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GPs should encourage lonely patients to take up singing and arts classes, say NICE

Health regulator NICE is calling for GPs to signpost patients at risk from loneliness and isolation to local singing, arts and crafts and walking groups, to help them stay healthy and keep living independent lives.

In a new Quality Standard, NICE advisors said GPs should be offering a range of community-run activities to people identified as being at risk, to help them ‘build or maintain social participation’.

But the standard also says organisations such as councils – rather than GP practices – should be responsible for identifying elderly people who are most at risk and making sure there plenty of services on offer.

It comes after Pulse revealed NHS chiefs are pushing for GP practices to receive funding dedicated to social prescribing, on the back of various models to help people with housing, debt or loneliness problems – most of which rely on link workers operating within the practice with input from GPs.

NICE said people over 65 who, for example, have lost a partner recently, are living alone, or have had to give up driving are the type of people particularly at risk. GPs should be encouraging them to attend things like dancing and swimming clubs, arts groups and singing programmes or helping with reading in schools, as well as volunteering and befriending programmes.

Professor Carolyn Chew-Graham, professor of general practice research at Keele University and member of the advisory group that came up with the standard, said: ‘As a GP it is often difficult to identify older people at risk as you won’t necessarily know if they’ve had a bereavement or lost a job.

‘It’s really tricky to keep up to date with what services are available in a local area, as they come and go. As a GP it is difficult to remember exactly which groups are available each day, so I’m not able to be specific in the suggestions I give to patients.

‘We must also remember this is not mandatory and some older people do manage to maintain their health despite not socialising.’

Quality statements

Older people who are at risk of a decline in their independence and mental wellbeing are identified by service providers.

Older people most at risk of a decline in their independence and mental wellbeing are offered tailored, community-based physical activity programmes.

Older people most at risk of a decline in their independence and mental wellbeing are offered a range of activities to build or maintain social participation.

Source: NICE QS137 – Mental wellbeing and independence for older people

Readers' comments (31)

  • The detractors might want to look up the evidence. Treating lonelieness is far more effective at reducing mortality than many medical interventions including treating hypertension:
    Social Relationships and Mortality Risk: A Meta-analytic
    Review
    Julianne Holt-Lunstad1.*, Timothy B. Smith2., J. Bradley Layton3
    1 Department of Psychology, Brigham Young University, Provo, Utah, United States of America, 2 Department of Counseling Psychology, Brigham Young University,
    Provo, Utah, United States of America, 3 Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
    Abstract
    Background: The quality and quantity of individuals’ social relationships has been linked not only to mental health but also
    to both morbidity and mortality.
    Objectives: This meta-analytic review was conducted to determine the extent to which social relationships influence risk for
    mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
    Data Extraction: Data were extracted on several participant characteristics, including cause of mortality, initial health status,
    and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment
    of social relationships.
    Results: Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI
    1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding
    remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were
    found across the type of social measurement evaluated (p,0.001); the association was strongest for complex measures of
    social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus
    with others) (OR = 1.19; 95% CI 0.99 to 1.44).
    Conclusions: The influence of social relationships on risk for mortality is comparable with well-established risk factors for
    mortality.
    Please see later in the article for the Editors’ Summary.
    Citation: Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316. doi:10.1371/
    journal.pmed.1000316
    Academic Editor: Carol Brayne, University of Cambridge, United Kingdom
    Received December 30, 2009; Accepted June 17, 2010; Published July 27, 2010
    Copyright: 2010 Holt-Lunstad et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
    unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    Funding: This research was generously supported by grants from the Department of Gerontology at Brigham Young University awarded to JHL and TBS and
    from TP Industrial, Inc awarded to TBS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
    Competing Interests: The authors have declared that no competing interests exist.
    Abbreviations: CI, confidence interval; CVD, cardiovascular disease; OR, odds ratio
    * E-mail: julianne_holt-lunstad@byu.edu
    . These

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  • Anonymous | GP Partner06 Dec 2016 7:32am

    I disagree. Having a "guidance" means we will have to read, understand, retain and then act on it. Even if we are not the responsible organization, we are expected to take part. All of this costs time (and likely) money.

    Not sure if you have ever been sued - I've nt been sued successfully but I've had first hand experience of this interesting experience. Solicitors (even your defense ones) will not hesitate to quote any NICE guidance out there which says "GP" in it. Any protest of having too many guidance which will be met with sneer and look of incompetency.

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  • Glad NICE are suggesting ways to fill up our spare time!

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  • Congratulations Tim Coker for injecting some common sense into this discussion

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  • One bit of advice I have given over the years and it's worked
    Get a dog

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  • At least the NICE heart is in the right place. This is not part of Medicine, but it is. Everything that impinges on a patient's health and well being is. So, of course it seems silly, but increasingly lonely, elderly and sad people are coming. Sometimes it is tea and biscuits and lotto.
    By the way, never mind the patients, I am away to sing like Pavarotti.

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  • Severe cardigan alert

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  • And GP's should visit old folk and clear the snow off the path in the winter and pop around an put a hot water bottle in their bed, then nip and do a bit of shopping fro them, then read them a bedtime story!

    We hear so many complaints about the elderly turning up in A&E unnecessarily and abuse of the NHS so where does one draw the line?

    Is there a GP available to come and warm my nightie before I go to bed?

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  • Isn't this the kind of the thing the Church does pretty well? Shall we encourage our lonely old patients to find religion? Whilst we're at it shall we track down their children, grand children and great grandchildren and remind them to give their lonely old relative's a call and encourage them to get out a bit more?

    As a final thought isn't being told by your GP who is more and more seeming to hate their job yet is chained to their desk for more hours in the day than ever before (according to the comments on here) to essentially 'get a life' a touch patronising???

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  • ailly article really
    weve always told people with mental heath probs and that would include loneliness to get out take up hobbies met new people but I don't think it should be the patients responsibility to arrange this. I give them age UKs number who I hope are helpful.

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