The opportunities and challenges that come with age may influence each person’s quality of life. While older adults sometimes report that health concerns cause them anxiety, in other cases when older adults consider What Matters to them, it may not be anything related to their health. Other frequently reported goals and preferences include social aspects of life such as spending time with friends and family, continuing to do activities that someone has always enjoyed, or giving back to the community.
As we get older, most of us will receive care across a variety of settings, including in our own homes, in senior housing, in assisted living residences, in hospitals, in nursing homes, in mental health settings, and elsewhere. Regardless of the place a person calls “home,” we need an integrated system in which clinicians and others learn to speak the same language when they share information about how to best meet the mental and physical health and social needs of older adults. That is one of the reasons that Age-Friendly Health Systems has scaled and spread across the United States and in more than 40 other countries.
What Is an Age-Friendly Health System?
Every older adult deserves Age-Friendly, equitable care with each episode of care in every setting. Age-Friendly care entails reliably providing a set of four evidence-based elements of high-quality care, known as the “4Ms” (What Matters, Medication, Mentation or The Mind, and Mobility) to all older adults in the system.
Age-Friendly Care:
- Follows an essential set of evidence-based practices;
- Causes no harm; and
- Aligns with What Matters to the older person (and if/when appropriate, care partners or family members).
Within Age-Friendly care, there is a focus on social determinants of health (SDOH) as well as preventing and treating disease. That is where Social Prescribing comes in.
What is Social Prescribing?
The concept of Social Prescribing means considering a person’s underlying reasons for asking for help, some or all of which may be social and not necessarily health-related. For example:
- Is the person worried because they are unable to engage in certain activities or physical exercise that they used to do regularly?
- Is the person feeling lonely or isolated?
- Is the person experiencing issues such as boredom or anxiety?
Social Prescribing includes the option of writing out a prescription for a non-medication approach such as, “Walk or run outdoors for 20 minutes three times a week,” or “Call a friend once every two weeks to catch up and plan a date to get together.” The act of handing someone an actual prescription adds weight to a clinician’s recommendation and shifts the focus from adding another medication to engaging an older person with community social supports.
The Medication Use Process involves several members of the interprofessional team, and of course, the older adult themselves. Each member of the team may have valuable information to share that could influence whether to write a Social Prescription or prescribe a medication.
In hospitals, nursing homes and other care settings, there are comprehensive medication reviews by a clinical pharmacist to evaluate medication-related concerns. This is just one example where additional education or guidance about Social Prescribing may be incorporated.
Social Prescribing as a Tool to Help Deprescribe
Older adults may be on nine or more medications on average—some are on many more. Increasing attention is being paid to “deprescribing,” which is defined as “the planned and supervised process of dose reduction or stopping of medication that might be causing harm or no longer be of benefit. Deprescribing is part of good prescribing—backing off when doses are too high, or stopping medications that are no longer needed.”
One prescription for a non-medication approach might be, “Walk or run outdoors for 20 minutes three times a week.”
Social Prescribing is being used as well as studied in places such as England and in clinical fields such as psychiatry. This work is important in that it illustrates Age-Friendly care and the 4Ms as a set. Members of the interprofessional team share information about an older person’s social situation, mental and behavioral health, and other characteristics that can meaningfully influence social and/or medication prescribing.
Sharing Information Across Settings and Care Teams—the My Health Checklist
The My Health Checklist is a comprehensive tool designed to help older adults assess their health holistically—what’s going well, what could be improved, and any questions or concerns they may have. This tool helps them to prioritize their top questions and focus on what truly matters most to them.
Often, the most important issues with older adults are not purely medical. These can include concerns about caregiving responsibilities, adjusting to retirement, maintaining social connections, or navigating one’s home and broader community. Each section of the checklist includes examples of these issues as well as topics some people might hesitate to discuss, such as loneliness, the financial burden of treatments, and matters of relationships and intimacy.
Addressing many critical issues with older adults starts with asking better questions and truly listening to the answers. In addition, being well-prepared for appointments empowers older adults to ask for the care that’s right for them.
The My Health Checklist can be shared in different ways. In healthcare settings, teams have mailed it before appointments, handed it out at the end of visits or in waiting rooms, introduced it during “Welcome to Medicare” visits, and included it in electronic patient portals.
It is also important to reach people where they live, work, worship, and learn. Introducing the 4Ms or the My Health Checklist in places such as senior centers, community health fairs, YMCAs, AARP state offices, Meals on Wheels programs, independent and assisted living residences, faith-based organizations, libraries and caregiver gatherings can help reach larger audiences. Anyone can help older adults receive person-centered care.
Summary
Comprehensive, person-centered approaches to how communities support older adults includes health systems and clinicians—but is broader than healthcare alone. We must integrate healthcare and community-based social support systems to build on the strengths of each so that every older person has access to the best possible programs and services in their neighborhood and community.
So, how can we promote appropriate Social Prescribing to optimize each older adult’s quality of life?
- Address ageism head on.
- Consider the whole person and the entire community.
- Promote Age-Friendly care and social support. Incorporate the principles of Social Prescribing into curriculum for all team members.
- Learn more about any home- and community-based programs and services for older adults in each community. Refer older adults for social support as needed—make that part of the care plan and prescribing practices.
Do One Thing
What is one thing you will do in the next week to promote Social Prescribing in your practice setting or community? WRITE IT DOWN!
Include a timeline or due date. Talk about it with a friend or colleague. Be accountable for making it happen. For more information, consult one or more of the following resources.
Alice Bonner is senior advisor for Aging at the Institute for Healthcare Improvement (IHI) Nicole Brandt is executive director at the The Peter Lamy Center at the University of Maryland School of Pharmacy, and Kate DeBartolo is senior director at The Conversation Project, also at IHI.
Photo credit: Shutterstock/Carmen Whitehead
Resources
For more information about Social Prescribing:
https://www-bmj-com.umassmed.idm.oclc.org/content/bmj/364/bmj.l1285.full.pdf
https://pmc-ncbi-nlm-nih-gov.umassmed.idm.oclc.org/articles/PMC9444010/pdf/JGF2-23-299.pdf
For more information on Medication Optimization, including Deprescribing:
U.S. Deprescribing Research Network: https://deprescribingresearch.org/for-patients/
https://deprescribing.org/what-is-deprescribing/
For more information about Age-Friendly Health Systems:
https://www.ihi.org/networks/initiatives/age-friendly-health-systems
For more information about the My Health Checklist:
https://www.ihi.org/my-health-checklist https://ihi.org/myhealthchecklistEnglish (also available in Spanish, Portuguese, and Chinese).
