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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 29-32

The impact of loneliness on physical and mental health among older adults in the era of coronavirus disease 2019 pandemic


Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Date of Submission09-Jan-2021
Date of Decision01-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication11-Mar-2021

Correspondence Address:
Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_3_21

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  Abstract 


Coronavirus disease 2019 (COVID-19) pandemic has a significant negative impact on emotions and feelings of loneliness in terms of lack of companionship, social isolation, and connections in older adults. Compulsive loneliness can negatively alter cognition, mental, and physical health and lifespan in the elderly. Isolation and restricted social interaction in the time of COVID-19 pandemic was clearly connected with the symptoms of mood and behavioral disorders in older adults. The aim of this narrative review was to evaluate the impact of loneliness caused by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health in older adults. Articles regarding the effect of loneliness caused by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health of older adults were searched on PubMed electronic database. Relevant articles were selected; full-text articles were assessed; and significant evidence were extracted. To avoid the negative impact of social isolation on older adults during the era of COVID-19, it is essential to involve older adults in the activities such as physical activity, playing games with their peers, and sightseeing.

Keywords: Coronavirus disease 2019, elderly, loneliness, mental health, public health, social isolation


How to cite this article:
Okechukwu CE. The impact of loneliness on physical and mental health among older adults in the era of coronavirus disease 2019 pandemic. Apollo Med 2021;18:29-32

How to cite this URL:
Okechukwu CE. The impact of loneliness on physical and mental health among older adults in the era of coronavirus disease 2019 pandemic. Apollo Med [serial online] 2021 [cited 2021 Apr 11];18:29-32. Available from: https://www.apollomedicine.org/text.asp?2021/18/1/29/311111


  Introduction Top


Community health social isolation measures implemented because of coronavirus disease 2019 (COVID-19) pandemic has significant health consequences, especially in individuals aged 65 years and above, the mental and physical health in older persons is undesirably affected as a result of the social-distancing measures aimed to curtail the spread of COVID-19.[1] Hence, physical activity and mental health promotion strategies are highly recommended for older adults during the era of COVID-19 pandemic to mitigate chronic diseases and mood disorders.[1],[2],[3],[4],[5],[6],[7],[8] Readiness to tackle and handle older people's loneliness may reduce adverse psychological problem provoked by COVID-19 pandemic, as well as at after the COVID-19 period and lockdown.[9] Van Tilburg et al. collected and analyzed the data from 1679 Dutch rural dwellers between the age group of 65 and 102 years, through an online survey, their feeling of loneliness, social and mental state were evaluated in May 2020.[10] They found out that during the COVID-19 pandemic, the loneliness of elderly persons increased, but their state of mental health were slightly stable, they also found that strategic measures for social isolation did not cause much seclusion; however, individual financial losses or loss of a close friend or family member, fears about COVID-19, and a loss of confidence in public establishments were linked to rise in psychological problems mostly the feeling of loneliness and panic.[10]

Macdonald and Hülür collected the data from 99 older adults in Switzerland who participated in a 3-week assessment survey on social interactions and health in 2019 and in a weekly online study during the period of COVID-19 lockdown in Switzerland.[11] The outcome of their study reveals that the COVID-19 pandemic had significant negative effects on older adults' mental well-being and that it aggravated loneliness in the elderly.[11] However, the social-distancing measures legislated during the era of COVID-19 posed as a hostile factor for older adults mental well-being and may perhaps increase loneliness.[11] However, older adults who were able to sustain social interaction to a reasonable level during the period of COVID-19 had a better mental health and reduced loneliness.[11] Enabling older adults to stay in touch with their social circle based on their personal preferences might reduce the impact that any future lockdown might have on their well-being.[11]

Grossman et al. collected the data from 243 Israeli older adults using an online survey platform, the participants completed the measures of COVID-19-associated mood disorders, loneliness, sleep problems, COVID-19 associated fears, and resilience, they found that COVID-19 related loneliness was associated with increase in sleep difficulties.[12] The connection between loneliness and sleep difficulties was more prevalent among older adults with further COVID-19 associated fears and in those with lesser resilience.[12] Social isolation observed during the COVID-19 pandemic may have unintentional negative effects on social interaction among older adults triggering loneliness and anxiety.[13] Moreover, older persons with already existing psychiatric disorders and those complaining of serious financial difficulty during the COVID-19 pandemic were more likely to develop psychological problem in Italy.[14] Data collected from 38,217 adults from the United Kingdom were examined from March 23, 2020 to April 10, 2020, and the results revealed a significant level of loneliness among numerous citizens.[15] COVID-19 restrictions substantially reduced the social lives of older Japanese adults which over a long period of time can affect their cognitive flexibility.[16] COVID-19 social isolation measures have a severe impact on the mental health of older adults in Uganda, an east African country.[17] Social isolation is likely to lead to reduction in physical activity levels, and consequently, the cardiorespiratory fitness levels and cardiometabolic health in older adults which could result in immune system dysfunction, thus increasing infection vulnerability and aggravating the pathophysiology of chronic conditions that are already prevalent in older adults, comprising of mental disorders, movement disorders, cardiovascular diseases, cancer, and inflammatory conditions.[18] The preventive measures to decrease the risk of COVID-19 are commenced at the detriment of rising the risks of aging-related cardiovascular, musculoskeletal, neurological, and oncologic diseases.[19] Remaining physically active is exceptionally crucial for older adults in the time of COVID-19 pandemic, notwithstanding the fact that before COVID-19 pandemic, many older adults were not engaging in sufficient PA to attain health benefits.[20]

The aim of this narrative review was to evaluate the impact of loneliness caused by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health in older adults.


  Methods Top


Literature search

Articles regarding the effect of loneliness triggered by the public health social isolation measures aimed to curtail the prevalence of COVID-19 on the physical and mental health of older adults were searched on PubMed electronic database. Relevant articles were selected, full-text articles were assessed, and significant evidence were extracted. The MeSH system was used to obtain the relevant research studies from PubMed using the following keywords: COVID-19, OR aging, OR loneliness, OR mental health, OR physical health, OR social isolation, and OR public health. All selected articles were published in English.


  The Association between Coronavirus Disease 2019 Social Isolation Measures, Loneliness, and Deterioration on Physical and Mental Health in the Elderly Top


Wong et al. found that there could be a rise in mental health problems because of the present COVID-19 pandemic and its intervention policies.[21] This might be more detrimental for older adults with multiple chronic diseases, they also found that older patients with multiple illness in primary health care had worse mental and chronic condition after the start of the COVID-19 pandemic.[21] However, being a female, living as a single person, and having multiple chronic disease conditions were related to a greater risk for graver consequences.[21] They also found that older adults who lived single were more likely to suffer from loneliness during the era of COVID-19 pandemic, this was because they depend on family members and friends who they were not living together with for social support, and such support was reduced because of physical distancing during COVID-19.[21] It will be very vital for public health experts to evaluate sensitive alterations in older individuals' mental health, as the length of the COVID-19 social isolation remains uncertain.[22] Adverse mental health effects of the COVID-19 pandemic comprising of suicidal ideation are likely to be prevalent for a lengthy-time even after the COVID-19 pandemic, to decrease suicides during the COVID-19 pandemic, it is very important to lessen mental stress, worry, uncertainties and loneliness in the global population, especially in COVID-19 prevalent countries.[22] Moreover, there should be continuous promotion of social media networks as a medium of interaction among older adults to encourage mental-wellbeing.[23] To reduce loneliness, worry, fear, and psychological stress effective campaign is needed, particularly for older adults with present neuropsychiatric disorders, individuals with history of psychiatric disorders, and among COVID-19 survivors.[23]


  Strategies to Minimize Loneliness and its Effect on Mental and Physical Health of Older Adults in the Era of Coronavirus Disease 2019 Pandemic Top


Social isolation is an unprejudiced state of having few social associations or uncommon social interaction with others, whereas loneliness is a personal emotion of being isolated.[24] Physical isolation and loneliness are serious underrated health risks that distress a substantial population of older adults.[24] The COVID-19 pandemic will have a long-term and profound impact on older adult's health and well-being globally. Social isolation and loneliness are the possible major risk factors that influence elderly health.[24] Policies to tackle these health problems could possibly be applied globally, these approaches comprise of enlightening older adults, their caregivers, and family members on the health consequences of social isolation and loneliness.[24] There is a need to use state-of-the-art technology-based approaches to create the techniques to pinpoint social isolation and loneliness among the elderly people admitted in hospitals or health-care centers and those living in retirement homes.[24] Elderly people should maintain a healthy and balanced nutrition, get adequate sleep, and stay away from heavy alcohol consumption and use of illicit drugs during this period of COVID-19 pandemic.[25] Moreover, there is a need for the utilization of telehealth services to sustain health-care delivery in the era of COVID-19 pandemic.[26]


  Healthy Guidelines for Older Adults in the Era of Coronavirus Disease 2019 Pandemic Top


Older adults should be encouraged to remain associated with their relatives to reinforce social connections during the pandemic. Older adults should adhere to a common sleep-wake cycle, sustain physical activity, and healthy diet. Older adults who are overweight or obese should be encouraged to fast intermittingly, to improve their cardiometabolic health.[27] Older adults should be encouraged to use the electronic platforms such as the social media video-communication platform to interact with friends and family regularly. Older adults should be encouraged to participate in moderate intensity physical exercise training either at home or in protected environment at least for 30 min daily.[28] Lifestyle modules such as mind-body exercises, cognitive behavioral therapy, mental, and spiritual counseling should be delivered to older people through telehealth platforms. Individuals who have an aged parent, sibling or close friend with neurological disorder should be encouraged to have regular communication with them in the era of COVID-19 pandemic.


  Future Directions Top


There is a need for more studies investigating the association between social isolation, social media use, and loneliness among the elderly population in the time of COVID-19 pandemic. There is also the need to investigate the relationship between social isolation, loneliness, and development of neuropsychiatric disorders in the elderly during the era of COVID-19 pandemic, especially in the most-affected countries. Moreover, encouraging home-based physical activity and well-regulated outdoor activities in parks is an effective means to counter the effects of social isolation in older adults, especially those living with chronic diseases associated with senescence and lifestyle behaviors. However, the negative health impacts of long-period of social isolation should be thoroughly examined.


  Conclusion Top


COVID-19 pandemic has a significant negative impact on emotions and feelings of loneliness in terms of lack of companionship, social isolation, and connections among older adults. Older adults felt lack of companionship, felt socially isolated, and had few interactions with their close friends and family members during the time of COVID-19 than in the past years. Compulsive loneliness can negatively alter cognition, mental and physical health, and lifespan in the elderly. Isolation and restricted social interaction in the time of COVID-19 pandemic was clearly connected with the symptoms of mood and behavioral disorders in older adults. Older adults who do not participate in physical exercise and social interaction with peers, feel lonelier than those who participate in frequent physical activity. It is vital to realize the effects of COVID-19 social isolation measures on the overall mental and physical health of older adults and to find the appropriate preventive measures. Rises in loneliness and rare social interaction in older adults during the period of COVID-19 outbreak were majorly because of the preventive policies used to reduce the prevalence of COVID-19 pandemic mostly the social-distancing measures.

Interventions should be set-up to recognize older adults at greater risk of suffering loneliness, isolation, or commonly disengaged from others, especially older adults living on their own and those with neuropsychiatric disorders and chronic diseases in the era of COVID-19 pandemic. The constant use of social media to interact with friends and family members, which could be beneficial for older adults, may perhaps not cushion the thoughts of loneliness for all older adults. Older adults who intermingle with people in their locality and interact with green spaces may feel less lonely. However, individual connections and social activities maybe soared during the COVID-19 pandemic. Nevertheless, offering secure opportunities for routine and significant interaction with others and within the green environment is important to reduce loneliness and maintain social relationships among the elderly in this era. While the COVID-19 pandemic lingers, it is important for decision-makers, physicians, caregivers, and families to tackle the sentiments of loneliness in older adults to prevent its adverse effects on their mental and physical health. However, continual loneliness, adversely affects the mental and physical health of older adults, in addition to accelerating the apparent adverse health condition associated with aging, loneliness leads to an emotional and physical health condition that is more problematic to manage. Moreover, loneliness is more noticeable, when the elderly live alone; this is because of lack of expressive social associations. Persistent loneliness increases depression and anxiety in older adults. However, to avoid the negative impact of social isolation on older adults during the era of COVID-19, it is essential to involve older adults in the activities such as physical activity, playing games with their peers and sightseeing, to help them make new friends and strengthen there already existing friendship bond, and to encourage them to foster new relationship and to share experiences and quality time among themselves.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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1 Editorial
Raju Vaishya,SatishKumar Agarwal
Apollo Medicine. 2021; 18(1): 1
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