Consequences for the Elderly After COVID-19 Isolation: FEaR (Frail Elderly amid Restrictions)

Abstract

Older adults rank in the most at-risk segment of the population because the basal functional resilience, meant as the ability to cope with physical trauma and psychological stressors, is fading (Cesari et al., 2017). Aging is physiologically associated with cognitive decline and impaired stress response (Bishop et al., 2010), with the spinal circuitry degeneration leading to progressive alterations of motor performance (Borzuola et al., 2020). This reduced resilience and cognitive impairment intimately coexist in the rampant -definitely endemics- frailty syndrome (Ofori-Asenso et al., 2019), which is known to be associated with disability, traumatic falls, and hospital admission (Eeles et al., 2012). Regrettably, the wearisome settings of hospital wards provide poor incitements to the oldest minds and often oversee the abilities of individuals, who cope with progressive restlessness, dietary impoverishment, and nutrition-related or activity-related sarcopenia (Eeles et al., 2012; Ligthart-Melis et al., 2020). Multidisciplinary interventions, such as the HEPAS approach (Healthy Eating, Physical Activity, and Sleep), are models for dealing with multiple issues simultaneously (Briguglio et al., 2020c). Despite this knowledge, contemporary society, and health services put the older adults in the background. From the most complex digitization of services to the simplest use of public transport, there is “No Country for Old Men” (Ethan and Joel Coen, 2007). It is therefore not surprising that when the new strain coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus of 2019) spilled out to infect humans found not only fertile ground -a population of old people- but also countries ready to choose treating people with more life expectancy. After the outbreak of viral pneumonia in Wuhan, China, (December 2019), SARS-CoV-2 spread rapidly in Europe. Italy resulted among the worst-hit countries with 214.457 infected and 29.684 deaths (May 7, 2020, WHO situation report 108). The northern region of Lombardy accounted for the overall 52.3% of the deaths (May 7, 2020, Italian SARS-CoV-2 Surveillance Group), with the older adults suffering from chronic cardiovascular diseases and malnutrition counting the highest case-fatality ratio (Briguglio et al., 2020b). Considering that the region counted 128.528 subjects over 60 years of age at the beginning of the past year (Annual Italian Census of 2019), we can say that the north of Italy lost over 10% of its older population. This rapid increase of infected severe cases led to a rapid saturation of health facilities in March-April 2020 and public health interventions focused on social isolation, travel restraints, and at-home confinement. Containment measures have been applied with different degrees of restriction in different Italian regions, but the northern regions -the worst-hit- have suffered the most severe lockdown measures. In Lombardy, almost 100.000 older adult residents locked themselves up in the house. Leaving the house was permitted, but only for proven health or job reasons. Interregional travel was also banned. Most commercial activities were shut down, few have been minimized. Buying necessities was allowed, but only one individual per family wearing masks and gloves. To respect social distancing, supermarkets regulated the entrances eventually forming long queues, with people possibly waiting for hours. Priority tickets could be booked online, as well as masks that were sold out by pharmacies but available on various web sites at inflated prices. Eventually, these measures contributed to reduce the impact on health services and the risk of severe illness (Steffens, 2020). Although reasonable and essential, the social lockdown has affected both the bourgeois and the less well-off classes of the population. However, are the vulnerable groups -the older adults- who will be carrying the worse future debt of disability? In the pre-COVID-19 era, over 50% of older adults were known to be at risk of loneliness (with associated morbid events) (Fakoya et al., 2020) and this feature fused with reduced health care capacity during the pandemic. In the COVID-19 era, most medical clinics closed or adhered to special hours and the reorganization of the health system led to a significant reduction in clinical and surgical assistance. These restrictions prevented the older adults from having a continuity of care for their co-existing chronic conditions. The decline in social relations combined with reduced support increase the disability debt, with the reaching of the “social frailty.” Results from a Chinese -another worst-hit country- online survey proved over 50% of respondents rating the psychological impact of COVID-19 moderate-to-severe, with depressive and anxiety symptoms being prevalent (Wang et al., 2020). Dramatic events, such as the loss of a kin, but also anxiety from the fear of being infected and the inability to do something can further compromise the mental health. On one hand, the Italian daily newscast informed the public about the disease severity, reporting hundreds of daily deaths. On the other hand, the indirect fear inherent in those who were watching has been a major side effect. Frailty therefore acquired a mental nature, becoming “psychological frailty” (Gobbens et al., 2012). Older adults require increasing cognitive demand to perform any motor task (Seidler et al., 2010). The COVID-19 restrictions have been not only associated with psychological derangements, but also with an increasing “bed-kitchen-sofa” lifestyle. Low environmental information-processing was consequently prevalent during daytime, with further impairment of age-associated spatial disorientation, proprioception, disequilibrium, and incoordination (Dunsky, 2019). At-home confinement easily led to sarcopenia. The sedentary lifestyle associated with constant stress that decreased the desire to eat....