From diagnosing loneliness to prescribing social connection

content from: healthy aging report

Published October 1, 2024

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“Loneliness seems to be such a painful, frightening experience that people will do practically anything to avoid it,” wrote Frieda Fromm-Reichmann, a German American psychiatrist, in 1959. Yet despite being recognized as a deeply undesirable state of being, she also noticed “a strange reluctance to seek scientific clarification on the subject,” leading to loneliness not being mentioned in “most psychiatric textbooks.”

Inspired by this quote, Dr. David Conn searched the more than 1,000 pages of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the standard classification of mental disorders that is used by professionals, for a mention of loneliness.

“Loneliness is mentioned only once – under the topic of prolonged grief,” says Dr. Conn, a geriatric psychiatrist at Baycrest Centre and professor at the University of Toronto who led the development of Clinical Guidelines on Social Isolation and Loneliness in Older Adults on behalf of the Canadian Coalition for Seniors’ Mental Health (CCSMH), a non-profit organization with the mission to promote the mental health of seniors by connecting people, ideas and resources.

“Intense loneliness is an extremely difficult feeling to deal with, and we’ve long known about the impacts of social isolation on our physical and mental health,” says Dr. Conn, who explains that in older adults, loneliness and social isolation have been associated with higher rates of depression, anxiety and suicidal thoughts. Other consequences include higher risk for stroke, heart disease, cancer death and functional decline.

With an increased risk of death of 45 per cent in adults over 50, prolonged loneliness and social isolation have been compared to smoking 15 cigarettes a day. While these insights have inspired a number of initiatives in different countries, Dr. Conn believes the CCSMH’s clinical guidelines are the first in the world.

“We were surprised we couldn’t find any clinical guidelines anywhere,” he says. “Since loneliness is often considered a social problem rather than a health problem, there hasn’t been the kind of medical diagnosis we have for diseases like diabetes or depression, for example.”

The absence of a diagnosis also meant tools to assess and treat social isolation and loneliness were lacking. The CCSMH guidelines strive to fill this gap by encouraging health practitioners and social service providers to integrate questions about loneliness and social isolation into their practices, Dr. Conn explains. “The critical thing is to understand the person and their needs through a comprehensive assessment – and then figure out the different interventions that can work optimally.”

While some seniors may benefit from being referred to the nearest community agency or community centre, others may have health issues contributing to social isolation, such as poor hearing, he says. “A lot of older adults don’t hear well, with a big percentage not wanting to wear a hearing aid. For some people, that’s the missing link. As soon as they use their hearing aids, they can engage more fully with family and friends.”

In other cases, non-pharmacological or pharmacological therapies can offer relief, for example, when people withdraw due to clinical depression or social anxiety disorder, Dr. Conn notes.

Another potential intervention is “social prescribing, which focuses on recommending particular activities to foster social connections,” he says. “This can include referrals to a group of workers with specialized resources, called link workers or system navigators, who can help a person make warm connections and figure out what is available in the community.”

Such efforts are at the core of a new national hub, the Canadian Institute for Social Prescribing, which aims to link people and share practices that connect people to community-based supports and services.

Examples from across the globe can also help to inspire action, says Dr. Conn, who references a campaign against loneliness in the Netherlands. It includes a range of innovative measures, such as special supermarket checkout lanes for customers who would like to talk with the cashier, public servants on the lookout for signs of social isolation, and Oopoeh, a program linking dog owners who may be busy during the day to retired people who enjoy dog walking but don’t have the energy or resources to own a pet.

Oopoeh “connects these groups, and it’s a triple win: for the owner of the dog, for the older adult who gets to walk the dog, and for the dog,” says Dr. Conn.

He hopes implementing the CCSMH’s clinical guidelines can spark similar ideas as part of a steadfast commitment – from health-care and social-service providers as well as the general public – to counteract loneliness with efforts to build strong and inclusive social connections.