Frailty and cognitive changes in the COVID-19 era

As we return to lockdown in the wake of rising cases of Covid-19, and a winter of social isolation and increased anxiety beckons, we need to consider the long-term impact of social distancing measures on the oldest members of the population.

My PhD, identifying and working with those living with physical frailty and cognitive impairment, began in December 2019 and has inevitably been overshadowed, compromised and shaped by the situation we all find ourselves in. Physical frailty, a state of physical decline that leads to vulnerability to illness, and cognitive impairment are commonly seen in the oldest members of our population. Additionally, people can have both physical frailty and cognitive impairment. Those living with both physical and cognitive decline are more at risk of having a poor quality of life and worse health outcomes. Policy acknowledges the terrible risk Covid-19 presents to this group as many were asked to shield themselves from others earlier in the year to reduce risks.

Factors which contribute to physical and cognitive health in later life are complex and interwoven, there is often not one apparent trigger for the onset of decline. However, it is evident that the pathway to healthy ageing is easier for those in financially secure and socially supportive environments. The impact of Covid-19, and social distancing measures, appears to be more keenly felt in those already disadvantaged, evident across all generations.

As part of my PhD I have reviewed the evidence to explore the influence of psychosocial and socioeconomic factors on people living with both physical frailty and cognitive impairment. I found that, higher levels of depressive symptomology, lower levels of education, lower wealth and living alone appear more common in those who experience physical and cognitive decline. Whilst such findings highlight these potential risk factors there is a lack of understanding about how such factors exert their effects. Furthermore, and most importantly, what modifiable factors might present as targets for intervention in the increasingly precarious and constrained environment we find ourselves in.

My PhD will consider how specific psychological and social context might influence the lived experience of ageing. I will work with adults in later life from the Community Ageing Research 75+ (CARE75+) cohort study to hear stories from the past and about their present day lives. This information will gain insight into how they feel their circumstances and experiences have shaped their physical, psychological and social health.

Covid-19 has created an unprecedented situation for healthcare, where short-term risks are prioritised and long-term disadvantages of preventative and protective strategies may appear a distant concern. Reducing burden on the NHS is deservedly paramount. However, social isolation, decreased or delayed access to essential services, high levels of fear and anxiety as well as physical deconditioning are likely to prove catalysts for physical frailty and cognitive impairment. Whilst clinicians turn their expertise to the immediate need, we must consider the long-term outcomes of social distancing measures.

This blog was written by Alison Ellwood, PhD student, Centre of Applied Dementia Studies, University of Bradford (Older people with frailty theme)

Email: | Twitter handle: @ellwood_alison

23 November 2020