April 9, 2020
[Excerpts] With the world in the grip of the covid-19 pandemic, unprecedented restrictions have been placed on social freedoms.
Social isolation is associated with increased morbidity from chronic disease and with higher all-cause mortality. Detrimental health behaviours, such as smoking and reduced physical activity may mediate over 30% of this effect. [2,3] Both subjective and accelerometer data from adults aged 50-81 indicated that social isolation is independently associated with reduced physical activity and increased sedentary time, suggesting that this may play a role in the increased risk of disease. [4,5] Current Chief Medical Officer (CMO) guidance for older adults recommends 150 minutes of moderate intensity aerobic activity, or 75 minutes of vigorous intensity activity accumulated each week, in addition to weight-bearing activities and the breaking up of sedentary time with light activity.  In adults aged over 60 years, even doses of activity below this are associated with a 22% reduction in all-cause mortality.  Additional gains are seen in functional ability and reduced risk of falls, whereas sedentary time is associated with increased indices of frailty.  One challenge during the covid-19 pandemic is therefore mitigating the adverse effects of isolation and maintaining physical activity levels in older adults to protect health when social networks and access to exercise and leisure facilities are reduced. Furthermore, the current situation is different from previous studies of social isolation given the additional impacts of fear and uncertainty, with no certain endpoints from the pandemic.
Social isolation also has significant implications for mental health in the elderly. Perceived social isolation and loneliness lead to a wide range of psychological symptoms, including depression and anxiety, and impact negatively on quality of life.Enforced social isolation in the context of a pandemic may, however, be very different to that arising in normal circumstances. A recent rapid review on the psychological impact of quarantine in disease outbreaks found links to anxiety, depression and symptoms of post-traumatic stress, with some evidence that these could persist long-term.  Factors associated with negative outcomes included quarantine for over 10 days, fears relating to infection, frustration and boredom, and lack of information and supplies.
Given the unprecedented nature of the current outbreak measures, there is a lack of evidence for the impact of measures which are currently expected to last at least 12 weeks. However, extrapolating on what we know about the negative effects of both social isolation in the elderly and short quarantine times, the impact could be considerable. Avenues for mitigation could involve web-based solutions, and smartphone-based videoconferencing for nursing home residents which can lead to reduced subjective feelings of loneliness and pain scores.  However, there will be issues with access and ease of use of technology for isolated older individuals, with 47% of over 75s never having used the internet.  We suggest a three-tiered approach. First, dedicated online, television and radio resources for older adults, providing access to mental health, physical activity and dietary advice, in addition to guidance on the use of digital tools to maintain connections with friends and family. Second, at an individual level, clinicians can help guide older adults with brief physical activity advice.
To access the entire article, click on: https://blogs.bmj.com/bmj/2020/04/09/the-effects-of-isolation-on-the-physical-and-mental-health-of-older-adults/