Is social connectedness a risk factor for the spreading of COVID-19 among older adults? The Italian paradox

Abstract

Italy was one of the first European countries affected by the new coronavirus (COVID-19) pandemic, with over 105,000 infected people and close to 13,000 deaths, until March 31 st. The pandemic has hit especially hard because of the country's demographic structure, with a high percentage of older adults. The authors explore the possibility, recently aired in some studies, of extensive intergenerational contact as a possible determinant of the severity of the pandemic among the older Italian adults. We analyzed several variables to test this hypothesis, such as the percentage of infected patients aged >80 years, available nursing home beds, COVID-19 incidence rate, and the number of days from when the number of positive tests exceeded 50 (epidemic maturity). We also included in the analysis mean household size and percentage of households comprising one person, in the region. Paradoxically, the results are opposite of what was previously reported. The pandemic was more severe in regions with higher family fragmentation and increased availability of residential health facilities.

August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19

“…LTCF COVID-19 units should receive transfers from within the facility as well as new admissions/re-admissions from COVID-19-positive hospitals. In Lombardy (Italy) however, public policies aimed at discharging COVID-19 cases from hospitals to LTCFs to improve the capacity of the health systems to face the lack of hospital beds are suspected to have also increased the risk of infection in the nursing homes’ hosts [ 43 , 44 ].…”

Does the Coronavirus (COVID-19) Pandemic Call for a New Model of Older People Care?

“…Surprisingly, these entities have been often used to host paucisymptomatic COVID-19 patients, thus resulting in further expansion of the epidemic through both new guests and health personnel (14,15). As a matter of fact, in Italy higher LTCF bedrates appear to be associated with higher infection-rates among older adults (16).…”

Social Frailty in the COVID-19 Pandemic Era

“…Regardless of COVID-19 pandemic, it is known that different aspects of social relations are measured by social isolation and loneliness and both are slightly associated with different health outcomes and also mortality (social isolation to a greater degree than loneliness) (26). Currently, with the spread of COVID-19, social connectedness not necessarily is associated to higher mortality rate among older Italian adults (27). Inversely, variables associated with social isolation are found to be risk factors for an increased proportion of mortality in Italian patients aged 80 years and over.…”

“…Inversely, variables associated with social isolation are found to be risk factors for an increased proportion of mortality in Italian patients aged 80 years and over. The conclusion could be that social relationships during a crisis impacting the frailest populations are a protective factor against increased mortality rates (27). Considering the lack of data on the acute effects of the illness, in terms of applicability to COVID-19, inferences must be drawn with care.…”