Foster John D, Torke Alexia M, Willis Deanna R, Kamwendo Shadreck W, Slaven James E, Tucker-Edmonds Brownsyne, Cheng Erika R, Behringer Tricia, Howard Notoshia, Session Sherri
Indiana University Health, Indianapolis, Indiana, USA.
The Evans Center at Indiana University Health, Indianapolis, Indiana, USA.
J Am Geriatr Soc. 2025 Apr 26. doi: 10.1111/jgs.19493.
Social isolation and loneliness are significant public health crises that can exacerbate stress and diminish health behaviors, leading to overall reductions in well-being. The effects of systemic upstream social determinants of health (SDOH) can worsen these effects. Partnerships between communities of faith and health systems have the potential to reduce social isolation and loneliness, address unmet social needs, and improve access to healthcare.
The Congregational Care Network (CCN), a collaboration between a health system and local congregations in neighborhoods with high poverty and gaps in other SDOH, provided 1 h per week of individual, volunteer companionship to older adult patients for 90 days. The health system provided training and professional support from social workers and chaplains. A program evaluation measured loneliness before and after participation and healthcare utilization in the 90 days before, during, and after the program.
CCN recruited 28 congregations representing diverse religious affiliations and 335 patients participated in the CCN program. Patients who received CCN services had a median age of 64.9 years (standard deviation 11.5), were 27.2% male, and 58.8% Black. There were significant reductions in DeJong Gierveld loneliness scores from before to after program engagement (median change score: 1 (interquartile range (IQR) 0-2, p < 0.001)). The proportion with 1+ emergency department visits was significantly lower after CCN compared to before (16.8% vs. 24.6%, p = 0.007); the proportion with inpatient visits was lower during CCN compared to before (12.2% vs. 17.3% vs. p = 0.032). The proportion with outpatient visits was higher during CCN than before (71.0% vs. 63.8%, p = 0.045).
The CCN partnership between congregations and a local health system is a feasible model for at-risk older adults that may reduce loneliness and shift healthcare utilization from acute to outpatient settings, providing greater continuity of care and fewer burdensome acute care visits.
社会隔离和孤独是重大的公共卫生危机,会加剧压力并减少健康行为,导致整体幸福感下降。系统性的上游健康社会决定因素(SDOH)的影响会使这些情况恶化。宗教团体与卫生系统之间的合作有潜力减少社会隔离和孤独,满足未得到满足的社会需求,并改善医疗服务的可及性。
在贫困率高且其他健康社会决定因素存在差距的社区,由一个卫生系统与当地教会合作建立的教会关怀网络(CCN),为老年患者提供每周1小时的个人志愿陪伴,为期90天。卫生系统提供培训以及来自社会工作者和牧师的专业支持。一项项目评估测量了参与前后的孤独感以及项目前、项目期间和项目后的90天内的医疗服务利用情况。
CCN招募了代表不同宗教信仰的28个教会,335名患者参与了CCN项目。接受CCN服务的患者中位年龄为64.9岁(标准差11.5),男性占27.2%,黑人占58.8%。从项目参与前到参与后,德容·吉尔维尔德孤独感得分显著降低(中位变化得分:1(四分位间距(IQR)0 - 2,p < 0.001))。与CCN项目开展前相比,参与CCN项目后有1次及以上急诊就诊的比例显著更低(16.8%对24.6%,p = 0.007);与项目开展前相比,CCN项目期间住院就诊的比例更低(12.2%对17.3%,p = 0.032)。CCN项目期间门诊就诊的比例高于项目开展前(71.0%对63.8%,p = 0.045)。
教会与当地卫生系统之间的CCN合作模式对有风险的老年人来说是可行的,可能会减少孤独感,并将医疗服务利用从急症转向门诊,提供更高的护理连续性,减少繁重的急症护理就诊。