“The consequences of loneliness are enormous,” says NEJM Catalyst Leadership Board Founder Tom Lee. What should clinicians do for patients for whom social isolation and loneliness is the biggest social need?
When people feel down and don’t have anything to do — especially as they age and have to give up certain activities — clinicians might not know how to help them, says Consuelo Wilkins, a geriatrician and Executive Director of the Meharry-Vanderbilt Alliance. But most communities have organizations that provide social activities, ways to meet and connect with new people and to learn. “This is a clear first thing to do in my mind, is not to prescribe something but to find some resources in the community for people to get connected,” says Wilkins. “They are plenty of those out there.”
“Can you give me an example?” asks Lee. “Frankly, I would be sitting there in my office and I wouldn’t know of where to send them.”
“That’s the problem,” says Wilkins. “We’re so disconnected from all the other resources that you need in the community. You may not even know where to send people to get food. Do you know how to find the nearest food bank? Do you know how to get people access to affordable housing? What if they need job training? We don’t know any of those things.”
Some communities have built links between health and social organizations to better connect them. But if clinicians aren’t sure where to point their patients, Wilkins encourages them to look to the community health centers. “[They] probably know how to get people to these places. They’re very well connected in the community and have branches and know how to access folks.”
Russell Rothman, an internal medicine, pediatrics, and health policy professor and Vice President for Population Health Research at Vanderbilt University Medical Center, adds that “we often don’t even ask these questions as health systems of clinicians because we’re afraid to open this Pandora’s Box — because we’re not sure what to do about it.” Emphasizing the need for improved communication approaches in health care, he says, “We really need to ask these questions, and we also need to think about how we ask them, because there can be trust issues, and people can be embarrassed, and people don’t always share how they feel.”
The other part is having processes in place as health systems and health teams to address issues like loneliness, and Rothman reiterates Wilkins’ point: “This is where partnering with our communities can be so valuable; they often are the ones that do know of the community resources locally on the ground that can help people.”
From the NEJM Catalyst event Expanding the Bounds of Care Delivery: Integrating Mental, Social, and Physical Health, held at Vanderbilt University Medical Center, January 25, 2018.