Aging, Social Distancing, and COVID-19 Risk: Who is more Vulnerable and Why?

Abstract

Perceived social support represents an important predictor of healthy aging. The global COVID-19 pandemic has dramatically changed the face of social relationships and revealed elderly to be particularly vulnerable to the effects of social isolation. Social distancing may represent a double-edged sword for older adults, protecting them against COVID-19 infection while also sacrificing personal interaction and attention at a critical time. Here, we consider the moderating role of social relationships as a potential influence on stress resilience, allostatic load, and vulnerability to infection and adverse health outcomes in the elderly population. Understanding the mechanisms how social support enhances resilience to stress and promotes mental and physical health into old age will enable new preventive strategies. Targeted social interventions may provide effective relief from the impact of COVID-19-related isolation and loneliness. In this regard, a pandemic may also offer a window of opportunity for raising awareness and mobilizing resources for new strategies that help build resilience in our aging population and future generations.

Keywords: COVID-19; aging; allostasis; allostatic load; confinement; lockdown; novel coronavirus; nursing homes; physical distancing; senior care; social distancing; social isolation; two-hit model.

Figure 1.

Overview of relevant literature that discussed link social support, stress response and/or immune status to the chances of healthy aging.

Figure 2.

Representation of hypothetical mechanisms that potentially affect the impact of social relationships in humans. Positive social relationships are characterized by reduced HPA axis activity, which translate into positive emotions in a sex-dependent manner. Via biological mediators, such as epigenetic regulation, and via expression of the peptide hormone oxytocin, both the HPA axis and the positive emotional state will affect the resilience, coping and mental wellbeing, and ultimately promote healthy aging and longevity.

Figure 3.

The two-hit model of vulnerability to COVID-19 infection in older individuals. According to the two-hit model of stress, developmental or lifetime stress exposure represent the first hit that makes an older individual more vulnerable to experiencing a second hit, such as social isolation, as being stressful. The cumulative impact of perceived stress may potentially reduce the resilience when faced by a COVID-19 immune challenge.