image of Ashwin Kotwal, M.D.

Geriatricians are advocating for “social prescriptions” for lonely older adults after finding that these isolated seniors are significantly more likely to use psychotropic drugs.

In a new study of 6,000 older study participants, the higher the degree of loneliness, the greater the proportion of prescriptions for opioids, anti-anxiety medications and sedatives, reported Ashwin Kotwal, M.D., a geriatrician with San Francisco VA Medical Center. These seniors also used antidepressants, sleep medications and benzodiazepines at double the rate of their non-lonely peers, he and his colleagues reported. 

Commonly used drugs included Valium, Xanax, BuSpar and Ambien, and the group with the highest degree of loneliness was more likely to be on five or more medications.

When loneliness is a risk factor for new physical or psychological symptoms, medications may not treat the underlying social experience of loneliness, Kotwal cautioned his fellow physicians. And when loneliness is the consequence of symptoms such as pain or depression, it may increase the intensity of these symptoms, he and his research colleagues added.

Kotwal and study team recommend that clinicians prescribe fewer psychotropic drugs for older adults who are lonely. Instead, “social prescribing” with referral to helpful resources may be more beneficial, they said. 

“Identifying and addressing loneliness may have the added benefit of allowing clinicians to reduce or avoid prescription of high-risk medications,” the researchers wrote. This can be done by connecting patients to amenities like senior centers, exercise classes, grief groups or volunteer programs, they suggested.

Opening up about loneliness

Loneliness shouldn’t be pathologized, and most people experience loneliness at some point in their lives, Kotwal said. “But when experiences of loneliness persist for many months or years, it can cause physiologic changes, such as a ramped-up stress response, sleep problems, and even heart disease.”

What’s more, a lack of social contact can erode social skills, making it more difficult over time to connect with others and creating a vicious cycle, he added.

The pandemic has taken some of the stigma out of loneliness, Kotwal noted, allowing older adults more opportunity to discuss their feelings with their clinicians. Talking to patients about their preferences can be a first step to finding programs that fit their needs, he said.

Deprescribing may take time

Kotwal and team used data from the National Social Life, Health and Aging Project. They found that many of the medications prescribed to study participants were associated with adverse consequences among older adults, including opioid dependence, gastrointestinal bleeds, falls, fractures, delirium or cognitive impairment, new functional disability and death. 

In busy clinical practices with complex patients, contraindications may not come to light until a patient is suddenly hospitalized, Kotwal said. 

“It’s only then that we might find out that a patient’s prescriptions include Valium and he’s been taking it for more than 20 years,” he said.

Deprescribing takes time and effort, and may be challenging for patients who are already in distress, the authors acknowledged. They urge caution in switching a drug that acts promptly with one that may take several weeks to have an effect.

Full findings were published in JAMA Internal Medicine.

In related news:
More virtual contact equals more trouble with loneliness, study in seniors finds People over the age of 60 who had more virtual contact with family and friends during the pandemic experienced a greater increase in loneliness, a new study has found. “Our findings show that despite rapid digitization … virtual means of social interaction cannot replace in-person contact in supporting older people’s mental health,” co-author ​​Yang Hu, Ph.D., of Lancaster University, said. The study, which followed participants in the United States and the United Kingdom, was published in Frontiers in Sociology.