Loneliness

Introduction:

Loneliness affects nearly a third of adults aged >70. It increases the risk of conditions including depression, coronary artery disease and stroke. Lonely individuals are at increased risk of falls, hospital attendances and prolonged admissions. Following hip fracture, patients are particularly at risk and pre-fracture loneliness is associated with poorer outcomes. An inpatient stay offers the opportunity to screen for and address pre-fracture loneliness.

Method:

Aims: 100% of patients to have a University of California Los Angeles (UCLA) 3-item loneliness score by day 5 post-operatively. A score of 6 or above necessitates referral for befriending services.

Study population: Patients aged >70 admitted with femoral neck fractures to orthogeriatric wards.

Methods: The project followed a PDSA approach. Electronic records were reviewed weekly for documentation of loneliness scores and referral to community befriending.

Interventions: 1. Doctor education session on loneliness and the UCLA 3-item loneliness scoring. 2. Inclusion of the loneliness score in the pre-populated ward round proforma.

Results:

Of 102 patients, 63% of patients were female, mean age 85. At baseline, 0% had a loneliness score documented. This improved to 57% following intervention 1, returning to 0% after 2 weeks. Following intervention 2, this improved to 56% but fell to 25% after 6 weeks. Of 23 patients with completed scores, 5 (22%) had a high loneliness score and 4 patients were referred for befriending services.

Conclusion:

High rates of loneliness were demonstrated, in line with national predictions. Assessment improved following each intervention, but was not sustained. Investigation suggested this was due to rapid turnover of doctors, and successive cohorts were unaware of quality improvement programmes before moving on to their next post. We believe this to be an important finding, with wider implications for research into improving patient care. Further steps include discussion of loneliness in weekly departmental meetings with the wider Multi-Disciplinary Team.

Background

Loneliness is increasingly impacting older people in the UK and associated with poor health. The “Campaign to end loneliness” estimates that 1.2 million people are lonely. Age UK states that 2 million people will be lonely by 2026. For half of people aged >65, their main source of company is TV or pets.

Our objectives are to identify the prevalence of loneliness in the population presenting to Leighton Frailty Unit, develop a social prescribing tool to reduce this and highlight community services.

Methods

During September 2023- February 2024 we gathered baseline data on loneliness by encouraging staff to provide our questionnaire, based on the UCLA 3-item loneliness scale and Age UK guidance on direct loneliness questioning, to patients in chair spaces at Leighton Frailty Unit. We developed a social prescribing leaflet with activities in the local area using LiveWell Cheshire East. We re-contacted patients from cycle 1, repeated the questionnaire and asked if they had utilised the intervention leaflet.

Results

From Cycle 1, 53% of patients experienced loneliness, with 23% reporting “often” feeling lonely. From Cycle 2 when assessing the impact of the social prescribing leaflet, 37% of patients experienced loneliness, with 19% reporting “often” feeling lonely. Patients did not use the social prescribing leaflet, citing being unable to attend activities as a reason.

Conclusions

We are increasingly identifying and assessing loneliness as part of a CGA and raising awareness of services. Rates of loneliness may have reduced due to simply talking openly about it. However, engagement with the intervention was poor. Loneliness differs from social isolation, it is complex and multi- factorial. Community care connectors are an under used resource and could help support the issue of accessibility. We will ask them to deliver teaching to the Frailty Unit about their services and which patients would be suitable.