Impact of Social Restriction Imposed by 2019-ncov Pandemic on the Mobility of Older People: A Scope Review Protocol

The 2019 ‐ nCoV pandemic represents a high risk for older people that sustain higher mortality rates compared to young adults. Limited social contact and restriction of mobility in the community (stay-at-home precautions) are recognised as measures to prevent SARS-CoV-2 infection among older people. The impact of these measures on health, physical function and emotional wellbeing are numerous, and might result in long-term adverse outcomes such as disability, falls and limited mobility. Thus, the objective of this scope review is to map the estimated impact of measures of social restrictions on the mobility of older people living in the community and to systematize the existing recommendations, anticipating possible intervention strategies gaps.

Documents and reports with recommendations from governmental and nongovernmental organizations will be consulted. Complete studies available in the English, Spanish or Portuguese languages included in the different methodological approaches (original articles, literature reviews, editorials and guidelines) that necessarily address the recommendations of social restriction measures for preventing Covid-19 disease and their impacts on mobility of older people will be included. Two reviewers will select the studies based on their titles and abstracts. The manuscripts and documents selected for full reading will be analysed by reviewers concerning the eligibility criteria. When disagreements occurred in any phase of the selection process, a third reviewer will be included for a consensus analysis. Data will be extracted using a template form and the PRISMA-ScR checklist will be used to guarantee quality and transparency. Results will be presented as a narrative summary, including tables and gures.

Discussion
Globally, recommendations to stay-at-home and social distancing are substantially affecting health and wellbeing of older people. Preserving mobility is crucial to active and healthy ageing. The evidence summarized in the selected studies will be analysed in order to answer the research questions. The results of this review will help clinical practitioners, health care providers and policy makers to estimate the impact of measures to protect older people from 2019-nCoV and to identify gaps and anticipate needs for targeted interventions to prevent mobility decline.
Systematic review registration submitted on 10-09-2020 in https://osf.io/registries Background Covid-19 is a public health emergency that disproportionately affects older people. The risk of death is higher among older persons (about 15%) when compared to younger people (1) . The disease assumes a more severe manifestation among people with chronic diseases. Around 30% of older adults have multimorbidity, which makes the older population more vulnerable (2) .
Measures of social restriction, such as stay-at-home, social distancing and social isolation are recommended to prevent contamination and the spread of the disease. A meta-analysis carried out with data from 149 countries and regions that implemented one of the ve social distance interventions (closing schools, workplaces and public transportation, restrictions on mass meetings, public events and movement restrictions) showed an overall decrease of 13 % in the incidence of Covid-19 in these locations (3) . Despite the bene ts, this type of intervention can have devastating consequences for the health, functionality and psychological well-being of the elderly (4)(5)(6) .
The concept of social distance is not clear in the literature and generates controversies in the current pandemic because it is commonly used as a synonym for the terms isolation and quarantine. The most widespread conception is that social distance refers to the reduction of interaction between people to reduce the transmission of the virus, while isolation refers to the separation of people who are known to be sick from non-sick and, nally, quarantine refers to the restriction movement of people who were probably exposed to a disease but are not infected or are still in the incubation period. In common, all these measures aim to reduce contact between people and stop the spread of the virus (6,7) .
It is known that con nement at home and the restriction of commuting outside the home reduces the opportunity for engaging in physical, social and health care activities, exposing older people to social isolation, loneliness and the decline in health and mobility (8,9) . About a third of the older adults have mobility di culties, which is considered an early sign of global functional decline (10) . The circumscription to a smaller physical area and decrease in the frequency of displacement of the older people during the pandemic (11) determines a greater restriction of mobility in the living spaces. The consequence of this scenario is worrying, since those with restricted mobility in living spaces are at risk of negative outcomes such as falls, depression, disability, dependence and eventually the need for long-term assistance and services (10,12) .
Although the pandemic takes on different scenarios in regions of the world, since the epidemiological evolution of Covid-19 is dynamic and many countries are already in less restrictive stages in terms of social distance, the negative impact for the older population will remain until a vaccine is developed. The trajectories of transition in mobility as a result of the pandemic are still uncertain. Studies show that older people can spontaneously regain their independence for walking and for personal care activities.
However, these transient states of loss of mobility and functional performance tend to be permanent for the very old, for women, those with physical fragility and cognitive impairment (13,14) .
Although restricting mobility is a dynamic process, it is recognized that interventions to mitigate these negative effects are necessary. In particular, interventions in transition phases for greater commitment, such as the social distance imposed by the pandemic. The identi cation of older people at risk of decline and early and sustained initiation of multiprofessional interventions are recommended in usual settings. However, it is a challenge never before faced and combined efforts to reduce the burden of social distance for older persons, their families and health systems are more than necessary. However, the repercussions of social distance on the mobility of the older population as an effect of the pandemic have not yet been mapped and systematized. There is an urgent need to identify the effects of social distance on the mobility of the older adults in order to structure updated and safe preventive measures that can minimize the impacts of the pandemic in this age group. This review aims to map the estimated impacts of social distance on mobility in this population and to systematize the existing recommendations, identifying possible gaps.

Methods
A scoping review will be carried out to map the studies available in the topic of interest. The study will follow the recommendations proposed by Arksey and O'Malley, being subdivided into ve stages: identi cation of the guiding question; identi cation of relevant studies; selection of studies; mapping of information; grouping; summary and report of results (15) . This scoping review will follow the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA) (16) . Additionally, the checklist of veri cation of Preferred Report Items for Systematic Reviews and Meta-Analysis for Scope Reviews (PRISMA-ScR) (17) will be used to guarantee the quality of the publication, corroborating the adequacy of the constituent parts (Additional File 1).
The scope review is conceptualized as a tool used to map the main concepts that support a research area. In addition, they are useful to gather the knowledge available in emerging evidence, such as Covid-19, for addressing issues beyond those related to the effectiveness or experience of an intervention (18) .
The realization of this scope review will also recognize the impacts of social distance on the mobility of the older adults, as well as identify gaps and encourage the development of preventive strategies to maintain functionality.

Identi cation of the research question
What are the impacts of social distance as a way of preventing Covid-19 on the mobility of the older people?
What are the recommended interventions to mitigate possible negative effects of social distance on mobility?
How are these recommendations being disseminated to reach older persons?

Information sources and search strategy
The strategy for inclusion of studies in this review will be based on the recommendations of the protocol of the Joanna Briggs Institute (JBI) (18) . The search will take place with a standardized protocol in the databases: Agency of Canada (PHAC) and Ministry of Health (MS) will also be consulted. Initially, a search was made at MEDLINE and CINAHL in July 2020 to retrieve articles dealing with the theme. The titles and abstracts were read and the words contained in them were used to develop the complete search strategy, including the keywords. Descriptors and keywords will be combined with the Boolean terms "AND", "OR" and "NOT. A complete search strategy for the PubMed database is included in Additional File 2. No time limit and language will be established in the searches.

Selection of elegible studies
The mnemonic strategy PCC (Population, Concept and Context) will be used for the inclusion of studies based on the research question.

Population
The review will consider studies involving the older people, however, no age limit will be de ned for such classi cation, since this chronological marker may vary according to the location studied.

Concept
Two concepts will be studied in this review. The primary concept is mobility, conceptualized as the ability to move independently from one point to another, constituting an important factor for maintaining autonomy and independence (19) . And the secondary concept is aimed at social distance, which in the approach most accepted by the scienti c community, refers to reducing the interaction between people to reduce the transmission of a virus (6) .

Context
The context for this review will be studies related to the Covid-19 pandemic and the Sars-Cov-2 virus.

Type of records
This scope review will consider all methodological approaches (original articles, literature reviews, editorials and guidelines) that necessarily address the recommendations on measures of social distance and the impacts on mobility of elderly people related to the new Coronavirus that causes Covid-19. We will use a wide variety of methods to search for relevant grey literature and information. Expert's opinions, editorials, and documents and reports published on relevant organisations (governmental and nongovernmental websites, professional associations, etc) will be searched and Internet search engines (e.g. www.google.com) and grey literature databases (e.g.opengrey.eu) will be used (20) .

Study selection
After the nal search in indexed sources and in the grey literature, duplicate articles will be excluded and two independent reviewers will read the titles and abstracts. In case of doubts from reviewers regarding the relevance of a study based on its title and abstract, the full version of the text will be evaluated. Subsequently, the two reviewers will examine the studies in full to verify the ful lment of the inclusion criteria. Disagreement situations between reviewers will be resolved through discussion with a third reviewer. Articles that do not meet the objectives of the studies or that do not deal with information relevant to the topic will be excluded. The included studies will be imported into the EndNoteX9 web library database and the nal results of the review will be presented in the form of a ow diagram according to the checklist of Preferred Items for Reports for Systematic Reviews and Meta-analyses (PRISMA-ScR).

Data extraction
Data will be extracted from articles that meet the inclusion criteria from a data extraction template form developed by the reviewers. This tool includes the following elements: publication data (year, authors and country of publication); type of publication (editorial, experts opinion, research article, etc); study or manuscript objectives or main topic; methodological characteristics if it's the case (characteristics of the study population); main results or main added contribution or clinical implications (measurement of outcomes and main ndings or contributions); inserted context (location of care and relevant cultural factors); dissemination approach (pdf reports for download, lea ets, manuals, videos, etc.) and will initially be tested in ten studies, in order to adjust the information to be extracted and small adjustments can also be made throughout the process.

Presentation of data
Tables accompanied by a narrative synthesis to address the scoping review objectives will be used to present the results.

Discussion
The proposed scope review will aim to map the estimated impacts of social distance on the mobility of older people and systematize existing recommendations, identifying possible gaps. It will also support the development of interventional measures that can prevent and minimize the impacts of the social distance imposed by the Covid-19 pandemic on the older population. It is also noteworthy that this review is the rst stage of a study that aims to develop a website with guidelines on improving mobility and active and healthy ageing aimed at optimising intrinsic capacity and functional abilities of older people.
Summarizing this information will enable greater knowledge about this topic in the current context, providing a basis for building guidelines with greater scienti c evidence. Availability of data and materials All data available from public sites and databases via the university.

Competing Interests
The authors declare that they have no competing interests Funding Not applicable Author's Contributions All authors contributed to the manuscript and read and approved the nal draft