Older people’s physical and mental health has been a concern throughout the pandemic, with many shielding at home for most (or all) of the past year. Many haven’t seen their family and friends for months or been able to access parts of their support network or services. 

Research published by Age UK in October revealed that while some older people have been coping with the pandemic, a sizeable minority are finding life incredibly tough. Those who are not very well and have long-term health conditions were particularly likely to report that this is an extremely challenging time for them. 

“This pandemic is tough for everyone, but older people have the added anxiety of knowing that for them the risks of catching Covid-19 are higher,” says Caroline Abrahams, Age UK’s charity director. “We have rightly heard a lot about the enormous problems facing people in care homes, but this research reveals that life is extremely challenging for many cooped up for month after month in their own homes too.”

In November, The Physiological Society and Centre for Ageing Better called for a national Covid-19 resilience programme to keep older people healthy and resilient, especially over the winter months. The expert panel on the project brought together 20 leading scientists and clinicians working in the fields of physiology, nutrition and physiotherapy.

YouGov polling for the project found that almost one in three older people did less physical activity during the first lockdown last March. Of those, 43 per cent 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 per cent were worried about catching Covid-19, and 29 per cent reported lacking motivation to exercise. 

Home confinement in older people can 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. “Lockdowns, while important to reduce transmission of Covid-19, can have a detrimental effect on both the physical and mental health of older people,” says Paul Greenhaff, professor of muscle metabolism at the University of Nottingham, and co-chair of the expert panel. “These changes happen rapidly, within three days of not using muscles. 

“People can experience significant decreases in muscle mass and quality, which might be the difference between an older person being able to get out of a chair by themselves or not. Older people need clear, tailored guidance about how to keep healthy and resilient, which covers physical activity, nutrition and mental wellbeing.”

According to the expert panel, a national programme should include:

• a tailored exercise programme focused on older people with key Covid-19 risk factors
• clear guidance about the importance of a healthy balanced diet containing sufficient levels of protein and appropriate energy
• the creation of virtual communities to counter social isolation and enhance mental health
• enlisting the help of relatives and volunteers to support behaviour change among older people.

Social care needs

A House of Lords Science and Technology Committee on Healthy Ageing report in January revealed that while people are living longer, many of those extra years are spent in poor health, and the pandemic has highlighted the need for close coordination between different parts of the health and social care systems. Two million people in the UK aged over 75 live alone and could be at risk of loneliness; improving access to technology that enables older people to connect with friends and family is essential.

Back in November, Age UK warned that one in seven older people receiving care before the pandemic have since seen a reduction in the care they receive. Ms Abrahams says that the older population’s need for care has been increasing during the pandemic, despite less care being available to them. Ordinary activities, such as going upstairs or washing, have become difficult, and previously independent older people have become reliant on walking aids to move short distances, which they used to manage with ease. This can increase their susceptibility to falls and ill-health. 

“A number of patients we are in touch with have been struggling with mental health issues,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow. “They feel lonely not being able to go out for a walk or having day-to-day contact with other people. Many have been sitting in the same armchair every day or just walking a few steps in their home for months. They haven’t been visiting doctors or other support services, and quite a few have gone downhill in their physical and mental health.”

Two million people in the UK aged over 75 live alone and could be at risk of loneliness

According to Ms Thakerar, medication has been one constant in many older people’s lives since the beginning of that first lockdown a year ago. “Pharmacy is one of few primary care services that patients still have access to,” she says. “Some may have monthly medicine deliveries; others may have weekly dossette boxes or dressings delivered more than once a week. We always ask older customers how they are getting on when they call us up. If we are worried about anyone, we speak to their surgery, who can then signpost them to whichever service is necessary.”

Some pharmacies are helping their older customers, especially those living alone, with other aspects of daily life. “We have been looking after some of these patients for 20 to 25 years,” Ms Thakerar says. “We have a Tesco next door, and some patients ask whether the driver can bring items such as toilet roll, vitamins and incontinence pads with their medication delivery. This isn’t a digital or cyber generation. Many older patients have never used email or the internet, so can’t visit a website. Some of them aren’t even sure if their GP surgery is open, and struggle to cope with the long answerphone messages, so we have emailed their GP on their behalf.”

Self care advice

Age UK’s research found evidence of new and emerging cognitive decline in older people. This may have happened anyway, but some families believe it has been exacerbated by social isolation and a lack of mental stimulation, which has left older people more forgetful and confused. 

Mild cognitive impairment (MCI) affects 15 to 20 per cent of people aged 65 and over. People with MCI may be more likely to suffer from depression and anxiety due to the frustrating and isolating symptoms, which include problems with memory, language, thinking and judgement. MCI can be an early stage of dementia, but other conditions, such as depression, low vitamin levels and thyroid problems, can also cause similar mild memory problems.

Clinical research conducted by the University of Sherbrooke in Canada, published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, has established that people with MCI experienced significant improvement in cognitive function when consuming a specialised ketogenic drink (BrainXpert Energy Complex) twice a day for six months. Clinical researchers behind the treatment say the hope now is to investigate if ketones can slow down the progression of Alzheimer’s disease and other forms of cognitive decline linked to ageing. 

This isn’t a digital or cyber generation. Many older patients have never used email or the internet, so can’t visit a website

Age UK research has also found that some older people are experiencing increased pain due to untreated health conditions. These have impacted on appetites and diets, which threatens to weaken their resilience further.  

New research from Mentholatum for its Regenovex Actiflex brand found that nearly three in five people with joint problems say the cold is the type of weather that most affects their joints, bones and muscles. “The impact of the weather is a real phenomenon,” says Dr Emma Derbyshire, public health nutritionist. “Scientific studies from the past five years show that weather impacts on the joints, with barometric pressure, temperature, humidity, precipitation and wind being key factors.”

Pharmacies can offer customers with joint pain a range of over-the-counter products, from analgesics (oral and topical) to natural supplements. “Early intervention is key, especially when dealing with the impact of joint conditions on an ever-aging population,” says physiotherapist Sammy Margo. 

“Pharmacists can play a pivotal role in encouraging and supporting people to look after their joints. By promoting lifestyle changes and a well balanced diet, including the recommendation of targeted joint supplements, such as LanesHealth GOPO Joint Health Plus Ginger, pharmacists can help to protect and repair patient’s joint health.”

Incontinence is often seen as a taboo subject, yet many older customers will experience it to some degree. “It is vital that community pharmacies provide the necessary product advice and support,” says Alex Staw, marketing manager UK & Ireland at Ontex Healthcare. 

“Ontex can provide pharmacies with nurses qualified in the field to offer product training and support advice for pharmacy staff, category management tools to help display and grow sales, and e-learning and online support around types, causes and best practice advice for incontinence. We can also provide patients and their carers with materials on improving incontinence symptoms, including diet and exercise tips.”