Getting to the root of loneliness

An estimated 45% of seniors report feeling lonely on a regular basis. That sense of isolation can increase the likelihood of conditions such as Alzheimer's disease, stroke and obesity. It can also lead to premature death.

Yet, it is a challenge for healthcare providers to effectively address the problem. It requires physicians, nurses and caregivers to ask the right, often delicate, questions and gather the appropriate, often out-of-reach resources.

"Doctors don't like to find problems they can't solve," said Dr. Sachin Jain, president of CareMore, an Anthem subsidiary that offers Medicare Advantage plans and operates outpatient clinics in seven states, including Arizona and California. "In the absence of therapy, we don't look for the disease staring us in the face."

Jain believes loneliness should be treated as a disease since it can impact a patient's overall health. Studies show lonely patients are more likely to be depressed, not follow their care plan and are vulnerable to readmissions. Also, because loneliness and other social determinants of health can increase risks for other chronic diseases, health systems are motivated in this shifting reimbursement climate to address these issues.

To help providers address these issues, CareMore this week is launching a clinical effort focused on getting lonely patients the treatment they need.

So far, CareMore has flagged 1,100 patients who could benefit. These patients answered affirmatively when asked whether they felt lonely in their comprehensive health assessments, which about 80% of new members opt to complete. "We've been asking our patients this question for years, so we were able to quickly pull together a registry," Jain said.

Patients are called frequently to follow up. The calls are meant to gauge why patients might be lonely and what activities they might be interested in to increase socialization.

Overseeing the phone calls and the initiative is Robin Caruso, the system's newly appointed chief togetherness officer. Caruso has been a social worker at CareMore for over a decade. Two other employees from the customer service department have also been brought on and trained to help connect with patients.

All CareMore clinicians have also been trained to ask patients about their personal lives. If patients don't appear to have a strong social support system, physicians and nurses are encouraged to tell them about the social opportunities available and pass along their information to Caruso's team. "We are trying to encourage consciousness around the issue," Jain said.

To evaluate the program's success, CareMore will routinely monitor clinical outcomes such as depression and readmission rates. Jain said he expects patients will be healthier both physically and mentally as a result of this initiative.

CareMore has many options available to help members feel less lonely, Jain said. Most of CareMore's 52 outpatient centers have an attached gym through its partnership with Nifty After Fifty, which encourages physical fitness among seniors.

The organization also has relationships with community-based organizations so patients can get involved or volunteer. For example, veterans may want to join a veterans organization so they can share their stories with others.

"A lot of healthcare innovation is just about connecting dots for things that already exist," Jain said.

Caruso said building relationships with patients will allow them to understand their unique needs. For example, a patient might not want to leave their home after their spouse dies, so a CareMore staffer will visit. "A part of this is understanding what are the barriers to becoming social again," she said.

CareMore also expects to hold social events for these patients, such as lunches at CareMore centers to allow patients to forge relationships, Caruso said. Jain hopes more health systems will look to address loneliness for their patients, calling it a "problem of our times." Families have become much more nuclear in recent decades and most seniors aren't as apt to use computers or social media, isolating them more from others, he said.

"We have to see our patients in context of their broader lives," Jain said. "That is the paradigm shift that needs to take place in American medicine."