Keeping our elders healthy during COVID-19 lockdown

Public health agencies across the UK should launch a National Covid-19 Resilience Programme to support older people through the pandemic and to keep them healthy and resilient over the winter – that’s the recommendation from a leading group of scientists and clinicians working in the fields of physiology, nutrition and physiotherapy.

The recommendation will be made in a new report by The Physiological Society and Centre for Ageing Better to be launched this Monday at a meeting of Parliamentary and Scientific Committee. The Expert Panel for the project brought together 20 leading scientists and clinicians.

New polling carried out by YouGov for the project found that almost 1 in 3 older people did less physical activity during the first lockdown in March. 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; 32% were worried about catching Covid-19; and 29% reported lacking motivation to exercise.

Physical activity is an important factor in staying healthy and resilient. Home confinement in older people will be associated with muscle loss, body fat gain and the development of insulin resistance, which are driving factors in the development of weakness and Type 2 diabetes. These changes happen within days if inactivity is marked. This could have dramatic functional consequences for older people, perhaps tilting the balance from being just able to do something, such as rise from a chair, to not.

A National Covid-19 Resilience Programme would bring together a package of measures to support older people through the lockdown and beyond, keeping them healthy and resilient over the winter. The Government should repeat the approach taken at the start of the first national lockdown in March to identify and proactively contact those at highest risk to offer support and advice (4).

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”; (www.facebook.com/groups/MakeMovementYourMission);
• 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 should be supported by a digital platform and by national broadcasters such as through regular televised activity classes on the BBC.

Professor Paul Greenhaff, University of Nottingham, UK and Expert Panel Co-Chair said:

“With England now in its second lockdown it is likely that people across the country will be less physically active. Physical activity is an important factor in staying healthy and resilient and will help protect against risks from Covid-19.

“Lockdowns, while important to reduce transmission of Covid-19, can have a detrimental effect on both the physical and mental health of older people. These changes happen rapidly: within 3 days of not using muscles, people can experience significant decreases in muscle mass and quality which might be the difference of an older people being able to get out of a chair by themselves or not.

“We are calling on public health agencies to urgently address this by launching a National Covid-19 Resilience Programme to support older people through the pandemic. Older people need clear, tailored guidance, about how to keep healthy and resilient, that covers physical activity, nutrition and mental wellbeing.

“Older people are facing this lockdown as the days are getting shorter and colder and therefore we must all re-double efforts to keep older people healthy.”

Dr Alison Giles, Centre for Ageing Better, and Expert Panel Co-Chair said:

“As this report highlights, coronavirus lockdowns can be particularly challenging for older people as they can exacerbate a variety of health issues, such as cardiorespiratory deconditioning and weight gain, as well as increased loneliness and social isolation.

 “As the country enters a second national lockdown it’s important to acknowledge that blanket advice based on age can lead people to feel that they don’t have control over managing their own health and risk around COVID-19.

“A National Covid-19 Resilience Programme would give older people more control and offer guidance on how to take care of themselves as the pandemic continues. We must provide people with tools that will allow them to make their own informed decisions on their health, wellbeing and resilience.”

Programme elements

A National Covid-19 Resilience Programme should comprise the following elements:

Encourage appropriate exercise:

• A tailored exercise programme should be made available nationally, focusing on older people with key Covid-19 risk factors (obesity, type 2 Diabetes, cardiovascular disease and sarcopenia). This should offer indoor physical activity recommendations designed for people with different levels of fitness. It will need to be designed in conjunction with exercise scientists and older people themselves and need to generate benefits within a short space of time. This could draw on the “Make Movement Your Mission” model (www.facebook.com/groups/MakeMovementYourMission) or similar schemes, with public health authorities across the UK (Public Health England, Public Health Scotland, Public Health Wales and the Public Health Agency in Northern Ireland) rolling a programme like this out nationally.
• A broader intervention to support increased activity levels with guidelines detailed enough to cover “when”, “how” and “how frequently” to exercise, which should be provided using multiple channels. As well as a digital platform, the national broadcasters should promote the benefits of physical activity by running regular televised activity classes. These should be developed in conjunction with exercise scientists in order to ensure that the approach is suitable for older people with different underlying levels of fitness and frailty.

Support optimised nutrition:

• Clear guidance about the importance of a healthy balanced diet containing sufficient levels of protein, with an appropriate energy content. This advice should be linked explicitly to maintaining health and the body’s resilience against Covid-19, so that older people understand the direct link between lifestyle choices and health and resilience.

Enhance mental health and wellbeing:

• Using communities (both virtual and physical) to counter loneliness and isolation in order to improve mental health. Virtual communities, such as the community that has formed around Make Movement Your Mission, can also be of benefit to mental health – existing organisations and charities could be supported to explore widening the participation of older people in virtual communities using social media and video conferencing.
• Explore viability of allowing older people to form “super bubbles” to enable them to interact in slightly larger groups (e.g. four people across two households), provided social interactions are restricted beyond the super bubble.

Embed behaviour change:

• None of this will work unless we can successfully re-build older adults’ confidence and support them to stay active and keep well. Therefore, we will need to be able to enlist the help of relatives, care workers and other professionals to reinforce messages around resilience in their day-to-day interactions with older people in their families or for whom they care. There may also be a role for NHS Volunteer Responders to play in supporting this behaviour change, perhaps through telephone befriending or other schemes, provided appropriate safety checks have been carried out.
• Repeat the approaches taken at the start of the first national lockdown in March to identify and proactively contact those at highest risk to offer support and advice, using social prescribing link workers and the NHS responders.

A National Covid-19 Resilience Programme should comprise the following elements:

Encourage appropriate exercise:

• A tailored exercise programme should be made available nationally, focusing on older people with key Covid-19 risk factors (obesity, type 2 Diabetes, cardiovascular disease and sarcopenia). This should offer indoor physical activity recommendations designed for people with different levels of fitness. It will need to be designed in conjunction with exercise scientists and older people themselves and need to generate benefits within a short space of time. This could draw on the “Make Movement Your Mission” model (www.facebook.com/groups/MakeMovementYourMission) or similar schemes, with public health authorities across the UK (Public Health England, Public Health Scotland, Public Health Wales and the Public Health Agency in Northern Ireland) rolling a programme like this out nationally.
• A broader intervention to support increased activity levels with guidelines detailed enough to cover “when”, “how” and “how frequently” to exercise, which should be provided using multiple channels. As well as a digital platform, the national broadcasters should promote the benefits of physical activity by running regular televised activity classes. These should be developed in conjunction with exercise scientists in order to ensure that the approach is suitable for older people with different underlying levels of fitness and frailty.

Support optimised nutrition:

• Clear guidance about the importance of a healthy balanced diet containing sufficient levels of protein, with an appropriate energy content. This advice should be linked explicitly to maintaining health and the body’s resilience against Covid-19, so that older people understand the direct link between lifestyle choices and health and resilience.

Enhance mental health and wellbeing:

• Using communities (both virtual and physical) to counter loneliness and isolation in order to improve mental health. Virtual communities, such as the community that has formed around Make Movement Your Mission, can also be of benefit to mental health – existing organisations and charities could be supported to explore widening the participation of older people in virtual communities using social media and video conferencing.
• Explore viability of allowing older people to form “super bubbles” to enable them to interact in slightly larger groups (e.g. four people across two households), provided social interactions are restricted beyond the super bubble.

Embed behaviour change:

• None of this will work unless we can successfully re-build older adults’ confidence and support them to stay active and keep well. Therefore, we will need to be able to enlist the help of relatives, care workers and other professionals to reinforce messages around resilience in their day-to-day interactions with older people in their families or for whom they care. There may also be a role for NHS Volunteer Responders to play in supporting this behaviour change, perhaps through telephone befriending or other schemes, provided appropriate safety checks have been carried out.
• Repeat the approaches taken at the start of the first national lockdown in March to identify and proactively contact those at highest risk to offer support and advice, using social prescribing link workers and the NHS responders.

The full report is available on The Physiological Society’s website: www.physoc.org/policy/covid19resilience.