The Physiological Society met with Dr Alison Giles from the Centre for Ageing Better and Professor Paul Greenhaff from the University of Nottingham to discuss the launch of the recent joint report they co-chaired A National Covid-19 Resilience Programme: Improving the health and wellbeing of older people during the pandemic.
The Physiological Society and the Centre for Ageing Better brought together physiologists, nutritionists, geriatricians, physiotherapists and clinicians to discuss the impact of the pandemic and lockdown on older people. The report was launched at a meeting of the Parliamentary and Scientific Committee on 9 November 2020.
What was the impetus for looking at the impact of Covid-19 on older people?
AG: When we started the project, it was clear that the data trends for new Covid-19 infections as summer ended and autumn began, were not good. Since we started the project, all four nations of the UK are increasing restrictions on daily life and business in response to a resurgence of Covid-19 infections, hospitalisations and fatalities. At the same time, a number of very promising potential vaccines have emerged but they will take time to be approved and rolled out so restrictions are likely to remain in place for months and not weeks. While lockdowns are a challenge for us all, there are particular challenges facing people in later life, some of whom may have health issues, and who are less likely to be digitally connected than the younger population.
If the data suggests older people are most at risk then why should we move away from shielding policies?
AG: It has certainly been the case that the response to the pandemic has been framed primarily in terms of minimising the exposure of the over 65’s to Covid-19 and this is absolutely crucial given their poorer health outcomes on average than younger people. However, while it is important to protect those at greatest risk, a blanket policy based on age can make older people feel that they are unable to make a positive contribution to their own health and mitigate the impact of Covid-19 on their lives. It is important to ensure that older people feel they have more control over their lives and that they receive clearer guidance about how to manage their health and wellbeing, both now and beyond this pandemic.
Why are policies designed to prevent onward transmission of Covid-19 of particular concern to older people?
PG: The risks from the Covid-19 disease increase with age, however, as physiological research into the impact of reduced daily step counts or immobilisation shows, lockdowns themselves can have a damaging effect on mental and physical wellbeing. With the closure of social spaces and recreational activities, people will spend more time in their homes, reducing their chances for social interactions, and making it harder to stay physically active. We know inactivity is associated with muscle mass loss and deconditioning, and fat mass gain. This is of significant importance to older people who are at increased risk of impaired cardiovascular and metabolic health.
AG: In a YouGov poll commissioned by The Physiological Society in October, almost one in three over 50’s polled said they had done less physical activity during the first lockdown compared to normal. And, of those, 43% said that this was because they no longer had a reason, or had less reason, to get out of the house and be active. These data are worrying as a significant drop in physical activity levels is associated with poor health, as well as increasing people’s vulnerability to Covid-19.
PG: These consequences will happen to all age groups but they are particularly important among older people as they have less physiological reserve, and are harder to reverse. As a consequence this is more likely to have a negative impact on an older person’s daily life. As an example, a 5% reduction in muscle mass for a fit younger person can be accommodated during activities of daily living. But in an older person who is just about able to get out of a chair unaided then this is likely to have far wider-reaching negative consequences.
What have the Centre for Ageing Better and The Physiological Society done to raise this issue with Government and other organisations?
AG: We launched our joint report to parliamentarians at the beginning of this month at a meeting of the Parliamentary and Scientific Committee. The report calls for a National Covid-19 Resilience Programme that would bring together a package of measures to support older people through the pandemic and keep them healthy and resilient over the winter. The programme would limit the negative effects of lockdowns and encourage older people to take greater control of their health and wellbeing. While people in later life are not a homogenous group and have diverse levels of fitness and frailty, a universal programme would provide broad guidance specifically tailored to older age groups that would comprise three core elements.
PG: We felt that the most important component of a National Resilience Programme would be a tailored exercise intervention, targeted at older adults who have key Covid-19 risk factors such as obesity, type 2 diabetes, cardiovascular disease, and sarcopenia. This could be achieved by scaling up existing small programmes such as ‘Make Movement Your Mission’ based in Glasgow. We also want to see the provision of clear guidance about the importance of a healthy balanced diet containing sufficient levels of protein and appropriate energy content and the promotion of mental health through the creation of virtual communities to counter social isolation.
PG: While this programme will not change the fact that older age groups remain particularly vulnerable to the virus, physical activity is an important factor in staying healthy and may very well play a role in Covid-19 resilience. A National Covid-19 Resilience Programme would give people in later life greater control and offer guidance on how to take care of themselves as the pandemic continues. This way people in older age groups can be provided with the proper tools to allow them to make their own informed decisions on their health, wellbeing and resilience.
What are the next steps for the project?
AG: We are working together to promote the idea of a Covid-19 National Resilience Plan amongst Government members and those experts and officials responsible for drawing up plans and guidance. We are also working alongside other organisations on a campaign to encourage national broadcasters to develop programmes to support older people to keep active in their homes. The benefits of people remaining active in later life are not limited to Covid-19 so hopefully this is a timely opportunity to help people live longer healthier lives even as vaccines are rolled out and the threat of Covid-19 hopefully recedes into the past.
Greenhaff previously chaired The Society’s Expert Group for Growing Older, Better and the Centre for Ageing Better is a charitable foundation, funded by The National Lottery Community Fund, and part of the Government’s What Works Network designed to create change in policy and practice informed by evidence and work with partners across England to improve employment, housing, health and communities for older people.
Giles and Greenhaff are very grateful to the physiologists, nutritionists, geriatricians, physiotherapists and clinicians who gave their time and opinions in the generation of The Physiological Society and Centre for Ageing Better report.
Read the report here.
Please note that all views expressed on The Physiological Society’s blog reflect those of the author(s) and not of The Society.