Fayaz Ahmad Paul
The unprecedented crisis of the COVID-19 has spread throughout the world affecting almost all countries, with rising levels of anxiety among affected and unaffected nations. Most nations have resorted to quarantine, lockdown and curfew to contain the community transmission of infection. All these techniques warrant people in the community to stay at home and maintain social distancing. As is the case with most infectious diseases, older adults are the most vulnerable group. In this scenario, they are expected to adhere to these restrictions for extended periods, to minimise the risk of contracting the infection. However, these safety measures pose a risk of social isolation. Visiting community meetings, parks, neighbourhood, places of worship and day centers are possibly the only socialisation channels for most of the elderly. Elderly who live with their families are better placed in this respect; but some of them may still expected to maintain social distancing within their house considering their own existing ailments or COVID symptoms of family members. As younger generation may be busy with various chores, it is quite possible that the elderly may get neglected even when they are with their families. This leads to social and psychological isolation, which may be a contributing factor for poor mental health.
Most preventive measures during infectious disease epidemics focus on prevention of the spread of infection and looking after the physical health of infected person. In this state of crisis, a wide range of psychological problems often accompany the outbreak. Social isolation and loneliness are particularly problematic in old-age due to various reasons such as: decreasing functional limitations, economic and social resources, the death of spouse and relatives, changes in family structures and mobility. Lockdown adds more reasons to this list including: inactivity, repeated exposure to disturbing news related to the pandemic, reminiscences of previous traumatic events (and anxiety associated with those), the interactional problem within family members, and the lack of opportunities to share their worries.
Confinement, loss of usual routine and reduced social and physical contact with others are frequently shown to cause boredom, frustration, and a sense of isolation from the rest of the world, leading to distress.
Social isolation among older adults is a ‘serious public health concern’ because of their heightened risk of cardiovascular, autoimmune, neuro-cognitive, and mental health problems. Social isolation because of a pandemic brings other psychological issues such as: fear of contracting the infection (for self and family members), fear of quarantine or hospitalisation, death (of oneself or family members), fear of being abandoned, anxiety related to day to day provisions, regular health checkup visits and worries about family members living far away. Sleep and appetite problems may become more pronounced in the absence of physical inactivity. Quarantine can further amplify these problems. Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, create dramatic effects. Suicide has been reported, substantial anger generated, and lawsuits brought following the imposition of quarantine in previous outbreaks.
In the context of prolonged lockdown and social distancing, loneliness can become a core component of a variety of psychiatric disorders through a subtly or grossly declared clinical picture.
It may lead to hopelessness and discouragement, which can progress to depressive disorders and potentially self-destructive acts. It may aggravate fears and precipitate one or several types of anxiety disorders, including a variety of phobic syndromes.
