Older adults are more likely to suffer from social isolation; loneliness is increasingly being recognized as being bad for our health. The good news is that mattering and belonging can flip the script. Our series explores these and other related concepts.

When Pat Flude was experiencing painful side effects during her breast cancer treatment, a doctor from the pain clinic at Toronto’s Princess Margaret Hospital (PMH) gave her a “social prescription” for a mindfulness-based cognitive behavioural therapy class.

“I went every week for about three months,” says Flude, a 78-year-old retired teacher and cancer survivor. “The psychiatrist who led the program, Dr. Mary Elliott, was marvelous. It was so excellent; I even did a follow-up class in loving kindness.”

Since everyone in the class was also being treated for cancer, there was a real sense of community. Flude says she looked forward to the reunions that took place at quarterly graduate sessions. “For me, at that time,” she recalls, “it was really life’s blood.”

Although not every hospital is as proactive as PMH at offering prescriptions for things other than drugs, the “social prescribing” movement is growing by leaps and bounds. The guiding principle is to address the social determinants of health – non-medical factors that influence health outcomes – that are often neglected in medical settings. To fill that gap, primary health care providers refer a patient to a senior resource coordinator who steps in to “prescribe” wellness opportunities (specifically chosen classes or outings based on interest) often for older adults who have higher rates of being at-risk for loneliness and/or social isolation.

From isolation to inclusion

“The big one is social connection,” says Connie Newman, executive director of the Manitoba Association of Senior Communities. “We’ve got some older adults who haven’t been out of their apartments for too long. With a social prescription, we can connect them to one of Manitoba’s many older adult groups.

“Some might be at the local legion; in other communities, it could be the local senor centre,” Newman explains. “Wherever it is, the clients sometimes need a little support to join.”

Although research associating social isolation and loneliness with negative health outcomes began, in earnest, a little more than 40 years ago, programs to prevent or reverse these conditions and foster a feeling of belonging are relatively new. Spurred in part by the pandemic, which raised awareness of negative mental health effects associated with isolation, “social health” (well-being as an outgrowth of social connection), has become a hot topic lately. Japan and the United Kingdom both have ministries devoted to addressing loneliness, which some consider an epidemic, especially among older adults.

Here in Canada, the Canadian Coalition for Seniors’ Mental Health has recently launched the world’s first clinical guidelines for addressing social isolation and loneliness. Since older adults experiencing isolation often see health and social service professionals, clinicians are key people for identifying at-risk patients, so it’s very important to get them on board.

“Although there’s been a huge amount of research in the area focused on associated health risks there has been relatively little written from the perspective of how to actually help people,” says Dr. David Conn, a geriatric psychiatrist who works at Baycrest Health Sciences and the University of Toronto.

The guidelines, which are making their way into healthcare and community settings, are designed to help clinicians screen for loneliness and isolation, assess the problem and its causes and make helpful recommendations. In some cases, a social prescription might transform the quality of life of a person experiencing isolation but, for those with chronic loneliness, recovering from those feelings is often much more complicated.

Neuroscientists have even suggested that loneliness can re-shape the brain in ways that make social contact less rewarding, thereby making it harder—but not impossible—to “cure” loneliness. A meta-analysis of research found that a range of therapies including animal therapy, exercise, and cognitive behavioural therapy were associated with reduced feelings of loneliness in older adults.

The power of place in fostering connection

That’s a nugget of good news but, as we should all know at this point, prevention is, by far, the best intervention. Some researchers advocate for social prescriptions for people of all generations, as well as working to remove health equity barriers, so that we have a population that’s in good health as it moves into middle age. As Dr. Conn points out, problems with depression, hearing, vision, mobility, and chronic pain can impact our capacity for socializing and staying active.

Providing an environment for people to stay fit and connected to the community goes far beyond healthcare and even public health, since it involves reimagining a range of public spaces, some of which we take for granted. Over the past 20 or more years, we’ve heard a lot about the “third place”— spaces like barber shops, cafés, and shopping malls that are neither work nor home but can foster community and a sense of belonging. The next frontier may well be “fourth place”— streets, squares, bus stops — which, if well-designed, can help promote social health and cohesion. That can only work if they’re truly accessible, however.

“The design is often good in a privileged neighbourhood,” says Julie Karmann, PhD candidate at the University of Montreal’s School of Public Health. “But if you go into a more deprived neighbourhood, you can see that the street is no longer that accessible and not that pleasant for walking.”

Karmann’s work is based in the idea that the simple act of walking can help social health, of which connectedness is an important component. Even relatively well-designed fourth places, though, often miss the mark when it comes to being truly age-friendly.

“Basic improvements like more accessible and affordable transit, safer intersections, and well-maintained sidewalks are essential,” says Eddy Elmer, a Vancouver gerontologist and research consultant specializing in aging and mental health. “People don’t want to go outside if the streets are dark or feel unsafe, regardless of age, but this is especially true for older adults who worry about slipping, falling, or other hazards.”

Maintenance, regular snow and ice clearing, as well as accommodations for persons with disabilities should seem like a bare minimum, but austerity measures in various municipalities have often led to worsening conditions. While we wait for political change, social health programs such as prescriptions can help, especially the ones that move beyond the individual and involve the community.

More walks, more smiles

“One of my favourite programs is from the Netherlands, which has a whole strategy and campaign against loneliness,” says Conn. “One of the programs is an app that connects older people who don’t have a pet with a younger person who has a dog but doesn’t have enough time to walk the dog because they’re out working all day long. It has many benefits for all involved including the dogs!”

Burnaby B.C.’s “Say Hello” campaign is arguably even more effortless. Initiated in 2020 by local physicians worried about pandemic-induced social isolation and loneliness, the project encouraged folks to be a little friendlier to the people they passed on the street.

“It’s super simple, but yet requires a whole paradigm shift, because it has nothing to do with a physician or a clinic,” says Karmann. “Just implementing the norms of greeting in the neighbourhood or smiling to the person you meet in the street can make a huge difference with your sense of belonging.”

Karmann says it’s a tiny gesture that can have a big impact on the population, not just the individual.

“It’s just knowing the people around you,” she adds. “It can be as easy as asking, ‘How are you doing?’.