PosterPDF Available

Addressing loneliness in the older adult

Authors:
AIM STATEMENT
KEY STAKEHOLDERS
PROBLEM CHARACTERIZATION
INTERVENTION
IMPLEMENTATION
EVALUATION
CONCLUSION
FAMILY OF MEASURES
PROBLEM DEFINITION
Cycle (time) Prediction/Plan Do Study Act
1
(10 weeks)
2
(4 weeks)
3
(4 weeks)
4
(4 weeks)
The standardization of social
resources in one easily
accessible prescription form will
improve social prescription in
lonely patients.
The single-item screening
will reduce time and
increase screening and
prescribing rate.
Engaging another
stakeholder will increase
screening and absolute
prescribing rates
Integrate a
standardized
social prescription
in the CGA.
Reduce screening
to 1 question: "Are
you lonely?"
A physical reminder to
screen posted in the
clinic area with printed
prescriptions available
Administrative
agents screen for
loneliness prior to
patients'
appointments
Screening: 46/78
Lonely: 17/46
Offered: 15/17
Accepted: 14/17
Inappropriate: 2/17
Screening: 23/33
Lonely: 5/23
Offered: 5/5
Accepted: 4/5
Inappropriate: 0/5
Screening: 34/53
Lonely: 11/34
Offered: 8/11
Accepted: 3/11
Inappropriate: 3/11
Screening:11/11
Lonely: 1/11
Offered: 1/1
Accepted: 1/1
Inappropriate: 0/1
Insufficient screening
rate. Running out of
time after loneliness
screening.
Loneliness screening
rate difficult to sustain.
Some clinicians continue
to forget to address the
issue.
Many competing medical
issues during the 3rd wave
of the pandemic. Lack of
time during the CGA.
A reminder outside of the
CGA will increase
screening and prescribing
rates
Social interventions are
difficult to track and social
prescription may be
inappropriate due to
patient factors.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
WEEKS
0
2
4
6
8
10
12
14
16
18
22
PERCENT PRESCRIBED
SOCIAL PRESCRIBING FOR LONELINESS
Screening
by
administrative
agent
Reduce
a question
Physical
reminder
Implement
prescription
in CGA Physical
reminder
Reduce
a question
Screening
by
administrative
agent
Implement
prescription
in CGA
- Frailty/comorbidities
- Perceived stigma
- Cognitive impairment
- Linguistic barrier
- Knowledge of services
- Access to local services
- Health literacy
- Vision and hearing impairment
- Prioritization of issues
- Perceived lack of time
- Lack of a standardized rx
- Resources that do not match
patients' needs
- Lack of ownership of
loneliness problem
- Provider forgot to address issue
- Lack of available program
- Lockdown mesures
- Lack of funding
- Reliability
- Referral criteria mistmatch
- Redeployment of personnel
- Inability to integrate
prescription in CGA
- Loneliness not prioritized in CGA
- Availability of the personnel
- EPR challenges
- Printing services for screening
and social prescription
Problem theory
Addressing lonely by
offering a standardized
social prescription to
lonely patients.
Patients Healthcare providers
Healthcare system Organisation
Loneliness is a complex issue to identify and treat and in the context
of the COVID-19 pandemic loneliness in the older adult has become
increasingly relevant.
Loneliness is common, affecting up to 40% of adults > 60-year-old. It
is associated with increased psychiatric illnesses, frailty, decreased
cognitive function, functional status, and increased mortality risk by
45% (1).
Miles et al., (2020) succeeded to increase the loneliness screening
rate to 84.6%, unfortunately, this was not sustained.
Gap analysis revealed that only 50% of patients identified as lonely
received a social intervention.
A social prescription has been demonstrated to be efficacious to
reduce loneliness in other health care settings (2).
Given the impact of the pandemic in older adults, there is a need to
optimize the identification of lonely older adults and implement an
intervention compatible with the context of the COVID-19
pandemic.
Loneliness was a prevalent problem during the COVID-19 pandemic.
Creating a standardized social prescription the rate of acceptance of a
social intervention to address loneliness
Unfortunately, given the redistribution of resources during the pandemic, our
level of intervention was not maintained.
Engaging another stakeholder (e.g. administrative agent) improves the rate of
screening and it may be more sustainable.
Addressing loneliness in the older adult
Yu Qing Huang, Carla O. Rosario, Janice CL Lee, Dena Sommer, Alex Day, and Dmitriy Petrov, Mireille Norris, Dov Gandell
Our objective was to give a standardized social prescription to
more than 70% of patients screening positive for loneliness by
May 1st 2021.
We created and offered a standardized social
prescription with local and predetermined
resources following public health guidelines.
The programs included had a variety of phone
and virtual interventions.
Figure 1: Ishikawa diagram showing contributors to the difficulties to implement an intervention to
address loneliness
Perissinotto CM, Stijacic Cenzer I, Covinsky KE. Loneliness in Older Persons: A Predictor of Functional Decline and Death. Arch Intern Med. 2012;172(14):1078–1084. doi:10.1001/archinternmed.2012.1993
Jopling K. Promising approaches to reducing loneliness and isolation in later life. London, UK,: The Campaign to End Loneliness and Age UK; 2015. Available from: https://www.campaigntoendloneliness.org/wp-content/uploads/Promising-
approaches-to-reducing-loneliness-and-isolation-in-later-life.pdf
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies. Research on aging, 26(6), 655–672.
https://doi.org/10.1177/0164027504268574
Noone C, McSharry J, Smalle M, Burns A, Dwan K, Devane D, Morrissey EC. Video calls for reducing social isolation and loneliness in older people: a rapid review. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD013632.
DOI: 10.1002/14651858.CD013632. Accessed 15 May 2021.
References:
1.
2.
3.
4.
Outcome Measures
Process Measures
Balancing Measures
Proportion of patients screened for loneliness
Proportion of patients to whom the standardized
social prescription was offered
Proportion of patients who accepted the social
prescription
Additional time MD took to screen and prescribe.
Audit of charts for common elements to ensure
the main elements of the CGA were present.
Time administrative support spent screening
Patients’ (& their caregivers’) receptiveness to addressing loneliness and social
programs
Physicians giving out the prescription
Clinic administrators who may be required to help deliver the social prescription
(printing, email, mail) and file additional papers in charts
Departmental/hospital leadership to value screening & addressing loneliness as
part of the CGA
March April
December
2020
February May
March April
December
2020
February May
Figure 2: Run charts for screening rate and social prescribing rates over time.
Table 1: PDSA cyles
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