Social distancing, emotional suffering, and cognitive performance in mature and older adults: a literature review

Santos, Gabriela dos; Lima-Silva, Thais Bento

doi:10.1590/1980-5764-DN-2022-0032

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Dementia & Neuropsychologia

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Sumário

View & Review • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2022-0032 copy

Social distancing, emotional suffering, and cognitive performance in mature and older adults: a literature review

Distanciamento social, sofrimento emocional e desempenho cognitivo em adultos maduros e idosos: uma revisão da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Variables related to social distancing can have negative effects on the emotional well-being and cognition of adults and the elderly.

Objective:

The aim of this study was to analyze the available studies that address the relationship between situations of social distancing, socioemotional aspects, and cognition in the lives of mature and older adults.

Methods:

A literature review study was carried out between December 2021 and January 2022, involving the SciELO, PubMed, and ScienceDirect databases, with studies published between February 2018 and December 2021.

Results:

A total of 754 studies were identified, and after selection, 18 were included. Notably, 16 showed significant effects of social distancing on cognition and socioemotional aspects, that is, the greater the social distancing, the lower the capacity for cognitive performance and the higher the index of symptoms of depression and anxiety, for example.

Conclusions:

Greater engagement in social activities and a closer contact with friends and family are protective factors against symptoms of depression and anxiety and cognitive decline.

Keywords:
Physical Distancing; Psychological Distress; Cognition; Aged

Author(s)/year	Objective(s)	Methods	Results/final considerations
Evans et al., 2018¹²12 Evans I, Llewellyn DJ, Matthews FE, Woods RT, Brayne C, Clare L, et al. Social isolation, cognitive reserve, and cognition in healthy older people. PLoS One. 2018;13(8):e0201008. https://doi.org/10.1371/journal.pone.0201008 https://doi.org/10.1371/journal.pone.020...	To examine the relationship between social isolation and cognition in later life, and to consider the role of cognitive reserve in this relationship.	Study type: Longitudinal; Sample: Older adults (n=1524); Variables assessed: Sociodemographic, social isolation, cognitive functions, and cognitive reserve.	Social isolation was associated with cognitive function at baseline and 2-year follow-up. Findings suggest that maintaining a socially active lifestyle in later life may enhance cognitive reserve and benefit cognitive function.
Yu et al., 2020¹³13 Yu B, Steptoe A, Chen Y, Jia X. Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study. Psychol Med. 2020;51(14):2414-21. https://doi.org/10.1017/S0033291720001014 https://doi.org/10.1017/S003329172000101...	To examine the relationships of social isolation and loneliness on cognitive function among older adult.	Study type: Longitudinal; Sample: Older adults aged ≥50 years (n=7661); Variables assessed: Social isolation, loneliness, and cognitive function.	Loneliness after adjusting for additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) was not associated with cognitive decline. By contrast, social isolation was significantly associated with decreases in cognitive functions considering general mental status, particularly episodic memory.
Yang et al., 2020¹⁴14 Yang R, Wang H, Edelman LS, Tracy EL, Demiris G, Sward KA et al. Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults. Age Ageing. 2020;49(4):599-604. https://doi.org/10.1093/ageing/afaa020 https://doi.org/10.1093/ageing/afaa020...	To investigate the potential mediation mechanism of loneliness on the association between social isolation and cognitive functioning among Chinese older adults within their cultural context.	Study type: Longitudinal; Sample: Older adults (n=7410); Variables assessed: Social activity engagement and cognitive functioning.	Results demonstrated that social activity engagement was significantly related to perceived social isolation. Higher level of social isolation was associated with worse cognitive performance.
Pegorari et al., 2021¹⁵15 Pegorari MC, Silva CFS, Araújo FC, Silva JS, Ohara DG, Matos AP, et al. Factors associated with social isolation and loneliness in community-dwelling older adults during pandemic times: a cross-sectional study. Rev Soc Bras Med Trop. 2021;54:1-7. https://doi.org/10.1590/0037-8682-0195-2020 https://doi.org/10.1590/0037-8682-0195-2...	To analyze the association of social isolation and loneliness with socioeconomic, clinical, health characteristics, and COVID-19-related variables among older adults.	Study type: Cross-sectional; Sample: Older adults (n=86); Variables assessed: Sociodemographic, psychosocial, physical status, and feelings related to the pandemic.	A moderate positive correlation was identified between loneliness and number of diseases, and a weak positive correlation between loneliness and number of medications and depressive symptoms and risk for sarcopenia. Higher loneliness scores were associated with a greater number of diseases.
Read et al., 2020¹⁶16 Read S, Comas-Herrera A, Grundy E. Social isolation and memory decline in later-life. J Gerontol B Psychol Sci Soc Sci. 2020;75(2):367-76. https://doi.org/10.1093/geronb/gbz152 https://doi.org/10.1093/geronb/gbz152...	To investigate associations between level and changes in social isolation and in memory in older men and women.	Study type: Longitudinal; Sample: Older adults aged ≥50 years (n=11,233); Variables assessed: Aspects of cognitive functioning, socioeconomic variables, social isolation, and depressive symptoms.	Based on date collected between 2002 and 2012, there was a perceived increase in social isolation over time and concomitant decrease in cognitive capacity.
Besselaar et al., 2021²³23 Besselaar JH, Vroomen JLM, Buurman BM, Hertogh CMPM, Huisman M, Kok AAL, et al. Symptoms of depression, anxiety, and perceived mastery in older adults before and during the COVID-19 pandemic: Results from the Longitudinal Aging Study Amsterdam. J Psychosom Res. 2021;151:1-7. https://doi.org/10.1016/j.jpsychores.2021.110656 https://doi.org/10.1016/j.jpsychores.202...	To assess depressive and anxiety symptoms and perceived mastery after the first wave of the COVID-19 pandemic compared to previous years in community-dwelling older adults.	Study type: Longitudinal; Sample: Older adults aged ≥55 years (n=1068); Variables assessed: Depressive symptoms, anxiety symptoms, and functional capacity.	Results revealed no significant increases in depressive or anxious symptoms of participants. This might be because older adults have better coping strategies.
Arai et al., 2021²⁴24 Arai A, Khaltar A, Ozaki T, Katsumata Y. Influence of social interaction on behavioral and psychological symptoms of dementia over 1 year among long-term care facility residents. Geriatr Nurs. 2021;42(2):509-16. https://doi.org/10.1016/j.gerinurse.2020.09.008 https://doi.org/10.1016/j.gerinurse.2020...	To investigate the effect of social interaction on BPSD among long-term care facility residents over 1 year.	Study type: Longitudinal; Sample: Older adults diagnosed with dementia/symptoms of pathological cognitive decline (n=220); Variables assessed: Sociodemographic, health conditions, activities of daily living, cognitive functions, and BPSD.	Results showed an association between activity participation, relationships with residents, and communication with family/relatives. Of the outcomes assessed, frequent communication with family/relatives was associated with lower severity of BPSD.
Santini et al., 2020²⁵25 Santini ZI, Jose PE, York-Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5(1):62-70. https://doi.org/10.1016/S2468-2667(19)30230-0 https://doi.org/10.1016/S2468-2667(19)30...	To analyze the relationship of social distancing, perceptions of social isolation with anxiety, and depression symptoms in older adults.	Study type: Longitudinal; Sample: Older adults aged 57–85 years (n=3005); Variables assessed: Aspects related to social distancing, perceived isolation, and symptoms of depression and anxiety.	Individuals with less social connectedness had higher perceived isolation and higher depression and anxiety symptoms.
Kobayashi and Steptoe, 2018²⁶26 Kobayashi LC, Steptoe A. Social isolation, loneliness, and health behaviors at older ages: longitudinal cohort study. Ann Behav Med. 2018;52(7):582-93. https://doi.org/10.1093/abm/kax033 https://doi.org/10.1093/abm/kax033...	To examine the associations between social isolation, loneliness, and engagement in health behaviors over 10 years among older adults.	Study type: Longitudinal; Sample: Healthy older adults without dementia (n=3,392); Variables assessed: Social isolation, loneliness, and health behaviors, besides socioeconomic covariables and depressive symptoms.	Individuals with higher levels of social isolation had greater prevalence of depressive symptoms. Loneliness was associated with the presence of chronic diseases.
Lara et al., 2019²⁷27 Lara E, Caballero FF, Rico-Uribe LA, Olaya B, Haro JM, Ayuso-Mateos JL, et al. Are loneliness and social isolation associated with cognitive decline? Int J Geriatr Psychiatry. 2019;34(11):1613-22. https://doi.org/10.1002/gps.5174 https://doi.org/10.1002/gps.5174...	To examine the association of loneliness and social isolation on cognition over a 3-year follow-up period in middle- and older-aged adults.	Study type: Longitudinal; Sample: Older adults aged ≥50 years (n=1691); Variables assessed: Loneliness, social isolation, and cognition.	Loneliness and social isolation were significantly associated with lower cognitive scores. The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression.
Okamoto and Kobayashi, 2021²⁸28 Okamoto S, Kobayashi E. Social Isolation and Cognitive Functioning: A Quasi-Experimental Approach. J Gerontol B Psychol Sci Soc Sci. 2021;76(7):1441-51. https://doi.org/10.1093/geronb/gbaa226 https://doi.org/10.1093/geronb/gbaa226...	To assess the relationship between social isolation and cognitive functioning.	Study type: Cross-sectional; Sample: Older adults (n=11,732); Variables assessed: Social isolation index, cognitive functions, health-related aspects, and sociodemographic data.	For both men and women, the association between social isolation and cognitive functioning was significant. This association, however, was not confirmed after further statistical analyses.
Souza-Filho et al., 2021²⁹29 Souza-Filho ZA, Nemer CRB, Teixeira E, Neves ALM, Nascimento MHM, Medeiros HP, et al. Fatores associados ao enfrentamento da pandemia da COVID-19 por pessoas idosas com comorbidades. Esc Anna Nery. 2021;25:1-9. https://doi.org/10.1590/2177-9465-EAN-2020-0495 https://doi.org/10.1590/2177-9465-EAN-20...	To identify factors associated with coping with the COVID-19 pandemic by older adults with and without comorbidities.	Study type: Cross-sectional; Sample: Older adults (n=569); Variables assessed: Sociodemographic, occupational activities, and emotions related to COVID-19.	There was a positive association of emotions of the older adults with comorbidities, where this group had twice the odds of reporting frequent crying during the pandemic.
Saraiva et al., 2021³⁰30 Saraiva MD, Apolinario D, Avelino-Silva TJ, Tavares CAM, Gattás-Vernaglia IF, Marques-Fernandes C, et al. The impact of frailty on the relationship between life-space mobility and quality of life in older adults during the COVID-19 pandemic. J Nutr Health Aging. 2021;25(4):440-7. https://doi.org/10.1007/s12603-020-1532-z https://doi.org/10.1007/s12603-020-1532-...	To investigate the relationship between life-space mobility and QoL in older adults with and without frailty during the COVID-19 pandemic.	Study type: Multicenter, prospective cohort; Sample: Older adults (n=557); Variables assessed: Mobility, frailty, demographics, comorbidities, cognition, functionality, QoL, loneliness, depression, and anxiety.	Mobility was restricted in 79% of participants and affected QoL for 77%. No significant results were found for depressive symptoms and anxious symptoms associated with the pandemic were observed in 19% of participants.
Savci et al., 2021³¹31 Savci C, Akinci AC, Usenmez SY, Keles F. The effects of fear of COVID-19, loneliness, and resilience on the quality of life in older adults living in a nursing home, Geriatr Nurs. 2021;42(6):1422-8. https://doi.org/10.1016/j.gerinurse.2021.09.012 https://doi.org/10.1016/j.gerinurse.2021...	To evaluate the fear of COVID-19, loneliness, resilience, and QoL levels in older adults in a nursing home during the pandemic, and the effects of these variables and descriptive characteristics on QoL.	Study type: Cross-sectional; Sample: Older adult residents of LTCF (n=103); Variables assessed: Sociodemographic, cognition, QoL, resilience, fear, and loneliness.	Results showed that social distancing, loneliness, and physical characteristics had the greatest impact on QoL. Fear was regarded as a protective aspect for health.
Di-Santo et al., 2020³²32 Di-Santo SG, Franchini F, Filiputti B, Martone A, Sannino S. The effects of COVID-19 and quarantine measures on the lifestyles and mental health of people over 60 at increased risk of dementia. Front Psychiatry. 2020;11:1-14. https://doi.org/10.3389/fpsyt.2020.578628 https://doi.org/10.3389/fpsyt.2020.57862...	To explore the effects of COVID-19 and quarantine measures on lifestyles and mental health of elderly at increased risk of dementia.	Study type: Cross-sectional; Sample: Elderly without dementia, but diagnosed with MCI or SCD (n=126); Variables a ssessed: Sociodemographic, cognitive functions, functional capacity, factors associated with COVID-19 pandemic, and psychological aspects.	There was an association of reduction in leisure activity with anxiety symptoms. Also, living alone was associated with greater presence of depressive symptoms.
Song et al., 2019³³33 Song D, Yu D, Li P, Sun Q. Identifying the factors related to depressive symptoms amongst community-dwelling older adults with mild cognitive impairment. Int J Environ Res Public Health. 2019;16(18):1-11. https://doi.org/10.3390/ijerph16183449 https://doi.org/10.3390/ijerph16183449...	To investigate the significant sociodemographic, lifestyle-related, and disease-related correlates of depressive symptoms among older adults.	Study type: Cross-sectional; Sample: Older adults with MCI (n=154); Variables assessed: Sociodemographic, cognitive functions, and depressive symptoms.	The prevalence of depressive symptoms among Chinese older adults with MCI was 31.8%. The analysis showed that poor perceived positive social interaction, small social network, low level of physical activity, poor functional status, subjective memory complaint, and poor health perception were correlated with depressive symptoms.
Ribeiro et al., 2018³⁴34 Ribeiro VS, Rosa RS, Sanchez GJC, Ribeiro IJS, Cassotti CA. Calidad de vida y depresión en idosos en el contexto domiciliar. Enferm Actual Costa Rica. 2018;(34):53-66. https://doi.org/10.15517/revenf.v0i34.30983 https://doi.org/10.15517/revenf.v0i34.30...	To analyze the relationship between QoL and depressive symptoms of older adults from a domestic setting.	Study type: Cross-sectional; Sample: Older adults (n=228); Variables assessed: Sociodemographic, cognitive functioning, depressive symptoms, and QoL.	The prevalence of depressive symptoms was 31.1%. On the final regression model, the physical, psychological, sensory, and intimacy domains continued to be a protective factor, and social participation was a risk factor for depressive symptoms. Thus, depression symptoms were associated with low perceived QoL in older adults.
Taylor et al., 2018³⁵35 Taylor HO, Taylo, RJ, Nguyen AW, Chatters L. Social isolation, depression, and psychological distress among older adults. J Aging Health. 2018;30(2):229-46. https://doi.org/10.1177/0898264316673511 https://doi.org/10.1177/0898264316673511...	To investigate the impact of objective and subjective social isolation on depressive symptoms and psychological distress among a national sample of older adults.	Study type: Cross-sectional; Sample: Older adults aged ≥55 years (n=1439); Variables assessed: Socioeconomic, depressive symptoms, objective, and subjective social isolation.	Objective social isolation was unrelated to depressive symptoms, whereas subjective social isolation from both family and friends and from friends only was associated with more depressive symptoms.

Impacts	Reference number
Impact on depression and/or anxiety	²⁹29 Souza-Filho ZA, Nemer CRB, Teixeira E, Neves ALM, Nascimento MHM, Medeiros HP, et al. Fatores associados ao enfrentamento da pandemia da COVID-19 por pessoas idosas com comorbidades. Esc Anna Nery. 2021;25:1-9. https://doi.org/10.1590/2177-9465-EAN-2020-0495 https://doi.org/10.1590/2177-9465-EAN-20... , ³⁰30 Saraiva MD, Apolinario D, Avelino-Silva TJ, Tavares CAM, Gattás-Vernaglia IF, Marques-Fernandes C, et al. The impact of frailty on the relationship between life-space mobility and quality of life in older adults during the COVID-19 pandemic. J Nutr Health Aging. 2021;25(4):440-7. https://doi.org/10.1007/s12603-020-1532-z https://doi.org/10.1007/s12603-020-1532-... , ²⁵25 Santini ZI, Jose PE, York-Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5(1):62-70. https://doi.org/10.1016/S2468-2667(19)30230-0 https://doi.org/10.1016/S2468-2667(19)30... , ²⁶26 Kobayashi LC, Steptoe A. Social isolation, loneliness, and health behaviors at older ages: longitudinal cohort study. Ann Behav Med. 2018;52(7):582-93. https://doi.org/10.1093/abm/kax033 https://doi.org/10.1093/abm/kax033... , ³²32 Di-Santo SG, Franchini F, Filiputti B, Martone A, Sannino S. The effects of COVID-19 and quarantine measures on the lifestyles and mental health of people over 60 at increased risk of dementia. Front Psychiatry. 2020;11:1-14. https://doi.org/10.3389/fpsyt.2020.578628 https://doi.org/10.3389/fpsyt.2020.57862...
Impact on cognition	¹³13 Yu B, Steptoe A, Chen Y, Jia X. Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study. Psychol Med. 2020;51(14):2414-21. https://doi.org/10.1017/S0033291720001014 https://doi.org/10.1017/S003329172000101... , ¹⁴14 Yang R, Wang H, Edelman LS, Tracy EL, Demiris G, Sward KA et al. Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults. Age Ageing. 2020;49(4):599-604. https://doi.org/10.1093/ageing/afaa020 https://doi.org/10.1093/ageing/afaa020... , ¹⁶16 Read S, Comas-Herrera A, Grundy E. Social isolation and memory decline in later-life. J Gerontol B Psychol Sci Soc Sci. 2020;75(2):367-76. https://doi.org/10.1093/geronb/gbz152 https://doi.org/10.1093/geronb/gbz152... , ³⁵35 Taylor HO, Taylo, RJ, Nguyen AW, Chatters L. Social isolation, depression, and psychological distress among older adults. J Aging Health. 2018;30(2):229-46. https://doi.org/10.1177/0898264316673511 https://doi.org/10.1177/0898264316673511... , ¹²12 Evans I, Llewellyn DJ, Matthews FE, Woods RT, Brayne C, Clare L, et al. Social isolation, cognitive reserve, and cognition in healthy older people. PLoS One. 2018;13(8):e0201008. https://doi.org/10.1371/journal.pone.0201008 https://doi.org/10.1371/journal.pone.020... , ²⁷27 Lara E, Caballero FF, Rico-Uribe LA, Olaya B, Haro JM, Ayuso-Mateos JL, et al. Are loneliness and social isolation associated with cognitive decline? Int J Geriatr Psychiatry. 2019;34(11):1613-22. https://doi.org/10.1002/gps.5174 https://doi.org/10.1002/gps.5174... , ²⁸28 Okamoto S, Kobayashi E. Social Isolation and Cognitive Functioning: A Quasi-Experimental Approach. J Gerontol B Psychol Sci Soc Sci. 2021;76(7):1441-51. https://doi.org/10.1093/geronb/gbaa226 https://doi.org/10.1093/geronb/gbaa226...
Impact on depression, anxiety, and cognition	²⁴24 Arai A, Khaltar A, Ozaki T, Katsumata Y. Influence of social interaction on behavioral and psychological symptoms of dementia over 1 year among long-term care facility residents. Geriatr Nurs. 2021;42(2):509-16. https://doi.org/10.1016/j.gerinurse.2020.09.008 https://doi.org/10.1016/j.gerinurse.2020... , ³³33 Song D, Yu D, Li P, Sun Q. Identifying the factors related to depressive symptoms amongst community-dwelling older adults with mild cognitive impairment. Int J Environ Res Public Health. 2019;16(18):1-11. https://doi.org/10.3390/ijerph16183449 https://doi.org/10.3390/ijerph16183449...
Impact on quality of life	³⁴34 Ribeiro VS, Rosa RS, Sanchez GJC, Ribeiro IJS, Cassotti CA. Calidad de vida y depresión en idosos en el contexto domiciliar. Enferm Actual Costa Rica. 2018;(34):53-66. https://doi.org/10.15517/revenf.v0i34.30983 https://doi.org/10.15517/revenf.v0i34.30...
Impact on quality of life and depression	³¹31 Savci C, Akinci AC, Usenmez SY, Keles F. The effects of fear of COVID-19, loneliness, and resilience on the quality of life in older adults living in a nursing home, Geriatr Nurs. 2021;42(6):1422-8. https://doi.org/10.1016/j.gerinurse.2021.09.012 https://doi.org/10.1016/j.gerinurse.2021...

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[1] Correspondence: Thais Bento Lima-Silva; Email: gerontologathais@gmail.com.