Lozupone Madia, La Montagna Maddalena, Di Gioia Ilaria, Sardone Rodolfo, Resta Emanuela, Daniele Antonio, Giannelli Gianluigi, Bellomo Antonello, Panza Francesco
Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
Front Psychiatry. 2020 Nov 3;11:577113. doi: 10.3389/fpsyt.2020.577113. eCollection 2020.
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.
对于严重急性呼吸综合征冠状病毒2（SARS-CoV-2，引发2019冠状病毒病（COVID-19）的病毒），应特别关注并努力保护易感人群，包括体弱的老年人，使其免受或减少与健康相关的不良后果。特别是，早期死亡病例主要发生在体弱的老年人中，这可能是由于免疫系统较弱导致病毒感染进展更快。体弱是一种与年龄相关的多维度临床状况，被定义为一种非特异性的脆弱状态，可识别出跌倒、入住养老院、住院、残疾、痴呆和死亡风险增加的老年人。在体弱的表型中，社会体弱的研究最少。它将社会经济背景的作用视为晚年的一种脆弱状态。COVID-19对所有人群的影响并不相同，社会不平等加剧了感染的传播。众所周知，社会隔离感，如孤独感，会影响身心健康，但与之相关的分子机制，也与免疫系统有关，以及其相关的认知和健康相关后遗症，目前了解甚少。由于封锁导致长期暴露于压力下而产生的心理困扰不断增加，以及支持来源减少，这对个人资源，即自我效能感和人际变量，提出了很高的要求。因此，感知到的孤独可能是与心理困扰相关的一个因素，其本身也是一个结果。在COVID-19大流行时代，正确评估社会体弱对于预防晚年神经精神疾病可能至关重要。
