Could We See More Patients Receive 'Social Prescriptions?'
Studies show social activities can complement other treatments to improve health
The practice of prescribing social activities as an alternative or complement to medication for a variety of ailments has become more common in countries such as Canada and the U.K., and it appears some people are finding it beneficial in the United States as well.
In 2017, a U.K. study published in the medical research journal BMJ Open found that these “social prescriptions” improved the health and well-being of people with long-term conditions, including cardiovascular disease, diabetes, depression and anxiety. Rather than prescribing medication to patients with these diseases, each patient in the study received personalized recommendations for community-based activities to either replace or complement pharmaceutical prescriptions.
In Canada, The Toronto Star reported in December 2018 that doctors are giving social prescriptions to combat anxiety and loneliness. Depending on what patients like to do, these prescriptions can be for activities like tai chi, fishing lessons, choir classes or group visits to cultural sites.
While not as widespread in the U.S., social prescriptions are being used by health practitioners to varying degrees with promising benefits.
Dr. Ayesha Sherzai, a stroke specialist, and Dr. Dean Sherzai, a behavioral neurologist, are proponents of this shift in treatment. The two are co-directors of the Alzheimer’s Prevention Program, a one-of-a-kind brain health initiative being conducted at the community level at Loma Linda University and the Beach Cities Health District in California. They also work one day a week at The Community Clinic, a free service that focuses on social prescriptions to help improve patients’ health through lifestyle changes.
A Complement to Medications
Dean Sherzai, who treats patients with dementia, diabetes, stroke, high blood pressure and high cholesterol, believes that medication is not an ideal long-term treatment option. “We need to treat the underlying cause and lifestyle is a dominant issue,” he says.
Using SMART goals (specific, measurable, achievable, relevant and time-based), his team addresses one behavior at a time, looking at how patients are doing with their nutrition, exercise, sleep and stress levels, and they prescribe activities that will optimize mental activity (like woodworking or learning a musical instrument).
“We’ve found that changing one element of their lifestyle at a time, using SMART goals, is very empowering for patients,” Sherzai says. “Broad stroke recommendations by doctors, like ‘eat healthy,' 'lose weight,’ or ‘get exercise’ intimidates them.”
Sherzai says some patients may even resist following their medication regimes if doctors push them too hard. “We’re focused instead on creating small changes in behaviors and habits over time,” he says.
In Ohio, Psychotherapist Sharon Otto Trekell is leading the Eldering with Grace project, a pilot program that offers tai chi, qigong (pronounced CHEE-gong, a Chinese system of physical movement and breathing technique) and holistic and spiritual care for elders who are otherwise lonely and isolated. The outcome has proven optimistic: To date, they’ve seen a noticeable reduction in participants’ emergency room visits.
“Everyone in the program has been recommended by a primary care practitioner, nurse practitioner or a specialist like a cardiologist or oncologist,” Trekell says. Doctors prescribe the program to patients looking to recover from surgery, reduce pain, increase flexibility and balance, and combat depression and anxiety. “Doctors are being flooded with (older) patients and need resources for offering social prescriptions,” she says.
Help With Loneliness
According to Melissa Henston, a geriatric psychologist in Denver, although social prescriptions are a regular part of her daily practice, many primary care physicians are not helping older adults get out and engage in the community.
“Physicians know they don’t have the time, so they’ll send their patient to me,” she says. “I’m big on making sure patients are involved in social activities. Loneliness is a problem with older adults who don’t know how or who are afraid to get involved,” she says.
Many of Henston’s patients are alone, widowed or divorced, and meet-up groups, spiritual communities and even adult learning classes make a huge difference in these patients’ lives, she says. From book clubs to swimming classes, social activities regularly reduce feelings of loneliness, depression and anxiety.
Although social prescriptions are not generally covered by insurance companies or Medicare, Henston believes they’re so critical to patient outcomes that she frequently searches for free or inexpensive programs for patients with limited funds. Examples of inexpensive community programs and initiatives include Silver Sneakers (offered by many fitness and community centers) memberships to senior centers, scholarship programs at educational institutions, and library book clubs.
Talk to Your Doctor
While it’s evident that social prescriptions are being used regularly by some doctors, it’s not yet standard practice in the U.S. “Unfortunately, primary care physicians are so busy, there’s no time (during an appointment) to get into lifestyle,” Henston says.
Trekell’s experience is similar. “Learning how to talk to your doctor is important,” she says. “Insurance has made it difficult for doctors -- they’re limited in the time they can spend with patients. A specialist is more likely to offer a social prescription because they have about 20 minutes allocated per patient, whereas a family doctor has only seven minutes.”
Once an older adult finds a doctor, psychologist or social worker who has the time to talk about their lifestyle and prescribe a social activity, the main question is which types of activities will they recommend? Henston bases her recommendations on the patient’s interests and whether they’re introverted (and may prefer something low key like a mindfulness class) or extroverted (and may prefer a social activity like a book club or dance class).
Sherzai, on the other hand, makes recommendations based on how a patient answers questions about past and current interests and activities. Patients then try different activities to see what they like.
There’s no doubt that social prescriptions are improving patient health and outcomes, but until the practice is more widespread here in the U.S., patients should take the initiative to ask for a social prescription. For now, the advice patients receive will vary depending on the medical professional they speak to and the amount of time the doctor has available.