Can social prescribing reach patients most in need? Patterns of (in)equalities in referrals in a representative cohort of older adults in England.

Abstract

Aims: Social prescribing (SP) is a mechanism of care referring people to non-clinical forms of support and services in local communities to improve health and wellbeing. But there is much contention over whether SP is provided disproportionately more to individuals who are less disadvantaged. A comprehensive analysis of who is receiving SP from both medical and non-medical referral routes has never been undertaken.

Methods: We used data from 7283 adults aged 50+ in the English Longitudinal Study of Ageing (ELSA), incorporating novel questions on SP into Wave 10. Multiple logistic regression models were used to explore predictors of self-reported referrals to SP.

Results: A total of 495 adults (6.8%) reported receiving an SP referral and 435 (88%) accepted. Referrals were more likely among older adults (odds ratio (OR) = 1.02, confidence interval (CI) = 1.01-1.03), those with chronic pain (OR = 1.78, CI = 1.40-2.27), those who were lonely (OR = 2.20, CI = 1.63-2.97), those from the lowest wealth tertile (OR = 1.59, CI = 1.17-2.18) and those receiving benefits (OR = 2.02, CI = 1.52-2.69). Diagnosed psychiatric conditions and depressive symptoms, sedentary behaviours, cardiovascular conditions, diabetes, and physical inactivity predicted referrals only in minimally adjusted models. But those with multiple long-term conditions were more likely to be referred (OR = 2.02, CI = 1.00-4.08).

Conclusion: There is promising initial evidence that SP referrals are occurring among older adults in England, with high uptake among those referred. Promisingly, those with the highest socio-economic need and most long-term health conditions particularly appear to be receiving support. Mental health appears more of a secondary rather than a primary referral predictor.