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

Importance 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 in fact provided disproportionately more to individuals who are less disadvantaged. However, a comprehensive analysis of who is receiving SP from both medical and non-medical referral routes has never been undertaken. Objective To incorporate bespoke novel questions on SP into a nationally-representative cohort study to assess whether SP is truly reaching individuals most in need. Design We used data from Wave 10 (2021/23) of the English Longitudinal Study of Ageing (ELSA) involving richly-phenotyped adults aged 50+ living in England. We explored how SP was patterned according to social and health inequalities, all measured in Wave 9 (2018/19; prior to the reported engagement in SP). Multiple ordinal regression models were used to explore predictors of receiving a SP referral. Setting Community-dwelling older adults living in England Participants 7,283 adults aged 50+ answered the self-completion questionnaire at wave 10 so were included in analyses. Main outcomes and measures Participants were asked if they had received a referral to a wide range of community-based activities by a doctor, social worker or other health professional Results 495 adults (6.8%) reported receiving a SP referral, and 435 (88%) accepted. Age was a significant predictor of referrals (OR 1.02, CI 1.01-1.03), but being female was not (OR 1.05, CI 0.84-1.30). Receiving benefits increased referral odds two-fold (OR 2.03, CI 1.53-2.70) and being in the lowest wealth tertile (relative to middle tertile) by 55% (CI 1.13-2.13). Education and employment status did not predict referrals. Referrals were most common for individuals with depression (OR=1.60, CI 1.20-2.12), diabetes (OR=1.52, CI 1.11-2.10), chronic pain (OR=1.57, CI 1.22-2.02), multiple long-term conditions (4+ conditions, OR=2.8, CI 1.41-5.51), and who were physically inactive (OR=1.63, CI 1.10-2.41). Conclusions and relevance There is some initial evidence of SP referrals occurring amongst older adults in England, with high uptake amongst those referred. Promisingly, those with highest socio-economic need and most long-term health conditions particularly appear to be receiving support. Key points Question Who is receiving referrals to social prescribing programmes? Findings In this analysis of a nationally representative cohort study of 7,283 richly-phenotyped adults aged 50+ living in England, SP was offered most to individuals experiencing socio-economic adversity with health needs including depression, diabetes, chronic pain, multiple long-term conditions, and those who were physically inactive. Meaning Promisingly, older adults with highest socio-economic need and most long-term health conditions particularly appear to be receiving support through social prescribing.