The Role of Cognitive Technology in Enhancing Social Care Services

Social determinants of health account for 30-55% of health outcomes (World Health Organization, 2008). These include policy, education, environment, and any non-medical factors that influence health outcomes. Among those health outcomes, social activity is particularly connected to cognitive function, mental health, and longevity, among all age groups including older adults (Jeste, 2022; Jester et al., 2023). And when it comes to dementia, social isolation has been identified as one of the modifiable risk factors for the disease (Samtani et al., 2022).

For the increasing global population of elderly patients, access to social care services can meet crucial social and emotional needs to improve health outcomes. For primary care providers, supporting these patients’ needs means potentially integrating social services into primary care, connecting patients with social workers, and improving continuity of care.

Data from cognitive and mental health assessments can point to age-related and/or health conditions that may affect (and be affected by) patient social health. Identifying these conditions allows practitioners to provide the care patients need, and they can also connect them with other services (such as social workers). 

In this article, we will explore the benefits of social care, examples of social services for older adults, and the best tools to improve quality of care.

What Is Social Care?

Social care refers to the support and services provided to individuals who need assistance with daily living, often due to age, illness, or disabilities. These services take a whole person care approach, addressing social, emotional, and practical needs as well as medical needs.

In one survey, 92% of older adults said they would prefer to age in place rather than in an assisted living facility (Forbes, 2024). Social care services aim to help people live as independently and comfortably as possible, while also providing a supportive network for their well-being.

What Are Social Care Services?

Social care services include programs that address patients’ practical needs, as well as provide social interaction, mental stimulation, and emotional support. 

Social care services for older adults can include:

Support with Activities of Daily Living

Activities of daily living (ADLs) refer to the fundamental skills and tasks people require to live independently (Edemekong et al., 2023). In the United States, 70% of people over 65 require assistance for the rest of their lives due to ADL losses (Johnson, 2019), and experience a negative impact on overall social wellness (Khalili et al., 2023). For individuals diagnosed with dementia, this lack of independence is at least partially caused by cognitive deficits.

Social care programs that provide assistance with these essential activities include:

• Home care assistance for activities such as bathing, toileting, dressing, meal preparation, light housekeeping, and medication management. Ideally, social services take a patient-centered approach, and are targeted for an individual's unique wants and needs.
• Transportation for medical appointments, grocery shopping, and community events. While driving cessation is often necessary for safety, 20% of seniors who lose their license experience depression afterwards (Ragland et al., 2005; Savoie et al., 2024). Transportation services get patients out of their homes and improve their quality of life.
• Home modifications and adaptations to improve safety and accessibility for people who are aging in place. Falls are the leading cause of injury for people over 65, with 14 million falls reported each year (CDC, 2024). Grab bars and wheelchair ramps may help  to reduce this number.
• Legal and financial assistance with things like budgeting, accessing benefits, and drafting wills and power of attorney documents. These services are especially helpful for those experiencing cognitive decline, and can also help to protect people from fraud, which impacts 30% of adults between 50-80 years of age (Solway et al., 2023).

Socialization Opportunities

The CDC has found that social isolation significantly increases a person’s risk of premature death from all causes, and is associated with an increased risk of dementia (Kuiper et al., 2015). With approximately one in four adults over 65 experiencing social isolation, loneliness is a major factor in population health for seniors (National Academies, 2020). 

Meeting patients’ social needs is just as important as meeting their physical health needs, and can be achieved through:

• Companionship services that offer volunteers who will talk, play games, and go for walks together with seniors.

• Adult day care centers that offer structured programs for seniors who require supervision but not full-time care, and provide relief for caregivers.

• Community centers that offer a variety of social and recreational activities.

• Intergenerational care centers that partner toddlers and seniors at the same day care centers. These centers improve seniors’ sense of belonging, and improve the social and emotional skills of young children (IFS, 2017).

Cognitive Health Services

Over 55 million people have dementia worldwide, and every year, 10 million new cases arise (World Health Organization, 2024). With these rising numbers, cognitive healthcare is more important than ever.

A few resources and programs for integrating cognitive and social care include:

• Cognitive assessment tools. Including cognitive function tests as a regular part of primary care for older adults gives providers measurable data about their cognitive wellness, and can catch early signs of dementia.
• Memory care programs in assisted living settings. Along with having special activities for patients, these programs create environments that are specifically designed to support cognitive well-being in a safe living space (Kovaleva et al., 2020).

Mental & Behavioral Health Services

Behavioral and mental health are key parts of brain care for older adults. Challenging behavioral symptoms can isolate seniors, and get in the way of effective medical treatment.

Some care services for behavioral and mental health include:

• Behavioral and mental health assessments. Questionnaires such as the GAD-7 and PHQ-9 enable healthcare providers to routinely assess a patient’s wellbeing. THe IADL and IQCODE-SR also support conversations around any changes to a senior patient’s independence.

• Substance abuse programs. 12% of adults over 65 experience alcohol and prescription drug abuse, which negatively impacts cognition, physical health, and social relationships (NIAAA, 2024).

• Support groups. Chronic illness, loss, and fears of aging are very normal for seniors. Connecting individuals with one another creates a space to share experiences and advice, as well as promote social interaction.
• Health and wellness programs. Physical activity has been shown to greatly reduce depressive symptoms among seniors (Lautenschlager et al., 2004). Exercise classes and wellness workshops can help seniors maintain their physical and mental health, and are a place to form connections.

Benefits to Incorporating Social Care Services

Along with helping older adults maintain their physical health and well-being, incorporating social care into their healthcare can also:

• Decrease isolation and loneliness, leading to improved health outcomes and greater quality of life (Landeiro et al., 2017)
• Reduce caregiver stress. 40-70% of family caregivers have significant symptoms of depression (Zarit, 2006). Respite care and support groups can give caregivers necessary breaks for their own mental health.
• Improve cognitive health outcomes by connecting patients with cognitive services. Early diagnoses empower patients to make choices about their care plan before experiencing further cognitive decline (Alzheimer’s Disease International, 2024).  
• Better coordination of services with a multidisciplinary team. Treating patients as a multidisciplinary team has many benefits, including improved physical health outcomes, reduced costs, and improved patient and staff satisfaction (Epstein, 2014).

Putting Social Care Into Practice With Older Adults

According to the World Health Organization, 1 in 6 people will be over the age of 60 by the year 2030 (World Health Organization, 2024). Putting social care into practice with this growing demographic can improve outcomes for individual and population health.

Here are four practical steps for integrating social care into primary care for older adults:

Utilize Cognitive and Mental Health Screening

Standardized, scientifically-backed cognitive and behavioral health assessments measure the needs and capabilities of each individual patient. These tools can also identify comorbidities, which helps doctors identify if symptoms such as depression are also indicators of cognitive decline (Alzheimer’s Society, 2024).

Along with this, easy-to-understand reports help healthcare providers interpret data for patients. Effective communication helps educate patients and direct them to appropriate health services and resources, and can improve patient compliance with their care plan.

Build a Social Care Network

According to a 2024 report from the Canadian Medical Association (CMA), 60% of physicians report that administrative burden is a direct contributor to the deterioration of their mental health (Canadian Medical Association, 2024). However, that same report notes that 38% of administrative tasks do not need the expertise of physicians to be completed.

A directory of social care resources and referrals to social services programs can reduce this burden, where providers can guide patients towards members of the health team that specialize in social care services.

These social services programs could include:

• Community groups
• At-home nurses
• Social workers
• Meal delivery services
• Transportation services
• Therapists who specialize in elder care 

Include Social Components in Care Plans

One report found that social isolation was associated with a 50% increased risk of developing a neurocognitive disorder or other serious condition (AMA, 2023). Along with establishing physical health goals, addressing patients’ social needs is essential to improving patient welfare.

Many programs that are designed for patients’ physical health can also have a social component, such as:

• Home health care that provides company while supporting patients’ ADLs.
• Local exercise groups that improve physical health while building community.
• Crafting and leisure activities have been shown to improve cognition among older adults while helping them make new connections (Geda et al., 2023).

Follow-Up and Coordinate with Social Care Providers

Prompt follow-up from providers is essential to positive health outcomes for patients. In fact, a one-month increase in time between primary care appointments makes it 13% less likely for patients to be able to access routine care when it’s needed (Price et al., 2020).

Establishing a system for regular follow-ups makes it easier to monitor the effectiveness of social care interventions. Taking a measurement-based approach to social care gives providers key insights into patients’ well-being, and regular check-ins keep that data up to date.

From there, connecting with other members of the care team ensures that patients are receiving consistent and integrated support. Tools that integrate with patients’ electronic health records can take the administrative burden off of communicating as a larger team.

Examples of Social Care in a Primary Care Context

In a primary care context, social care can look like:

• Taking a patient-centered approach to conversation, addressing social and emotional needs as well as medical care needs.
• Implementing routine cognitive testing and behavioral assessments to monitor performance and collect data on patients’ brain health and develop care plans.
• Connecting with family members to gain a better understanding of a patient’s support circle. This can also be an opportunity to make sure that caregiver health is also being taken into consideration (CDC, 2024).
• Providing patients with a physical and digital copy of social care services and resources. 40-80% of medical information is immediately forgotten after being delivered, and written documents are proven to help mitigate that challenge, especially when pictographs are included (Kessels, 2003).
• Prioritizing care-coordination with other providers, such as social workers, nurses, and nutritionists. 

A good time to apply social care to primary care is during the Annual Wellness Visit (Medicare, 2024). This visit is required by Medicare, is reimbursable, and is designed to review the current state of a patient’s health. From there, the patient and physician can establish health goals and focus on preventive care strategies.

If signs of cognitive impairment arise, providers can schedule an appointment for cognitive care planning, which can be reimbursed with CPT Code 99483.

Using Cognitive Technology to Enhance Social Care

Annual wellness visits are usually completed in about 30 minutes, leaving providers with limited time to connect with patients and address all of their concerns (CMS). This challenge can be addressed through the use of standardized screening tools, which gather crucial data without sacrificing patient-centered care.

At Creyos, our suite of cognitive, mental, and behavioral health assessment tools:

• Require no training to administer, and can be completed in the clinic or at home
• Are not time-intensive, which increases the rate of completion
• Can identify comorbidities such as depression and cognitive impairment
• Address multiple patient needs at once, reducing unnecessary referrals
• Include data-driven reports that integrate into electronic health records for social care workers to read

Our assessments and questionnaires help providers accurately measure cognition and mental health, detect early signs of dementia, and deliver care plans that are tailored to patients’ needs. 

Positive patient-provider relationships are proven to improve health outcomes for patients (Olaisen et al., 2020). By reducing the amount of time spent gathering data, providers can take extra time to foster a relationship with patients and understand their unique needs and circumstances. From there, providers can understand which social care services and resources would be the best fit for individuals.

Connect with us today to learn how Creyos can improve your clinic’s delivery of social care.

Final Thoughts: Meeting Patients’ Social Needs

Having one’s social needs met is a key factor in human health, especially when it comes to older adults (Fernandez-Portero et al., 2023). By identifying patients’ unique wants, needs, and social determinants of health, physicians can successfully guide them towards the right social care services—and build a network of providers in the process.