Loneliness and Social Isolation in our Health Care Systems

Transcription

1 Loneliness and Social Isolation in our Health Care Systems Carla Perissinotto, MD MHS Associate Professor of Medicine Assiciate Chief, Clinical Programs Division of Geriatrics University of California, San Francisco Division of Geriatrics

2 What we ll discuss: (1) The health system perspective: The case for early identification loneliness and social isolation across populations. What should we be measuring? (2) Getting health system leadership buy-in: How to integrate into electronic health records and capture the adverse impact of these factors (3) Impacting the bottom line: Capturing the value of investing in prevention strategies/interventions

3 2 Cases

4 Man, 102, dies of failure to thrive California, 2012 Dies in hospital because he did not have enough help at home He was homebound Had family out of state He had a visiting doctor, caring neighbors and maximum IHSS hours

5 82 yo woman with live-in help California, 2014 Relatively healthy, except for arthritis 4 children in area Several grandchildren Live-in 24 hour help Frequent social engagements

6 Lonely or Isolated?

7 Loneliness and Isolation Defined Loneliness is the subjective feeling of being alone. It causes distress Social Isolation relates to a quantifiable number of relationships -Cacioppo. U. Chicago

8 Myths about Loneliness It is a normal part of aging It is synonymous with depression It cannot occur if you live with others and have friends It does not exist in married couples It will go away if you join a social group

9 The Health System Perspective If you are a health care provider, or a health system administrator, or a public health advocate Who do you worry about? How can you determine if there is social isolation and loneliness? How does this affect the person, and your bottom line?

10 Loneliness is a Warning Sign People must belong to a tribe. They yearn to have a purpose larger than themselves ~EO Wilson Isolation [and loneliness] deprive us of both our feeling of tribal connection and our sense of purpose. On both counts, the results can be devastating for individuals and societies. (Cacioppo 2008)

11 What We Know and Don t Know There are many ways to measure social isolation and loneliness The most commonly accepted measure of loneliness is UCLA 3-item loneliness questionnaire Loneliness and isolation are not routinely or systematically asked about in health care encounters There is no national guideline But there will be

12 The Facts: What We KNOW Holt-Lundstad, APA 2017

13 Health Outcomes Outcomes: Death 45% increased risk Decline in Function 59% increased risk Increased risk of: Dementia, Diabetes, Cardiovascular disease Longer hospitalizations Perissinotto C. JAMA (Archives) Internal Medicine 2012

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15 Screening and Integration into Health Systems

16 Spectrum of Risk:

17 Population Level Primary Prevention: Identify patients at risk for loneliness and Isolation Women, lower SES, older, LGBT Requires screening Secondary Prevention: decrease the consequences for those who are lonely and or isolated Requires screening Knowing which interventions work

18 Loneliness Screening 3-item Loneliness Scale: Question Hardly Ever Some of the Time Often 1. I feel left out I feel isolated I lack companionship Max score 9: higher score=more lonely

19 Social Isolation Screening There are many tools but no gold standard Lubben Social Network Index Duke Social Isolation Scale Berkman-Syme Social Network Index

20 In practice. 1. Ask (Screen) 2. Document

21 Social Prescriptions 1. FOCUS on CONNECTION 2. AND talk about other health risks 3. Advanced care planning

22 Financial Implications

23 Current Topics in Health Care The triple aim Lower Cost Population Health Higher Quality

24 Achieving the Triple Aim Alternative Payment Models This is an opportunity to focus on what really matters to people in health and focus on the social determinants of health

25 Financial Implications Social isolation increases Medicare costs by at least $6.7 billion every year. AARP Public Policy Institute 2018

26 Costs to Medicare AARP Public Policy Institute 2018

27 Summary

28 Hope and the Future DISRUPT AGING 2014 Institute of Medicine recommended screening and follow-up for loneliness and isolation and made recommendation to include in EHR AARP committed to addressing loneliness and isolation National Academies of Sciences convening to make evidence based recommendations on prevention, risks and interventions Health Plans and Organizations delving into loneliness and isolation Caremore United Health Plan Wider Circle Why? Getting older can be costly Focusing on connections increase member satisfaction Opportunities for return on investment Isolation and loneliness matter

29 3 Cases Revisited 102 yo with failure to thrive: Not Lonely but is isolated Did his isolation lead to premature death and longer hospitalization? 82 yo with care Lonely, but not isolated Did her loneliness lead to more functional decline and premature death?

30 In Summary: We can make a personal and financial impact by integrating assessments into medical care We will develop a consensus on how to measure and how to document in EHRs We will have federal, state and local policies that place loneliness and isolation at the forefront of public heath We will evaluate interventions so that health care providers and give evidence-based guidelines on prevention and treatment There are ways to help adults feel more connected