A National Covid-19 Resilience Programme: Improving the health and wellbeing of older people during the pandemic

Greenhaff, Paul, Giles, Alison, Bolton, Charlotte, Faulkner, James, Greig, Carolyn, Harridge, Stephen D. R., Lambrick, Danielle, Lanham-New, Susan, Martin, Daniel, Montgomery, Hugh, Saynor, Zoe, Skelton, Dawn, Singh, Sally, Siow, Richard, Steves, Claire, Stewart, Claire, Tipton, Mike and Whitney, Julie (2020) A National Covid-19 Resilience Programme: Improving the health and wellbeing of older people during the pandemic , The Physiological Society, 20pp.

Abstract

Executive summary

COVID-19 poses a significant threat to the health and wellbeing of older people. The risks of serious illness requiring hospitalisation and dying both rise with age.

Moreover, measures to lessen the risk of suffering from COVID-19 such as lockdowns and shielding can make it harder for older people to stay active. Physical activity is an important factor in staying healthy and is likely to play a role in COVID-19 resilience. Lockdowns can also have a detrimental effect on the mental health and wellbeing of older people.

The Physiological Society and the Centre for Ageing Better brought together physiologists, nutritionists, geriatricians, physiotherapists and clinicians to discuss three critical areas where the impact of the pandemic and lockdown on older people required greater consideration.

What happens to an older person during lockdown or shielding?
Home confinement in older people may cause (i) cardiorespiratory and metabolic deconditioning, (ii) insulin resistance, (iii) muscle loss and (iv) increased fat mass. In addition, social isolation may be worsened.

How do COVID-19 risk factors relate to age?
COVID-19 disease severity rises with age and is also associated with comorbidities, such as obesity, diabetes and coronary vascular disease, that can accompany chronological age. Physical frailty is associated with poorer outcomes.

What are the physiological challenges to address as older people recover from COVID-19?
COVID-19 can cause or worsen frailty indirectly, e.g. deconditioning, or directly, e.g. lung disease, muscle wasting and neurological impacts. Mental health may also suffer, and needs for rehabilitation and mental health support may be quantitatively and qualitatively different from those of people who are younger. Risk of “long COVID”, where people experience long term effects of COVID-19, is greater in women and rises with age and with body mass index (BMI).

A National COVID-19 Resilience Programme
In the absence of vaccines and treatments, physical activity (with tailored exercise or physical activity goals) represents the single most impactful way in which older people can reduce the risk of developing severe COVID-19, improve recovery, and limit deconditioning and frailty from home confinement.

We also recommend (i) clear guidance about the benefits and nature of a healthy, balanced diet containing sufficient levels of protein, with a balanced energy intake, and (ii) preventative and mitigative strategies to address mental health impacts. Older people will need to be supported to achieve these goals through clear advice and tools tailored to their needs. These actions will be especially important over winter months, when access to outdoor activity is already limited.

We thus call upon UK public health agencies to launch a National COVID-19 Resilience Programme to support older people through the pandemic and to keep them healthy over the winter. This should:
- Encourage appropriate exercise and physical activity;
- Support optimal nutrition; Enhance mental health and wellbeing;
- Support behaviour change to embed these behaviours.

This programme might be supported by a digital platform and by national broadcasters, e.g. regular televised activity classes

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Contributors

Author: Danielle Lambrick

Author: Zoe Saynor

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