How to support older people to remain healthy through the pandemic

COVID-19 poses a significant threat to the health and wellbeing of older people. The risk of serious illness requiring hospitalisation and the risk of death both rise with age and this is reflected in the prioritisation of the vaccine across the UK. Indeed, the Joint Committee on Vaccination and Immunisation (JCVI) estimated that members of the public covered by the nine priority groups (eight of which include people over the age of 50, regardless of pre-existing health conditions) represent around 99% of preventable mortality from COVID-19. While this is undoubtedly good news, there is no doubt that the impact of COVID-19 pandemic will be felt well beyond this year.

In addition to the damage done by the disease itself, the associated lockdowns and shielding guidance reduces physical activity levels and so risks causing a loss of muscle and increased frailty. Findings from the Centre for Ageing Better’s State of Ageing 2020 report highlighted that physical inactivity increases with age – more than three in five people (62%) aged 55-64 are ‘active’ (that is, they do 150 minutes or more of moderate activity or 75 minutes of vigorous activity per week) but this drops just a little (to 59%) among people aged 65-74. Coronavirus guidelines have accelerated this lack of activity. Almost one in three people aged 50 or older polled as part of the joint report (32%) said they had done less physical activity during the UK’s first national lockdown (23 March – 4 July 2020) than before.  

This reduction in physical activity among older people is of concern – while a younger person may be able to cope with a slight reduction in muscle mass, it can have dramatic functional consequences, perhaps tilting the balance from being just able to do something, for example rising from a chair, and not. Indeed, data shows that that we are already living a longer portion of our lives with disability – males at birth could expect to live 18.7% of their lives with disability over the 2006-08 period, this had increased to 21.0% by 2016-18. For females at birth, the proportion of life spent with disability increased from 21.3% to 25.6% over the ten-year period to 2016-18 – and there is real concern the pandemic may have exacerbated this further.

Mental health may also suffer as a result of spending increased periods of time at home, and the needs of older people may differ from those in other age groups. In addition, while there is a broad spectrum of digital access and literacy among older people, there are few coordinated and targeted physical activity programmes for older people that are accessible through traditional media such as television and radio. Older people need access to physical activity recommendations that are appropriate to them and reflect the breadth of ability and underlying health conditions which are more likely to affect older age groups, through a medium that most will have regular access to.

This is why The Physiological Society and the Centre for Ageing Better’s report 'A National Covid-19 Resilience Programme: Improving the health and wellbeing of older people during the pandemic' called for a nation-wide approach to protecting the health and wellbeing of older people during lockdowns so they are better equipped to handle the indirect consequences of lockdown.

A National COVID-19 Resilience Programme should include:

• A tailored exercise programme, focused on older people with key COVID-19 risk factors (obesity, type 2 Diabetes, cardiovascular disease, and sarcopenia). This can draw on existing programmes such as “Make Movement Your Mission”
• Clear guidance about the importance of a healthy balanced diet containing sufficient levels of protein and appropriate energy content;
• Enhance mental health through the creation of virtual communities to counter social isolation;
• Enlist help of relatives and volunteers to support behaviour change among older people. This programme could be supported by a digital platform and by national broadcasters, e.g. regular televised activity classes.

To this end, The Physiological Society and the Centre for Ageing Better have written an open letter to the national broadcasters asking them to commission a series of short physical activity broadcasts over the lockdown, tailored to the needs of older people during the pandemic. This letter had over 75 signatories from organisations that work with older people from throughout the UK.

Although this blog identifies some negative physiological consequences of lockdown and shielding, it is not intended to criticise such strategies. Viral transmission to older people must be minimised, given COVID-19’s disproportionate impact. Our recent work has instead focused on the research from exercise physiologists and clinicians that will be required to inform how best to mitigate the longer-term impacts of lockdowns and ‘long COVID’ beyond the direct impact of infection with the virus and the universal rollout of a vaccine. The success of the health of older people in the aftermath of COVID-19 relies on both.

Note: This topic was discussed as part of the Parliamentary & Scientific Committee’s programme of work. Watch the webinar and launch of the report.