Guideline of the month: Supporting wellbeing in older people

The guideline

NICE’s new quality standard offers guidance for GPs on managing mental wellbeing and independence in patients at risk of loneliness and isolation. It features advice on community interventions and social prescribing.

Key points for GPs

GPs should identify patients who are most at risk of loneliness and a decline in their independence. Risk factors include living alone, having a low income, experiencing a recent health problem and being aged 80 or older. Recent bereavement or unemployment are also factors.
Having identified these patients, GPs should offer them a ‘tailored’, community-based programme of moderate physical activity. This could include a variety of exercises such as dancing, walking and swimming, depending on the person’s preferences.
A range of individual and group-based social activities should be offered. NICE suggest singing programmes, arts and crafts, and reading in schools to younger people as options for group activities. The document also suggests discussing the benefits of volunteering with these patients.

Practical issues

Given the existing pressures on GPs’ time, getting the profession to take this guideline seriously will be challenging. There will be difficulties in generating lists of at-risk patients as part of any identification process, as some of the risk factors are not recorded or are not searchable on GP systems.

Expert comment

Professor Carolyn Chew-Graham, a GP and member of the NICE quality standard advisory group, says: ‘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. 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.’