Addressing Social Isolation and Loneliness Through Community-based Palliative Care
Once simply considered social dilemmas, loneliness and isolation are finally getting the attention they deserve from public and private sectors that recognize their impact on individual health and well-being. While people of all age groups can experience this lack of connectivity, it is particularly troublesome for seniors, especially those who are experiencing a serious or advanced illness, where the physical challenges of mobility make the effort required to socialize with friends and family overwhelming.
Thanks to the expansion of Medicare Advantage (MA) guidelines to cover more supplemental benefits that help to relieve the burdens of social determinants of health (SDOH), including isolation and loneliness, a growing number of payers are introducing community-based palliative care as an important part of the solution.
Quantifying the Negative Impact on Health
As an illness becomes advanced, the lack of social contact for that patient, and oftentimes their caregiver, causes social isolation, which can lead to loneliness and negatively impact health. In fact, morbidity and mortality in the elderly have an inverse correlation with social contact, which is exacerbated by strained finances, reduced mobility and the death of acquaintances. An AARP loneliness study published in 2010, and now being updated, reported that approximately 42.6 million U.S. adults ages 45 and older were suffering from loneliness.
A meta-analysis of 148 studies looking at the relationship between social isolation and mortality found that having more supportive social relationships was linked to decreased mortality risk. In fact, researchers concluded that lack of social relationships is as strong a risk factor for mortality as smoking, obesity or lack of physical activity. Similarly, older adults who are lonely have an increased risk of dying sooner and are more likely to experience a decline in their mobility, compared to those who are not lonely.
Another study found that older adults with larger social networks of family members and close friends may be better at staying on top of recommended preventive health screenings and checkups than their more isolated peers.
Health risks associated with isolation and loneliness are thought to be related to elevated levels of stress hormones and inflammation that increases risk of heart disease type 2 diabetes, dementia, depression, and suicide attempts.
Community-based Palliative Care: Creating a Better Environment
Communities, medical homes, and health plans are recognizing the harmful effects of social isolation and loneliness and developing ways to address them. For those with serious or advanced illness, innovative models of specialized community-based palliative care (CBPC) – such as Turn-Key Health’s Palliative Illness Management (PIM) solution – can help to meet these challenges.
The PIM teams, comprised of nurses and social workers, perform home visits and screen patients and their caregivers for signs of social isolation and indicators related to SDoH. This is critical, given that non-medical determinants of health are believed to account for up to 60 percent of health outcomes. The gathering and sharing of non-medical information derived from these information-rich home visits lead to creating treatment plans to address social isolation and SDoH. Examples include referrals to community resources to address housing or transportation needs, food insecurity, and caregiver stress.
A Call for Greater Adoption of CBPC
People with a serious illness experience distress over and above the physical symptoms of their specific condition. A new survey from the Commonwealth Fund reveals that many are distressed. Sixty-two percent feel anxious, confused, or helpless at some point. Nearly half have emotional or psychological problems. Social isolation, a known risk factor for worse health outcomes, is common, with one-third of respondents reporting feeling left out, lacking in companionship, or isolated from others.
Researchers conclude that strategies for delivering a better health care experience — one that ensures comprehensive, holistic care while always respecting the dignity of the individual — already exist. They just need to be adopted on a much wider scale.
Among the recommendations to drive adoption is greater emphasis on managing the behavioral health needs of patients and their caregivers. Integrating behavioral health services into medical care requires more than simply improving communication among siloed professionals. Multidisciplinary care teams that include behaviorists, social workers, and patients working together can ease the sense of helplessness, the loss, and the social isolation that seriously ill people commonly experience.
This conclusion is an implicit endorsement of CBPC to mitigate the feelings of loneliness and isolation among those with serious illness. For palliative care professionals, this vote of confidence further strengthens their role in helping those with a serious or advanced illness overcome any “disconnects” that lead to a lonely, isolated existence.