Social prescribing - Addressing loneliness and isolation in older Australians

By Rajna Ogrin, Project Lead, Senior Research Fellow, Bolton Clarke, Kerry Rendell, Project Manager, National Account Manager, Bolton Clarke, and Ann Van Leerdam, Community Connector, Connect Local, Bolton Clarke 

Source: APNA Primary Times Winter 2023 (Volume 23 Issue 1)

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Loneliness and social isolation can have negative impacts on an individual’s physical and mental health, including higher risk of chronic illness. Many Australians suffer from chronic loneliness and ‘social prescribing’ is an intervention designed to strengthen community connections for people at risk. Connect Local is a new Melbourne-based program that involves social prescribing to reduce the loneliness and isolation of older Australians and to improve their health and wellbeing.  

Many Australians experience loneliness and social isolation.¹ Loneliness is a negative subjective feeling of a perceived lack or loss of companionship and social connection, and it arises when an individual perceives that the social relationships that they have are less than what they desire.² 

Loneliness is not the same as social isolation, a term that is often used in place of or alongside ‘loneliness’. Social isolation is an objective measure around the number of social connections individuals have with others and how frequent their contact is.³ Essentially, social isolation is about the quantity of social connections within a person's social network, while loneliness is about the quality of a person's social connections. Individuals can be socially isolated, but not feel lonely, or conversely, they may have many social connections, yet feel lonely.⁴ 

There has been more focus on loneliness by governments and health care providers in recent times, after research identified that experiencing long-term loneliness and/or social isolation are risk factors for mortality^.5 Additional research has shown the negative impacts of loneliness on a person’s mental, physical and social wellbeing, which can lead to increased risks of developing clinical depression and anxiety.⁶ This has led to a concerted effort to determine how many Australians are experiencing loneliness, and to work towards interventions to address this issue, including the development of the organisation Ending Loneliness Together.⁷ 

 

How many Australians experience loneliness? 

Australian population estimates of loneliness, based on online surveys conducted in 2018 and 2019, indicate that at least one in 4 Australians aged 12 to 89 experience problematic levels of loneliness.⁸ This equates to around 5 million Australians at any given time. 

Data collected between March and April in 2020 indicates that one in 2 Australians reported feeling lonelier since the onset of the COVID-19 pandemic.⁹ However, the impact of loneliness during COVID was not equal among survey respondents, with those who were the least lonely going into the pandemic returning to pre-COVID levels, while the loneliest became even lonelier. People on low incomes, those who lacked strong ties before COVID-19, and people with disabilities and their carers experienced residual loneliness. Of those who felt lonely ‘at least some of the time’, about 48% felt lonely in lockdown, while 41% felt lonely after lockdown.¹⁰ Given that loneliness increases the likelihood of poor health outcomes, these inequities are of concern and highlight that measures to address loneliness are needed to target those most in need. 

Figure 1. Example of a social prescribing patient pathway built on the ‘holistic’ model outlined by Husk and colleagues,20 adapted from World Health Organization, A Toolkit on How to Implement Social Prescribing.21 

 

The impacts of loneliness on health 

As mentioned above, prolonged periods of social isolation and loneliness can negatively impact a person’s mental, physical and social wellbeing. It can lead to increased risks of developing clinical depression and anxiety,6 and is associated with developing dementia,¹¹ cardiovascular disease¹² and early mortality.¹³ This has been compounded during recurrent COVID-19 lockdowns. The cumulative impact on a person’s mental health and social wellbeing increases the susceptibility to depression and anxiety.¹⁴  

What can prevent or reduce loneliness? 

Robust scientific evidence indicates that meaningful social networks and the ability to sustain positive social relationships are protective factors against loneliness and social isolation,¹ with a positive impact on health and longevity.¹⁵ 

Ideally, delivery of holistic care would consider an individual’s physical, psychological and social wellbeing, and enable continuity of care with early medical and psychosocial intervention should an issue develop.¹⁶ Unfortunately, holistic care is lacking and current models of care involve siloed services, with a predominant focus on medical aspects.¹⁷ Underlying social issues are often neglected, despite the negative impacts of social isolation and loneliness.⁶ This has led to a worldwide push for initiatives that work towards building in social initiatives within health care, and social prescribing is a good example of this. 

 

Social prescribing 

Social prescribing is defined as: 

a means for trusted individuals in clinical and community settings to identify that a person has non-medical, health-related social needs and to subsequently connect them to non-clinical supports and services within the community by co-producing a social prescription – a non-medical prescription, to improve health and wellbeing and to strengthen community connections.¹⁸ 

 

In essence, social prescribing is a pathway of relationships to link people to a set of activities for their health and wellbeing.¹⁹ When health care providers, family members or other trusted community members identify an individual as having a non-medical, health-related social need (e.g., issues with housing, food, employment, income or social support), they can co-produce a non-medical prescription with that individual for a social activity or program. This ‘prescription’ could be conveyed verbally or written down; it’s a way of formally advising them to engage in a social activity or program. Another option is to refer the individual to a ‘Community Connector’ (preferably a paid role), who is trained to draw out from individuals what matters to them, has a strong working knowledge of local services, and can support individuals to access local activities or programs. The Community Connector will then co-produce a non-medical prescription with the individual and connect them to the selected non-clinical supports and services within the community. Figure 1 provides an example of a social prescribing patient pathway. 

The UK has been delivering social prescribing for decades, with the development of a National Academy of Social Prescribing (NASP) and the Global Alliance of Social Prescribing. The NASP has been gathering evidence on the positive impact of social prescribing on holistic wellbeing, as shown in Box 1. 

There is more work needed, with researchers in social prescribing raising the need for more robust evaluations, and recommendations of future research to include evaluations on medium and long-term impact, intervention outcomes, implementation outcomes and cost-effectiveness.^19,23 

 

Box 1. 

The positive impacts of social prescribing can include:  

• reduced pressure on primary care, community nursing and community mental health services ²² 
• reduced health-care costs ²² 
• a favourable social return on investment (SROI) in most cases (SROI is an economic evaluation that uses a systematic way of incorporating social, environmental, economic and other values into decision-making processes) ²² 
• positive immediate impact on a wide range of outcomes, including decreases in participants’ loneliness, and improvements in their mental health, social connections, self-efficacy and overall wellbeing. ^23,24 

Figure 2. Connect Local – engagement process to find out what matters to eligible community members and to engage them in local social activities/programs with support from a paid Community Connector role.  

 

Connect Local: Evidence-based program involving social prescribing 

In 2021, The Ian Potter Foundation awarded a 4-year grant for the Connecting Communities to Care collaboration, led by Bolton Clarke and including Alfred Health, South Eastern Melbourne Primary Health Network and the Australian Disease Management Association. The program is based on a successful UK model involving social prescribing, Health Connections Mendip,²⁵ which showed a reduction in health service use, including reduction in unplanned hospital admissions and reduced length of stay in program participants.²⁶ 

Connect Local is an early intervention model that aims to support community members aged 65 years and older in the Glen Eira region of metropolitan Melbourne. The program involves participants who have one or more chronic conditions and who may be at risk of experiencing loneliness, social isolation and/or depressive symptoms. It will use social prescribing to help them access local community support services that improve their social connection, reduce their feelings of loneliness and depressive symptoms and improve their physical and mental wellbeing, while reducing avoidable use of health services (see Figure 2). 

To ensure the program is fit for purpose in the Australian context, it is based on existing evidence and involves co-designing a community-wide approach. This is underpinned by a commitment to the national Ending Loneliness Together initiative, which was established to combat chronic loneliness in Australia. It aims to bridge the health and social care silos by considering holistic needs and tailored solutions for the target cohort.  

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Call to action: We are asking all primary health care practices in the Glen Eira local government area to reach out to any patients they see that may benefit from social connection.  

 

What is Connect Local? 

• It is a program to address the gap between health and social systems, providing practical supports and linkages to local community services and activities, helping you help your clients. 
• It involves trained Community Connectors, who will spend time with your clients to identify meaningful goals and a personalised plan to address their non-medical needs to improve their overall wellbeing. The Community Connector will follow up with the client to make sure that the supports/activities are making a positive difference and keep you informed of progress. 

The program is free; however, there may be costs for some community activities. 

 

Who is Connect Local for? 

Anyone 65 years or older living in Glen Eira who: 

• has a chronic health condition 
• wants to improve their social connections and wellbeing 
• is experiencing or is at risk of loneliness, social isolation and/or depressive symptoms. 

It is not suitable for those who: 

• live in residential aged care 
• need more intensive mental health treatment or have complex issues that require care coordination, unless they are already receiving support for their complex needs. 

 

How can Connect Local help? 

It can assist your clients connect with local services and activities that help them do what matters to them. This could be:  

• social activities, such as book clubs, art classes, gardening clubs, special interest and multicultural groups  
• healthy lifestyle programs, such as exercise and walking groups, sport clubs and adult learning classes  
• volunteering opportunities  
• support services, such as legal or financial advice, Meals on Wheels, grief counselling, or access to government services.  

 

How can I refer? 

Simply fill out the referral form from www.connectlocal.org.au 

FREE CALL 1800 929 022  

Fax: 03 8414 2855  

enquiries@connectlocal.org.au  

 

Connect Local has been funded by the Ian Potter Foundation until mid-2025, and an evaluation is running alongside the program to assess whether it reduces loneliness, social isolation and/or depressive symptoms, improves wellbeing and is cost-effective. If successful, these findings can be used to advocate for similar programs to be implemented nation-wide. 

 

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Interview with Connect Local participant, ‘Sam’ 

How did you find out about the program? 

I was depressed because my wife died a few months ago. As my wife’s carer for many years, I felt as though I had lost my purpose in life and did not care if I was still alive. I spoke about this to my GP and others, but nobody understood my feelings and sense of loneliness, they just told me to move on. I knew there were many programs and services in Glen Eira, but I could not find any on my own. The council website has lots of information, but it is hard for me to figure out. I’m not in the habit of talking to many people and it is hard for me to step outside my house and just strike up conversations. So, when I saw the information about the Connecting Communities program, I thought I would give it a go and filled in the Connect Local online form. 

What did you think about being involved in Connect Local? 

It surprised me that the program responded to me so quickly, and it has changed me a lot. Normally, I don’t talk to people, and this program is really changing my personality. I am much happier, and my time is fully occupied during the week by engaging in the local community house. I started to share my happiness and stories with my family and friends in the local communities. My family members all tell me that I look much better and happier than before. 

How does your involvement in the program make you feel? 

I feel as though I am happy again with a sense of purpose. I feel connected and look forward to activities at Caulfield South Community House. I also feel that my sleeping has improved. I don’t feel depressed in the morning when I wake up. Previously, I was in a low mood with no motivation to get up and also experienced chronic pain. Now that I need to get up and get ready to go to Caulfield South Community House, I don’t feel pain anymore and I sleep better. I also have energy and enjoy talking and playing. I feel my mobility is improving. Everyone at Caulfield South Community House enjoys themselves and doesn’t take the games too seriously. I feel as though I have found my home. 

  

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References 

 

1. Ending Loneliness Together, Ending Loneliness Together in Australia, Ending Loneliness Together, Sydney, 2020. 

2. L Peplau and D Perlman, 'Perspectives on Loneliness', in Loneliness: A sourcebook of current theory, research and therapy, L. Peplau and D. Perlman (eds), Wiley, New York, 1982. 

3. J de Jong Gierveld and B Havens, 'Cross-national comparisons of social isolation and loneliness: introduction and overview', Can J Aging, 2004, 23(2):109–113. 

4. JC Badcock, J Holt-Lunstad, E Garcia, P Bombaci and MH Lim, Position statement: addressing social isolation and loneliness and the power of human connection, Global Initiative on Loneliness and Connection website, 2022, accessed 28 March 2023. www.gilc.global 

5. J Holt-Lunstad, TB Smith, M Baker et al., 'Loneliness and social isolation as risk factors for mortality: a meta-analytic review', Perspect Psychol Sci, 2015, 10(2):227–237. 

6. J Holt-Lunstad, TF Robles and DA Sbarra, 'Advancing social connection as a public health priority in the United States', Am Psychol, 2017, 72(6):517–530. 

7. Ending Loneliness Together, https://endingloneliness.com.au/, 2023, accessed 28 March 2023. 

8. MH Lim, Australian loneliness report: a survey exploring the loneliness levels of Australians and the impact on their health and wellbeing, Australian Psychological Society, Melbourne, 2018. 

9. M Lim, G Lambert, L Thurston et al., Survey of health and wellbeing: monitoring the impact of COVID-19, Swinburne University, Melbourne, 2020. 

10. R Patulny and M Bower, 'Beware the "loneliness gap"? Examining emerging inequalities and long-term risks of loneliness and isolation emerging from COVID-19', Aust J Soc Issues, 2022, 57(3):562–583. 

11. Holt-Lunstad, J., et al., Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science, 2015. 10(2): p. 227-237. 

12. Holt-Lunstad, J., T.F. Robles, and D.A. Sbarra, Advancing social connection as a public health priority in the United States. American Psychologist, 2017. 72(6): p. 517-530. 

13. Ending Loneliness Together. Ending Loneliness Together. 2023  [cited 2023 28th March]; Available from: https://endingloneliness.com.au/. 

14. Lim, M.H., Australian Psychological Society. Australian loneliness report: a survey exploring the loneliness levels of Australians and the impact on their health and wellbeing 2018, Australian Psychological Society, Swinburne University of Technology: Melbourne, Australia. 

15. Lim, M., et al., Survey of health and wellbeing – monitoring the impact of COVID-19. 2020, Swinburne University: Melbourne. 

16. Patulny, R. and M. Bower, Beware the "loneliness gap"? Examining emerging inequalities and long-term risks of loneliness and isolation emerging from COVID-19. Aust J Soc Issues, 2022. 57(3): p. 562-583. 

17. Wang, S., et al., Association between social integration and risk of dementia: A systematic review and meta-analysis of longitudinal studies. Journal of the American Geriatrics Society, 2023. 71(2): p. 632-645. 

18. Hakulinen, C., et al., Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women. Heart, 2018. 104(18): p. 1536. 

19. Long, R.M., et al., Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease: A Systematic Review, Meta-Analysis, and Meta-Regression. Psychosom Med, 2023. 85(1): p. 8-17. 

20. Lim, M.H., et al., Loneliness over time: The crucial role of social anxiety. J Abnorm Psychol, 2016. 125(5): p. 620-30. 

21. Holt-Lunstad, J., Loneliness and Social Isolation as Risk Factors: The Power of Social Connection in Prevention. Am J Lifestyle Med, 2021. 15(5): p. 567-573. 

22. Mann, J., et al., OPEN ARCH: integrated care at the primary–secondary interface for the community-dwelling older person with complex needs. Australian Journal of Primary Health, 2020. 26(2): p. 104-108. 

23. Department of Health, National Preventive Health Strategy 2021-2030, D.o. Health, Editor. 2021, Commonwealth of Australia: Canberra. 

24. Muhl, C., et al., Establishing Internationally Accepted Conceptual and Operational Definitions of Social Prescribing Through Expert Consensus: A Delphi Study. medRxiv, 2022: p. 2022.11.14.22282098. 

25. Calderón-Larrañaga, S., et al., What does the literature mean by social prescribing? A critical review using discourse analysis. Sociology of Health & Illness, 2022. 44(4-5): p. 848-868. 

26. Husk, K., et al., What approaches to social prescribing work, for whom, and in what circumstances? A realist review. Health & Social Care in the Community, 2020. 28(2): p. 309-324. 

27. World Health Organisation, A Toolkit on How to Implement Social Prescribing. 2022, WHO Regional Office for the Western Pacific: Manila. 

28. Health Connections Mendip, Health Connections Mendip. 2019. 

29. Abel, J., et al., Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities. British Journal of General Practice, 2018. 68(676): p. e803-e810.