Social Prescribing in Sweden (SPiS)- An Interventional Research Project Evaluating a Swedish Model

Loneliness among older adults has become an issue of public concern. There seems to be a high and stable prevalence of reported loneliness, with as many as 50% of older adults reporting serious or moderate loneliness. There is also growing evidence on the significant harmful effects of loneliness in older adults . Although the situation is urgent, no specific type of intervention has demonstrated a robust evidence base for reducing loneliness. There are, however, promising initiatives that manage to take the wider context in which the individual lives into account. Initiatives such as Social Prescribing in the United Kingdom identify the individual's needs, and guide them in getting involved with their community, by linking people with local supportive social activities and opportunities. However, such initiatives are sensitive to context, and may not be easily transferred between national contexts. The focus of this project is to develop and implement Social Prescribing in a Swedish context, as this has not yet been done. Our novel contribution to this field is: a) developing a Swedish version of a social prescribing method together with potential end-users and stakeholders; and b) evaluating the first test and implementation of this method. Thus, this project has the potential to develop important knowledge regarding how to prevent and/or reduce an urgent public health issue, loneliness among older adults, in a non-medical way via social prescribing in a Swedish context.

Background and point of departure

Systematic reviews show that social isolation and loneliness among older people is a substantial problem (affecting 7-17% and 40% respectively), and that lack of social inclusion and a feeling of loneliness negatively affects physical and mental health. These issues are especially prevalent in older people with health problems, and are associated with socio-demographic factors (gender) and social factors (e.g., civil status and meaningful social contacts). The research findings call for attention to be given to the provision of services for meeting societal ideals in caring for the older generation, confronting the rising isolation and subjective loneliness which harms individual health and burdens national and global economies.

There might though be protective factors addressing loneliness as research demonstrates the importance of social relations and social engagement in older people's health, well-being, and cognitive health. Strong mortality effects also exist,148 longitudinal studies revealed a 50% mortality reduction in persons with strong social relationships.

Societal services need to be developed that prevent loneliness and support social participation. A social equivalent to the physical activity on prescription is the United Kingdom initiative started in 2002 called social prescribing, which serves as a way of linking patients in primary care with sources of support within their local community. Social prescribing concerns expanding the options available to General Practitioners (GP) by allowing them to forward a client with psychosocial issues to existing meaningful activities in the community that meet these needs. There are no set standards in the procedures of social prescribing, but it gives a GP the option of using a non-medical referral, either as a stand-alone, or together with existing treatments. The sources of support in the community can be either in the volunteer or community sectors. Challenges that have been described include the multiplicity of options and the logistical difficulties although the idea is simple, the implementation is complex. What is essential is that there is a direct referral from primary care, and an identified coordinator who connects the person to local activities that meet their needs and aspirations.