Many older adults in Sweden suffer from involuntary loneliness—a condition that can be just as dangerous as smoking fifteen cigarettes a day. Researcher Ingeborg Nilsson at Umeå University, in collaboration with Husläkarna Health Center and the City of Umeå, is investigating whether social activity prescribed by a doctor can help reduce this problem.
According to the National Board of Health and Welfare, two out of three people in long-term care feel lonely. When loneliness is not self-imposed and persists over time, it can be just as harmful as smoking or obesity. The body can suffer from chronic stress. It becomes less able to fight off bacteria and viruses and more sensitive to pain. The risk of cardiovascular disease, dementia, low mood, and depression increases.
“Loneliness among older adults is a public health issue. But even though we know a great deal about its negative effects, few systematic efforts are being made to prevent involuntary loneliness among Sweden’s seniors,” says Ingeborg Nilsson, professor of occupational therapy at the Department of Community Medicine and Rehabilitation at Umeå University.
Bringing in a successful British idea
Ingeborg Nilsson has long conducted research on the importance of physical activity for the health of older adults. She is now collaborating with Husläkarna Health Center and the Culture for Seniors program at the City of Umeå to investigate whether social activity on prescription can be a way to prevent and combat dangerous loneliness.
The inspiration for the project comes from the United Kingdom, where “social prescribing” has been practiced for many years. The model enables healthcare professionals, with the help of a coordinator, to connect people who are lonely with social activities in the local community and cultural life.
“Previous studies have shown that being socially active and engaged is important for reducing loneliness and improving well-being. In our project, we want to adapt and test this approach in a Swedish context. We call it ‘social activity on prescription.’ The goal is for primary care providers to be able to prescribe social activity, just as they do medication or physical activity,” explains Ingeborg Nilsson.
Wants to make loneliness less of a taboo
The past year has really brought the issue of loneliness into the spotlight. But according to Husläkarna, many older adults felt isolated even before the pandemic.
“The older you get, the greater the risk of losing your partner and close friends. In addition, illnesses can limit your mobility and cause you to spend more time at home. This leads to a shrinking social circle,” says Hanna Jakobsson, a physical therapist at Husläkarna.
Since loneliness is often associated with feelings of shame, people typically do not speak openly about it.
“Involuntary loneliness can both cause and exacerbate health problems, which in turn leads to an increased need for health and social care. It becomes a kind of vicious cycle. We often encounter older adults who seek care without explicitly asking for help with their loneliness. Until now, we have lacked a clear strategy for supporting them,” Hanna Jakobsson continues.
As part of the "Social Activity on Prescription" project, a team working on mental health has developed a model to identify people’s needs for assistance. The first step is to identify people who feel lonely and are suffering as a result.
– At our health center, we’re introducing a routine where we simply ask: Do you experience involuntary loneliness? The person is asked to rate whether it’s never, rarely, sometimes, or often. Asking about loneliness should become as routine as asking about alcohol and smoking, says Hanna Jakobsson.
Can save both lives and money
If there is a need for assistance, the next step is to clarify that individual’s specific needs, preferences, and interests. The key is to guide them toward activities that feel meaningful, and this requires knowledge of what’s available. Here, the project receives valuable support from Culture for Seniors, a municipal initiative tasked with organizing free activities for everyone over the age of 65 in the municipality of Umeå. Everything from author talks, workshops, and art walks to sing-alongs, concerts, and fishing fairs.
“In addition to organizing at least two events of our own each week, we have a large network and stay well-informed about what’s happening in Umeå and the surrounding municipalities. Even if we can’t help in every single case, we can educate, remind, and inspire healthcare providers,” says Madelene Edlund, cultural consultant for the City of Umeå.
The organization is hopeful and confident in the concept, but emphasizes that it will require more than just the right skills among healthcare staff. Namely, sufficient resources.
“When we get together, have fun, learn new things, and feel like we’re part of something bigger, something happens to us as people—even physically. Even pain can be reduced, so it’s absolutely clear that this works! But it has to be allowed to cost something. This initiative can, in turn, save both lives and money,” Madelene Edlund continues.
The pandemic has both slowed down and broadened
During the pandemic, Culture for Seniors has sought alternative ways to continue its activities. In some cases, Ingeborg Nilsson’s research team and Husläkarna have experimented with helping older adults become more digitally active. The pandemic has also provided time to plan for the involvement of more than one health center. The project team has applied for funding and refined the model.
The plan is to launch the program at Husläkarna as early as fall 2021. Interested seniors have been able to sign up for a waiting list, and even curious politicians have reached out. From opinion pieces to legislative proposals, there is now a growing call to introduce social activity on prescription nationwide.
“We’re seeing a real desire to improve conditions for both the healthcare system and our elderly. It feels like this project is right on target and that it’s exactly what’s needed,” concludes Ingeborg Nilsson.
Would you like to learn more about the project and the research? Pleasecontact Ingeborg Nilsson at Umeå University