Social health

Social distancing challenges social health. Social health is a new paradigm bridging biomedical and social sciences by emphasizing the role of social interaction in managing health, formulated as the ability to adapt and self-manage. Social health reflects the competencies of the individual to participate in social interaction and the influence of the social environment on the individual’s balance of capacities and limitations (Huber et al., Reference Huber2011; Vernooij-Dassen et al., Reference Vernooij-Dassen2019). Social health ranges from a flourishing social life to loneliness. It is a dynamic process in which the individual is the conductor. Conducting complex social processes seems to be supported by wisdom. Wisdom might affect the quality of social relationships positively: loneliness has been found to be correlated strongly and inversely with wisdom (Lee et al., Reference Lee2019). In contrast to public opinion, loneliness severity and age had a nonlinear relationship with increased loneliness in the late 20s, mid 50s, and late 80s (Lee et al., Reference Lee2019). Social distancing restricts individuals reaching out to their social environment and vice versa. It also deprives older adults from meetings that allow them to fulfill spiritual needs and meet family and friends. For instance, for many Filipinos going to church on Sunday followed by family gatherings is a tradition they look forward to, but now adds to a sense of sadness (Buenaventura et al., Reference Buenaventura, Ho and Lapid2020). Thus, social distancing deprives people of the many valuable assets of social health: face-to-face interactions characterized by sharing emotions such as pleasure as well as physical closeness.

Face-to-face interactions have been replaced by e-communications. Technology is a great communication facilitator. But older adults need more than virtual contacts. When older adults are facing the challenges of social isolation, they are particularly vulnerable to rapid decline (Steinman et al., Reference Steinman, Perry and Perissinotto2020). This is especially evident in long-term care facilities.

In long-term care facilities, there is not only a high virus outbreak but also an outbreak of loneliness. Dying alone, due to the social distancing measures, is major fear and the last thing we want. The tragedy is that the very measure designed to protect older adults (namely, social isolation) endangers their quality of life and even their quality of dying.

Mental health

Social distancing in its extreme form by quarantine and social isolation during previous periods of severe coronavirus outbreaks has been found to be associated with mental health problems such as depression, anxiety, and stress (Rohr et al., Reference Rohr, Muller, Jung, Apfelbacher, Seidler and Riedel-Heller2020). More than 50% of Chinese people participating in a COVID-19 study (n = 1210) rated negative psychological impact of the outbreak, with 28.8% of the participants reporting moderate to severe anxiety (Wang et al., Reference Wang2020).

Cognitive functioning

Quarantine had negative associations with cognitive functioning (Rohr et al., Reference Rohr, Muller, Jung, Apfelbacher, Seidler and Riedel-Heller2020). These risks need more attention especially since social distancing may be mandatory for a longer period in some cases.

There is a striking consistency between these results and those of dementia research. A lack of social interaction is associated with incident dementia (Kuiper et al., Reference Kuiper2015). Conversely, epidemiological data indicate that a socially integrated lifestyle had a favorable influence on cognitive functioning (Bellou et al., Reference Bellou, Belbasis, Tzoulaki, Middleton, Ioannidis and Evangelou2017) and could postpone the onset of dementia (Fratiglioni et al., Reference Fratiglioni, Paillard-Borg and Winblad2004). Hypothetically, social interactions may trigger reactions which might require the use of preexisting cognitive processes or activating compensatory approaches (Fratiglioni et al., Reference Fratiglioni, Paillard-Borg and Winblad2004; Vernooij-Dassen et al., Reference Vernooij-Dassen2019).

How to explain this potential of the brain to improve cognitive functioning? It is in the plasticity of the brain. The plasticity of the brain allows activating preexisting cognitive processes or activating compensatory approaches: the cognitive reserve (Fratiglioni et al., Reference Fratiglioni, Paillard-Borg and Winblad2004). This is a very promising angle in dementia research.

But what is the working mechanism in relation to social health?

We hypothesize that social health can act as the driver for accessing cognitive reserve through active utilization of social resources (Vernooij-Dassen et al., Reference Vernooij-Dassen2019). It reflects hope on how to prevent dementia and to mitigate its consequences. Social interactions for humans are like water for plants.

Social interactions during the COVID-19 crisis are embedded within intergenerational solidarity. With an impressive intergenerational solidarity, the first outbreak wave has been managed. But intergenerational solidarity is shifting. Younger generations want to resume normal life and suggestions are being made about excluding those aged 60 plus from societal activities in order to regain normality. Ageism is playing a role. Almost one quarter of analyzed tweets during the COVID-19 outbreak had ageist content (Jimenez-Sotomayor et al., Reference Jimenez-Sotomayor, Gomez-Moreno and Soto-Perez-De-Celis2020).

Political decision makers are confronted with these tendencies. In this new unlocking phase of the COVID-19 crisis, it is crucial to reduce the negative consequences by limiting social distancing as much as possible. It is the balance between protection and its risks that counts. This is a call to translate this balance into policies that do not challenge intergenerational solidarity and lead to ageism. Therefore, the needs of all generations should be considered without excluding the older generation.