Caring for the Whole Person

Social Determinants of Health (SDoH) have taken center stage in recent health policy discussions because of the growing focus on global payment, accountable care organizations, and other population health-related initiatives. Data on the impact of social determinants on health vary, but a recent study by ‘Change Healthcare’ notes that as much as 80% of health outcomes are related to social factors. So what does this mean to all of us?

First of all, it’s important to understand what SdoH are. According to the World Health Organization, “Social determinants of health are the conditions in which people are born, grow, live, work and age.” These conditions are shaped by the distribution of money, power and resources at global, national and local levels—sometimes termed ‘structural determinants’ of health inequities.

From the literature, it is of interest that many of the SDoH impact our long-term care residents; and several could be addressed easily if we understand how negatively they affect the quality of life or health of the resident. Among those determinants that can lead to poor quality of life and/or outcomes are:

  • Female residents and social supports systems
  • Food insecurity and/or lack of culturally appropriate choices
  • Lack of autonomy or control
  • Social exclusions or isolation
  • Loneliness
  • Discrimination based on ethnicity
  • Cultural and language barriers
  • Lack of understanding of plan of care – poor health literacy
  • Chronic health problems
  • Frailty

Social Determinants and Frailty: A Key Connection

The proprietary algorithm for the Patient Pattern Frailty Risk Score follows the principles of incorporating variables from many domains based on a Comprehensive Geriatric Assessment. The analytics incorporate population health management while the care plans follow the guidance of best practices in geriatric medicine and population health management. The Clinical Decision Support addresses both medical and psychosocial management, where possible accommodating the SDoH. 

Managing both frailty and chronic health problems are primary goals and impacted by SDoH https://bmjopen.bmj.com/content/6/5/e011410. Addressing these determinants may add both quality and quantity to the lives of those in our care. 

Some possible interventions might include:

  1. Understanding the social connections of female residents and assign an activity professional to plan approaches to meet this need.
  2. Involving dietary and the family for culturally relevant food choices likely to be consumed by the resident.
  3. Giving every opportunity for residents to make their own decisions and choices.
  4. Considering the impact of isolation on residents and its impact on depression and loneliness. The interdisciplinary team should be involved to develop approaches to address the depression and the meeting of needs for the resident in isolation.
  5. Considering the use of translators to assure residents understands their plan of care

Much more can be done and the benefit to the residents and their families will be evident. It starts with understanding the impact of these social conditions on health and a willingness to address them deliberately and specifically.

Contact us to learn more about how assessing frailty can contribute to effectively addressing social determinants of health and improve quality of life and outcomes.