“Social prescribing” is a relatively recent and catchy term that refers to the practice of making referrals and/or “prescriptions” to improve social connections and health. Addressing loneliness (the subjective feeling of being alone) and social isolation (the objective lack of connection to family, friends, and the community)—key markers of social well-being—has received substantial attention in health systems due to their impacts on health and well-being. The idea of social prescribing has consequently gained traction because of its promise to provide a framework and structure for integrating social connection into care plans.
Social Prescribing in Practice
As a geriatrician and palliative care physician, this is not new. In our clinic visits, instead of asking “what brings you in today?” we often start with, “Before we jump to the medical issues, can you tell me a little about yourself?” We learn about where our patients were born and raised, their work and education history, key events in their life, their family and people they can rely on, hobbies, spiritual or religious practices, and major changes to their social life (i.e., widowhood, changes in residence, grandchildren). By centering their social context in the visit, we understand their values and how we might align medical treatment options with these values as needs arise.
Take, for instance, a recent visit in my palliative care clinic with John, a gentleman in his mid-80s who had developed a debilitating heart condition, cardiac amyloidosis. He had been a competitive swimmer and runner, worked in the fashion industry, had an adoring wife and numerous grandchildren, and was struggling deeply with loneliness. Loneliness and isolation were tied to his inability to easily leave his home due to stairs, fatigue and shortness of breath, and his illness had impacted his identity and sense of belonging in his community.
For John, successfully managing his medical needs, fatigue and breathing challenges was deeply connected to helping him re-engage in his social life. Our interdisciplinary team of physicians, nurses, social workers, psychologists, and chaplains all had ideas. We helped think through transportation options to reach a recreation center. We coached him on how to ask for help and encourage friends to visit, as he feared being a burden. We considered companionship opportunities in judgement-free settings, given the stigma he felt around his condition.
‘The process should make clinicians’ work easier, not add to an already overwhelming workload.’
Most importantly, we provided space for him to process his loneliness without rushing to “fix” it. And we acknowledged that while there might not be an easy solution, we would continue working with him to address his needs.
The fields of geriatrics and palliative care have long recognized that health and well-being in later life extends beyond a person’s lab values and medical conditions and is deeply intertwined with social lives. Unlike younger and middle-age adults, the trajectories of health and social lives continue to diverge as people age, leading to markedly diverse experiences. Individualized approaches to social needs—along with structured programs such as senior centers, volunteer programs and arts or exercise groups—have been linked to improvements in mood, cognitive function, and even physical health measures such as blood pressure and sleep quality.
Despite these benefits, careful consideration of how social and health needs are interconnected remains uncommon in clinical settings. Most primary care clinics have little time, few resources, and lack knowledge about community resources to link patients to appropriate social interventions. In contrast, geriatrics and palliative care clinics benefit from an interdisciplinary team and longer office visits, often 45 minutes to an hour long.
Clinicians Want Solutions, but Need Support
Clinicians are eager for more tools to address loneliness and social isolation. We regularly encounter clinicians who want to know—“What can I do? What can we offer?” Our lab’s research has shown that lonely older adults are more likely to be prescribed benzodiazepines and opioids. It seems obvious that we should not treat isolation and loneliness with potentially harmful medications, but rather with tailored social interventions.
I have seen firsthand how focusing on social needs can reduce the need for medications. An older adult experiencing chronic pain may find relief through participation in a community exercise program or mindfulness group due to physical, psychological and social effects, rather than relying solely on analgesics, which often have side effects. Similarly, social engagement can improve mood and cognitive function, potentially reducing the need for antidepressants or sedatives.
Yet, clinicians are unaware of the numerous community-based interventions and approaches or may “blindly refer” without understanding the root cause of their disconnection. Meanwhile, community programs lack a standardized approach to matching individuals with the right resources. For example, an occasional phone call from a Friendship Line may be adequate for a recently widowed, otherwise healthy older woman, whereas a severely isolated first-generation immigrant man with newly diagnosed cancer and housing insecurity may require a more intensive, multi-domain intervention, such as a senior center offering multiple services.
Making Social Prescribing Work in Health Systems
To ensure social prescribing is practical in health systems, two key barriers must be addressed. First, the process should make clinicians’ work easier, not add to an already overwhelming workload. Cross-sector communication, clear referral pathways, and partnership between social and healthcare are essential—it cannot simply be a “handoff” to community organizations.
Second, an efficient process must match people with appropriate community-based interventions, either at the health system or community level. Effective matching might account for factors like gender, cultural background, language preference, poverty, urban or rural living, and medical needs like memory impairment. Ideally, social and healthcare sectors would collaborate to enhance social connection and direct older adults to suitable programs.
In the United Kingdom, this occurs through “link workers” who bridge health systems and social programs. In the United States, no single link role serves this function, but various team members, such as medical staff, patient navigators, peer counselors and case managers might be able to play a similar role.
Taken together, social prescribing offers an opportunity to shift how we approach health and aging. Medical care alone is insufficient to promote well-being in older adults, and integrating social interventions into routine care can complement a comprehensive, patient-centered approach to care. By integrating social interventions into routine care, we can foster meaningful connections, enhance quality of life, and potentially reduce the burden of medication use, all while centering what matters most to people in later life.
Ashwin Kotwal, MD, is an assistant professor of Medicine in the Division of Geriatrics at UCSF School of Medicine and co-leads its Social Connections and Aging lab.
Photo credit: Shutterstock/Davide Angelini
