COVID-19, loneliness, social isolation and risk of dementia in older people: a systematic review and meta-analysis of the relevant literature

Who is essential in care? Reflections from the pandemic’s backstage

“…3 But beyond mere neglect, there is evidence that when public health interventions, aimed at containing the impact of the pandemic, are ethically blind for the backstage-understood as the sum of those unacknowledged, but at the same time indispensable framework conditions that must be met for any society to thrive-they will inevitably exacerbate the impact of these determinants on those most vulnerable and eventually even thwart the success of measures at the frontstage. 7,8 A sad reminder of this fatal dynamic is the evidence about the deleterious effects of the prolonged (and in many facilities still ongoing) social isolation of vulnerable populations facing disorders of consciousness and other illnesses, frailty, or imminent death 3,9,10 which has been based on a predominantly biological account of vulnerability. 11 At the heart of this account stood the conceptualization of Covid-19 not as a syndemic 4 , requiring tailored answers to different patterns of vulnerability, but basically as a plague, to be solely averted by the logic of lockdown and measures of physical distancing.…”

“…There has been a lot of talk about "ethical dilemmas" surrounding nursing homes under the pandemic. Having in mind the "backstage" of many nursing homes and their metamorphosis into "total institutions," 23 the evidence about the immense suffering and deaths through prolonged segregation and physical disruption of core relationships, 9,10,12,13,15 but also the scant evidence of these drastic measures in preventing viral spread in nursing homes, 24 the term "ethical dilemma" appears both belittling and hurting. As aforementioned, in contrast a "bureaucratic model of morality" (p. 119) 1 Little contends that affect-not detached reasoning-is crucial for moral knowledge.…”

“…A sad reminder of this fatal dynamic is the evidence about the deleterious effects of the prolonged (and in many facilities still ongoing) social isolation of vulnerable populations facing disorders of consciousness and other illnesses, frailty, or imminent death 3,9,10 which has been based on a predominantly biological account of vulnerability. 11 At the heart of this account stood the conceptualization of Covid-19 not as a syndemic 4 , requiring tailored answers to different patterns of vulnerability, but basically as a plague , to be solely averted by the logic of lockdown and measures of physical distancing.…”

“…But as available data strongly suggest, 13,15 not only the institutional implementation of such a biological vulnerability was ineffective in preventing high rates of nursing home deaths from Covid-19 but it also resulted in a fatal collapse both in quality of life and quality of care, and increased social vulnerability, which in turn negatively impacted biological vulnerability. 9,10,13,14 In this line of thinking, already the idea of distinguishing a front- from a backstage of the pandemic turns out to be deceptive, as it may evoke a false dichotomy between the biological and the social, resp. the mandatory of saving “lives” (the frontstage) and the optional of saving “livelihoods” (the backstage) in public health responses.…”

Knowing Well, Being Well: well-being born of understanding

“…This report summarizes decades of evidence on the health effects of SIL by researchers spanning continents and fields of study. These data, including systematic reviews and meta-analyses, find substantial evidence that SIL increases the risk for depression, 6 dementia, 7 cardiovascular disease and stroke, 8 and risk for premature all-cause mortality. 9 This report concludes that the evidence points to significant mental, cognitive and physical health morbidities with the strongest evidence associated with risk for premature mortality.…”