What about social engagement? Towards a more holistic approach to the care of older patients.

Think, for a moment, about the quality of your life as a physician, and the impact on your effectiveness in practice, if you had almost no opportunities for socializing outside of work. Would it even be possible to sustain this for very long? It is arguably vital for physicians and their patients alike to make time for social and physical recreation. Recreation can literally “re-create,” regenerating the psychological resources needed to face the challenges of our demanding lives. Recent research has consistently shown the importance of lifestyle factors, such as active involvement in social activities and social networks, for a variety of health outcomes, including cardiac and mental health to immune system function. For physicians, knowing about their patients’ lifestyles is relevant to making diagnoses, treatment recommendations, and prognoses. In their study, reported in this edition of the Journal, Ory and colleagues examined the prevalence of discussions about an important lifestyle factor—social engagement. They found that whether patients are socially engaged and what this means to their overall health are not topics commonly considered in the context of the typical primary care visit with adults aged 65 and older. The data in this report are somewhat preliminary and, as the authors have acknowledged, there are some design and analysis limitations that are fairly common in a secondary analysis of an existing data set. Nevertheless, the data are relevant and timely, and the authors seem poised to continue to explore more deeply some of the many dimensions of this important topic. The authors reported several key findings: (1) Social activity involvement discussions (SAIDs) occur in less than a third of unique visits. When they do occur, they are most often linked with discussions of the importance of physical exercise for health. (2) The race of both patient and physician is associated with SAIDs. (3) There is significant regional variation in the use of SAIDs across the US and between urban and suburban locations. (4) Middle-aged physicians are more likely than older or younger physicians to have SAIDs, and those who were rated more highly on a measure of “supportiveness” had SAIDs more often. These results point to a constellation of factors that may predict when SAIDs will occur. But why might these factors, specifically, influence the occurrence of SAIDs? Because medicine has historically emphasized a mind/ body distinction, some physicians may under-appreciate the importance of psychological factors on physical outcomes. Hence, SAIDs may occur more often when conversations about exercise—a more biomedical construct—are also brought up. Involvement in social activities is often linked to socioeconomic status (SES). Older adults with a higher SES have the resources to pursue social activities that those with lower SES do not. Thus, it may not occur to the practitioner to initiate SAIDs with inner-city minority patients. More immediate medical concerns—such as attending to diabetic management—are likely to be perceived as more pressing than SAIDs. Although relevant, the role of family and friends in helping to manage a diabetic condition (ie, the importance of social networks), may be overlooked. The low prevalence of SAIDs among physicians age 60 and older may reflect a training-cohort effect. Only in the last several decades has the impact of social connectedness on patients’ physical and mental health outcomes been recognized. Increased prevalence of SAIDs among “middle aged” physicians may reflect a growing awareness of the social networks literature, and their own personal involvement in social activities for protection against anticipated diseases in their own lives. The fact that younger doctors have SAIDs less frequently is a bit surprising; it may be that they are simply treating biomedical concerns without considering the importance of psychosocial well-being. They may grow in their awareness and confidence in addressing psychosocial matters as their experience increases. In a related vein, the From the Center on Age & Community, University of Wisconsin, Milwaukee, Milwaukee, and the Department of Neurology, Case Western Reserve, University School of Medicine, Cleveland, OH.