For Lonely Older Adults, a Social Prescription Is a Wonder Drug

For 92 years, Glenn was a socialite. In his local Columbus, Ohio community, he was a diehard Ohio State basketball fan. Later, he became a docent at his local art museum. And as a Korean war veteran, he says his strongest friendships were with his fellow comrades, who he'd keep in touch with over the phone and reconnect with at local Veterans Affairs-organized meet-ups. "I was never lonely when I was in the Army," he says.

But as Glenn got older, his friends and family did, too. When some stopped returning his calls, he learned the hard way that they had passed away. And then, when Glenn lost his ability to drive, he also lost his connection to in-person events as well.

Glenn didn't know what to do until one day, at a regular check-in with his VA social worker, he was prescribed an unconventional medicine: a "social prescription" for a weekly phone conversation with a volunteer, in a program called the Compassionate Contact Corps.

Defined as a nonmedical support or service that aims to improve a person's health and strengthen their connections, social prescriptions cover everything from art classes to cycling groups, and are prescribed just like other kinds of medicine. They draw their name from the way 80% of our health is determined by factors in our environment,  including the strength of our social connections.

But whereas most social prescriptions have promoted in-person social connections, Compassionate Contact Corps is unique in the way that the prescriptions reach people who are home-bound, and may be more vulnerable to loneliness.

Over the past two decades, researchers have demonstrated how health is harmed by loneliness — the gap between a person's desired and actual level of social connection. Julianne Holt-Lunstad, M.D., has led landmark meta-analytic reviews linking loneliness with a wide variety of health consequences, and carries risks comparable with smoking 15 cigarettes per day. 

Another landmark study followed more than 1,600 older people over six years and found that those who reported feeling left out, isolated or lacking in companionship — three benchmarks of loneliness — were more likely to die.

"There are many underlying biological mechanisms that lead to the functional decline and death we see in people who are lonely," says Carla Perissinotto, a professor, researcher and practicing geriatrician at UCSF who led the study. "But particularly with aging patients, who are especially at risk of polypharmacy,  this research helped me realize that not everything requires a pharmacological treatment, and a prescription that listens to the needs of patients and is social in nature may be more effective."

Indu Subramanian, M.D., a neurologist and clinical professor at UCLA, added her own research linking loneliness to worsened Parkinson's symptoms. Inspired by social prescribing models in the United Kingdom, where the practice originated, she began taking social prescriptions into her own hands, and hosting Zoom patient support calls for her older patients.

"Sometimes, we would talk about ordinary things — the weather, or whatever, and other times, we would just kind of check in on each other, like if somebody lost a friend,' says Subramanian, who also directs the VA's Southwest ParkVinson's Disease Research, Education and Clinical Center.

But Subramanian knows that kind of ad-hoc care isn't sustainable or feasible for most U.S doctors, dealing with their own overlapping crises of burnout and ethical frustrations. "Right now, medicine is very reactive; you get a symptom and disease, I write down the billing code, I prescribe you medicine," she says. "There has to be a shift in what defines health."

When Subramanian heard about Compassionate Contact Corps, she contacted the team, excited that a more systemic social prescribing program had finally reached the U.S. But the term was new to Prince Taylor, the V.A director who created the program. He says the apparent "social prescribing" program began by accident, when COVID-19 restrictions forced the VA's home visitation program to pivot to phone calls.

"We saw an immediate impact from participants and clinicians," Taylor says. "The feedback we got from the veterans was, 'I was very lonely, and receiving these phone calls has been tremendously helpful.' "

It was a no-brainer, then, to keep the phone calls going, and to bring on outside volunteers to help. But it was also important to go beyond just a regular check-in call, says Lori Murphy, a licensed clinical social worker at the VA Central Ohio, who helped design the program. "These calls are really meant to dive into each other's lives and connect on shared hobbies and current interests," she explains, as research says common interests are key in creating closeness.

To help, Murphy issues volunteers a survey, and attempts to match them with veterans based on their common interests and experiences. Then, if she senses a client might be experiencing loneliness, she'll "prescribe" them weekly, 60-minute phone calls with one of these volunteers called their "compassionate contacts."

That's how Glenn got paired with Ryan, a middle-aged father who signed up to be a volunteer after his own family network started to shrink, and he realized "he really missed the connection he had in his past," he says.

In their three plus years of calls, Glenn and Ryan have covered lots of ground: sports trends, Trivial Pursuit, their favorite television shows, and, a personal favorite for both, stories of Glenn's time in the service.

But eventually, the two dug into more personal subjects, which led Glenn to share some of his struggles, too. Through those conversations, with Murphy's help, Ryan persuaded Glenn to get more of the health care he needed: support with getting his laundry and medicine, and an in-home psychologist.

Murphy says that's common. "We found that friendships developed in these weekly phone calls, and, like any good friend would do, the volunteers often encourage veterans to seek help when it's needed," she says. "Sometimes getting that advice from a friend leads to a higher likelihood of veterans accepting the help that's available."

Ryan and Glenn's story is no anomaly. An estimated 83% of veterans participating in the program say it has made them feel less lonely, and 77% say it has improved their well-being across the board. It's one case study in a larger body of research that suggests social prescribing not only helps to improve health outcomes,  but also reduces pressures on health care  by lowering emergency room admissions and primary care visits.

Though most research and practice has taken place in the U.K., social prescribing programs serving older adults are growing in the U.S., where a volunteer coalition called Social Prescribing USA aims to make these prescriptions available to every American by 2035. In Ohio, a new agreement between the Cleveland Clinic's Center for Geriatric Medicine and Holden Forests & Gardens allows geriatricians to "prescribe" patients and their caregivers a limited number of passes to the arboretum or botanical gardens.

In New York, a program places "connection specialists" at Jewish Community Centers to link isolated older adults with social activities tailored to their interests. And all around the country, buoyed by ample evidence around arts and health, local programs are spreading, including models in Massachusetts and New Jersey, where an insurer is covering six months' worth of social prescriptions.

Still, despite the local momentum, the U.S. national health care system needs to address its deeper obstacles that stand in the way of social prescribing. Recently, for instance, though a physicians survey found 95% agreed their patients' health outcomes were affected by at least one social determinant of health, 87% wish they had more time and ability to address their patients' social needs. Then, especially for in-person social prescribing programs, there's the added challenge of logistics, like transportation, to make sure these social prescriptions can reach all people. And, of course, without a national health care system, there's the challenge of finding funding for the organizations offering the social prescriptions.

But in the meantime, without national resources, local communities are tapping into the resources they do have, like the will of their own members. "It's probably been more rewarding for me as a volunteer than it is for the veteran," Ryan says. "When I'm ruminating, I call Glenn, and it's like a vacation for my brain."

The feeling is mutual. And at the end of their phone calls, Glenn often reminds Ryan of how much he appreciates him. "He'll always say, 'Thank you for calling me. Thank you for not forgetting about me. Thank you for being interested in what I'm saying.' "

Julia Hotz is a solutions-focused journalist and author of "The Connection Cure," a book exploring the science, stories and spread of social prescribing. Her stories have appeared in The New York Times, WIRED, Scientific American, The Boston Globe, Time, and more. She helps other journalists report on the big new ideas changing the world at the Solutions Journalism Network. Read More