Geriatric practice during and after the COVID-19 pandemic.

Abstract

Dear Editor, Two aspects warrant consideration regarding the ongoing COVID-19 pandemic: prevention of COVID-19 infection and protection from the related changes among the elderly. For prevention, the Tokyo metropolitan government has announced a stay at home campaign that requests residents to stay at home. For the latter, the Japan Geriatrics Society (JGS) established the “COVID-19, Practice Caution for Older People” in March 2020 to raise awareness on “prevention of frailty” (Fig. 1). To achieve both goals, we need to avoid close contact and lead a routine, healthy life. COVID-19 influence can trigger age-related diseases other than frailty; therefore, it is necessary to identify the impact of this pandemic on the geriatric population. Here, we present two aspects of COVID-19, i.e., (i) physical effects, including frailty and aggravation of age-related comorbidities, and (ii) psychosocial effects of COVID-19-induced changes. COVID-19 is known to have poor prognosis in the elderly because it tends to be more severe in that population.1 There might be an association between angiotensin-converting enzyme (ACE) 2 levels and COVID-19 infection,2 and obese and diabetic patients may have increased ACE2 levels.3, 4 Therefore, patients with these diseases should be cautious of susceptibility and aggravation of COVID-19 infection. Although the long-term effects of COVID-19 infection on humans are unclear, the potential effects of excessive cytokines have been reported; inflammatory cytokines can cause frailty,5 cognitive deterioration6 and cardiovascular disease.7 Thus, further research is needed to investigate the effects of COVID-19 on various age-related diseases in addition to frailty. COVID-19 infections have a tremendous effect on the affected individual and the population due to the need for self-restraint and social distancing. Japan has experienced the 2011 Great East Japan Earthquake and the 2016 Kumamoto Earthquake, and has developed medical care for disasters. During this pandemic, several situations similar to those observed during natural disasters have emerged for the elderly. Decreased physical activity can cause hyperglycemia, increased susceptibility to infection, increased cardiovascular diseases, worsened psychological state, worsened cognitive function and more bone joint diseases. Social interaction is particularly important for the elderly. The battle with the COVID-19 pandemic is expected to last a long time, and this situation affects not only our daily life, but also our mental health. Mental health issues, including depression, discontent, hopelessness, hostility, anger and life events can cause incidents of stroke or cardiovascular disease and increase mortality.8 Behavioral and psychological symptoms of dementia may worsen. In contrast, protective psychological factors against stressors that include optimism, positive coping style, positive attitude toward aging and sense of coherence are related to a reduced incidence of stroke.8 Psychosocial interventions are crucial for the elderly people during and after the COVID-19 pandemic to prevent stroke and cardiovascular disease. To maintain the physical functions and daily routine of the elderly, the JGS recommends eight points related to the following three aspects: (i) exercise and nutrition, (ii) oral function, and (iii) social support (Fig. 1). It has been challenging to achieve these proposed practices and encourage people. Moreover, there are several unresolved issues: How do we restore our daily life? Is there any other communication option aside from calling our families? Is it not important to have an outpatient visit along with telephone consultation? To resolve these points, we need to develop a new medical care system for the elderly in consultation with clinicians, healthcare workers and researchers across the globe. Encouraging and educating the elderly in the use of personal computers could enable online group exercise therapy sessions, nutrition guidance and social networking. Information technology, including robots, would provide support for activities of daily living in older people with disabilities and psychological problems.9 These innovative strategies can create a new geriatrics in parallel with traditional face-to-face care for the elderly. Maintaining social connectivity will help us remain healthy in the current pandemic situation. On April 16, Captain Tom Moore, a 99-year-old army veteran, walked the last 10 laps from 100 backyard lengths as he reached his 100-year-old birthday to raise money for the National Health Services in the UK.10 This gesture encouraged people worldwide and conveyed to the elderly “You'll never walk alone,” as he sang. It is necessary to change the message from “just stay home” to “avoid close contact and maintain a physically, mentally, and socially active lifestyle.” We pay homage to the Japan Geriatrics Society (Prof. Masahiro Akishita, President) and the Subcommittee on Frailty and Sarcopenia (Dr. Hidenori Arai, Chairman) for their prompt announcement to prevent frailty during the pandemic. The authors declare no conflict of interest.