Addressing the social needs of older adults: A practical guide to implementing a screening and referral program in clinical settings

A Practical Guide to Addressing the Social Needs of Older Adults details how to implement a social needs screening and referral program for older patients into clinical practice. Driven by significant growth of the older adult population across the United States and the demand to improve health outcomes and reduce healthcare costs, there is heightened attention and increased awareness of the importance of social determinants of health. There is growing consensus that addressing not only the medical needs of an individual but also their social needs, is critical to achieve “whole-person care.” The screening and referral program that we share in this guide was developed and tested specifically for older adults in a clinical setting and considers key social needs that directly impact their daily function and ability to live independently.

This interactive guide provides an approach to address the social needs of older adult patients in four stages: ASSESS readiness, PREPARE teams and partners, IMPLEMENT the intervention, and EVALUATE the impact. The guide was developed based on insights from a collaboration between the Gary and Mary West Health Institute (WHI), the University of California, Irvine, Division of Geriatric Medicine and Gerontology, and SeniorServ, a large non-profit community-based organization in Orange County, CA.