Social Frailty in the COVID-19 Pandemic Era

Madia Lozupone,Francesco Panza,Maddalena La Montagna,Emanuela Resta,Antonio Daniele,Antonello Bellomo,Ilaria Di Gioia,Gianluigi Giannelli,Rodolfo Sardone

doi:10.3389/fpsyt.2020.577113

Abstract

Special attention and efforts to protect from or reduce health-related outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus triggering coronavirus disease 2019 (COVID-19), should be applied in susceptible populations, including frail older people. In particular, the early death cases occurred primarily in older people with a frailty status, possibly due to a weaker immune system fostering faster progression of the viral infection. Frailty is an age-related multidimensional clinical condition defined as a non-specific state of vulnerability, identifying older people at increased risk of falls, institutionalization, hospitalization, disability, dementia, and death. Among frailty phenotypes, social frailty has been least studied. It considers the role of socioeconomic context as a vulnerability status later in life. COVID-19 does not affect all populations equally, and social inequalities contribute to drive the spread of infections. It was known that the perception of social isolation, e.g., loneliness, affects mental and physical health, but the implicated molecular mechanisms, also related to the immune system, and its associated cognitive and health-related sequelae, are poorly understood. The increasing psychological distress derived by prolonged exposure to stress due to the lockdown scenario, and the reduced sources of support, contributed to making heavy demands on personal resources, i.e., self-efficacy and interpersonal variables. So, perceived loneliness may be a factor associated with psychological distress and an outcome in itself. In the COVID-19 pandemic era, a correct assessment of social frailty may be essential in terms of the prevention of late-life neuropsychiatric disorders.

Highlights

Data coming from epidemiological studies suggest an association between aging and the risk of developing life-threatening health problems and mortality related to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus implicated in coronavirus disease 2019 (COVID-19) [1]
Preliminary data suggested that delirium, confusion, agitation, and altered consciousness, as well as symptoms of depression, anxiety, and insomnia were common in patients with COVID-19 [8]
The etiology of the neuropsychiatric consequences of COVID19 infection is likely multifactorial, including direct effects of viral infection inside the brain, a procoagulant state inducing cerebrovascular disease, a physiological impairment in terms of hypoxia deriving from respiratory failure, the activation of the immunological cascade, and the indirect effects of medical interventions, social isolation, the psychological impact deriving from a novel, severe, potentially fatal illness, concerns about infecting other people, and social stigma

Summary

Introduction

Data coming from epidemiological studies suggest an association between aging and the risk of developing life-threatening health problems and mortality related to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus implicated in coronavirus disease 2019 (COVID-19) [1]. The present perspective article aims to explore the risk of social isolation and loneliness sequelae in older frail adults subjected to isolation measures during the ongoing COVID-19 pandemic, for both preventative and transmissionrestricting purposes. Social participation is an indicator of successful aging and important determinant of health-related outcomes, including mortality [4].

Results

Conclusion