Arif Nazir, M.D.

We are just as likely to be impacted by our social surroundings as we are by our body’s health. These social determinants of health can determine how healthy we are today and what our future health might be. In fact, they can impact up to 70% of our overall health. 

Senior living providers can have a positive impact on residents’ social determinants of health by offering them personalized engagement so they can live meaningfully. Providers need to provide older adults with more than just medicine. A “social prescription” is something that senior living professionals can use as a non-drug solution that is based on an older adult’s life history, individual preferences and current abilities. 

A study by AARP found that social isolation can be as bad for your health as smoking 15 cigarettes a day. According to a study published in 2015 in Perspectives on Psychological Science, social isolation is a risk factor for death.

“Social isolation will be a greater threat to healthy aging than obesity.” – The American Psychological Association 

Without this focus on a person-centered approach, providers can find themselves overusing antipsychotic medications. The latest data from CMS shows that the national average of prescribing these kinds of medications is 14.4% for Q1 2022 — practically the same as it was four years ago. This lack of progress tracked by the National Partnership to Improve Dementia Care in Nursing Homes clearly shows the need for new approaches. 

Charles de Vilmorin

As in other care settings, the physician is involved with the prescription of medication such as antipsychotics. The physician will offer education, resources and prescription with information and research that elders, and their advocates, can use to make informed decisions about their treatment plan.

It is, therefore, easy to jump to the conclusion that physicians are partly responsible for the misuse of medication and a lack of person-centered care.

This is incorrect for at least three reasons:

First, without a formal structure, approach and a team to address social determinants of health, the physician is ill-equipped to help the residents because they see elders only through their medical practices. Without enough interaction, education and teamwork with other disciplines, their options are limited, and this often results in decisions that simply cannot take into consideration the psychosocial preferences of elders.

Second, the life enrichment and social services department is in charge of understanding the psychosocial needs of the residents and formulating a plan to address them. Historically, senior living communities have not placed enough importance on these practices. This has resulted in a lack of staffing, education and advocacy for the profession. In addition, leadership doesn’t listen to this department as much as they should.

Finally, the voice of the resident isn’t heard enough. Our industry continues to make progress in implementing a person-centered approach, but there is progress to make. One crucial component blocking this progress is the lack of interdisciplinary teamwork at the industry level.

Despite the COVID pandemic, the senior living industry has made progress and initiatives to radically improve care have made headway, such as The Drive to Deprescribe Initiative. The Post-Acute and Long-Term Care (PA-LTC) is arguably the most at-need population but one of the most challenging implementation settings for deprescribing. In early 2020, the Society for Post-Acute and Long-Term Care Society (formerly AMDA) sponsored the Drive to Deprescribe (D2D) initiative, which was developed to address the unique deprescribing-related needs of PA-LTC residents and providers alike.

An example of a provider that has elevated social services is American Senior Communities. Their effort, called CARE Companions programs led by Janean Kinzie, dramatically reduced the use of antipsychotics by more than 2% for their 59 skilled nursing and memory care communities. Their average long-stay antipsychotic rate is now at 8.9%, compared to the national average of 14.2% reported by CMS. 

Additionally, research led by Linked Senior and funded by Baycrest-led Centre for Aging + Brain Health Innovation (CABHI) found that being highly engaged in recreational activity is associated with increased cognitive functioning and social engagement, as well as decreased aggression and antipsychotic medication use.

As we emerge from the COVID-19 pandemic, there are a lot of promising opportunities for our elders to live meaningful lives. Our industry needs to continue engineering new designs of team communication, accountability and understanding impact with patient engagement and life quality as the key metrics.

These goals are essential and exciting as we all know that meaning is medicine.

Dr. Arif Nazir currently serves as the Chief Medical Officer, Primary Care at BrightSpring Health Services, while leading SHC Medical Partners, a large, value-based, geriatric practitioner organization. He is Past President of AMDA, a founding member of the Society’s Innovation Council, and Co-chair of Society’s Drive to Deprescribe initiative.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.