people are going to start talking to you as opposed to you just sitting on a park bench alone,” conn says. “there’s lots of good lessons here.”
ultimately, the complex range of issues that contribute to social isolation and loneliness in older adults won’t be solved overnight. the road ahead may be rocky, but the guidelines offered by the ccsmh will provide healthcare and social service professionals with some much-needed direction along the way — guidance that is critical to improving social isolation by teaching them to recognize the warning signs and how to intervene, says dupuis-blanchard.
conn agrees.
“we are uniquely positioned to make a difference — we can be part of the solution,” he says. “but in order to make a substantial change, we need a multi-pronged approach at multiple levels of society. we will continue to work with organizations, groups and individuals across the country to try to reduce social isolation and loneliness.”
to read more about the guidelines, read the press release by clicking here.
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