From diagnosing loneliness to prescribing social contact

“Loneliness seems to be such a painful and frightening experience that people would do virtually anything to avoid it,” wrote Frieda Fromm-Reichmann, a German-American psychiatrist, in 1959. But although it was recognized as a deeply undesirable condition, She also noted “a strange reluctance to seek scientific clarification on the subject,” which resulted in loneliness not being mentioned in “most psychiatric textbooks.”

Inspired by this quote, Dr. David Conn searches 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 used by professionals, for a mention of loneliness.

“Loneliness is mentioned only once – under the theme of persistent grief,” says Dr. Conn, a geriatric psychiatrist at the Baycrest Center 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 Aim to promote the mental health of older people by connecting people, ideas and resources.

“Severe loneliness is an extremely difficult feeling, and we have long known the impact social isolation has on our physical and mental health,” says Dr. Conn, who explains that loneliness and social isolation in older adults is associated with higher rates of depression, anxiety and suicidal ideation. Other consequences include a higher risk of strokes, heart disease, cancer death and loss of function.

Prolonged loneliness and social isolation were compared to smoking 15 cigarettes a day, with a 45 percent increased risk of death in adults over 50. Although these findings have inspired a number of initiatives in various countries, Dr. Conn believes that the CCSMH clinical guidelines are the first in the world.

“We were surprised that we couldn’t find clinical guidelines anywhere,” he says. “Because loneliness is often viewed as a social problem rather than a health problem, there is currently no medical diagnosis like there is for diseases such as diabetes or depression.”

The lack of a diagnosis also meant a lack of tools to assess and treat social isolation and loneliness. The CCSMH guidelines attempt to close this gap by encouraging physicians and social service providers to integrate questions about loneliness and social isolation into their practices, explains Dr. Conn. “The key is to understand the person and their needs through a comprehensive assessment – ​​and then identify the different interventions that can work optimally.”

While some seniors may benefit from being referred to the nearest community agency or community center, others may have health problems that contribute to social isolation, such as poor hearing, he says. “Many older adults do not hear well and a large percentage do not want to wear hearing aids. For some people, this is the missing link. Once they wear their hearing aids, they will be able to interact better with family and friends.”

In other cases, non-pharmacological or pharmacological therapies can provide relief, such as when people become withdrawn due to clinical depression or social anxiety disorder, notes Dr. Conn firmly.

Another possible intervention is “social prescribing, which focuses on recommending specific activities to promote social connections,” he says. “This may include referral to a group of staff with specialized resources, called link workers or system navigators, who can help a person make good connections and find out what is available in the community.”

Such efforts are the focus of a new national center, the Canadian Institute for Social Prescribing, whose goal is to connect people and share practices that connect people to community-based supports and services.

Examples from around the world can also inspire action, says Dr. Conn, who refers to a campaign against loneliness in the Netherlands. It includes a range of innovative measures, such as dedicated supermarket checkouts for customers who would like to speak to the cashier, officers looking out for signs of social isolation, and Oopoeh, a program to connect dog owners who may be busy during the day Retirees 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 that implementing the CCSMH's clinical guidelines as part of an unwavering commitment – from health and social care providers and the general public – can inspire similar ideas to address loneliness by building strong and inclusive social connections.

For more information, see ccsmh.ca.

Promotional piece produced by Randall Anthony Communications. The Globe editorial team was not involved.