Proper nutrition is a key pillar of resilience for frail older people coming out of lockdown; but exercise, mental wellbeing and behaviour change are equally important, concludes a report from The Physiological Society and the Centre for Ageing Better.

A National Covid-19 Resilience Programme: Improving the health and wellbeing of older people during the pandemic is the result of an online poll of over 2,000 people aged 50 and over, looking at exercise and physical activity levels, mental wellbeing, fruit and vegetable intake and ‘what actions to maintain health participants thought would be most effective’.

“One concern that we had was that the prevailing narrative is that every older person is frail and that everyone is equally vulnerable. It gave us concern that people were being treated as very passive, and the wider implications could be just as bad as the virus itself,” explains Dr Alison Giles, associate director for healthy ageing at the Centre for Ageing Better and co-chair of the expert panel producing the report. “And of course, for those people who were already frail, the messaging would lead to them being even less active than before, which makes a major difference.”

The report’s findings identified four major risks for older people as the result of lockdown, and its enforced inactivity: losing cardio-respiratory fitness; losing muscle mass; developing insulin resistance; and consuming more calories than the body needs. Nutrition is implicated in all of these, interlocked with physical activity levels and metabolic resilience (the capability to respond to a physiological challenge).

Food and nutrition in lockdown

To some extent, lockdown appears not to have affected nutrition, in that people reported no change in their fruit and vegetable intake (although bearing in mind this is lower than the recommended levels, this does not necessarily point to an overall ‘good diet’) Interestingly, though, diet and nutrition were the issues that people most felt needed ring-fencing if more restrictions were put in place over the winter (as indeed they were); out of the chosen options of actions to help them maintain their health, the most frequently chosen option was ‘ better availability of supermarket shopping slots’ followed by ‘better availability of protected time for people my age to use supermarkets’. Food was a greater concern than activity.

However, Professor Paul Greenhaff of the University of Nottingham, who co-chaired the expert panel with Giles, is more concerned that people ate the same amount (or more) during a period of enforced inactivity, and risked gaining fat as a result of consuming extra calories. “I think it’s more important whether they were able to reduce food intake rather than tipping into positive energy balance. Lockdown did decrease in a huge decrease in energy levels.” The report recommends ‘clear nutrition advice’ for this cohort, explicitly explaining why and how good nutrition (and avoiding obesity) helps protect against and/or recover from the effects of Covid-19. It also suggests that addressing financial hardship will make it easier for older people to eat a suitable diet.

The report also focuses specifically on vitamin D. The high proportion of the older population which is deficient in vitamin D (with the knock-on effects for bone health in particular) is well-known, especially for people in care homes; but, Greenhaff points out, other people who would normally have been able to get out and synthesise it topically over the summer were unable to do so, under lockdown – especially if they do not have gardens or balconies. This heightens the need for supplements during the summer as well as winter.

Activity levels and shielding from Covid-19

However, nutrition cannot be taken in isolation, both co-chairs insist. It is well-documented that most people became less active during lockdown – and people who were shielding were obviously particularly affected. “The most important thing is to try to maintain physical activity levels. Not moving means that people lose a lot of muscle mass; and in an older person that can have significant consequences.

It’s also more difficult to regain,” Greenhaff says firmly. “They’ll also risk developing insulin resistance. In an older person who doesn’t have as much muscle mass in the first place this could be critical.”

“There were people who were just about able to get out to the shops or to the GP surgery before Covid,” Giles adds. “They were really doing their best, it was a triumph to go and do something – and then they felt they shouldn’t even do that any more. They’ve been put at much greater risk of losing physical function and confidence. It is so important for this group to remain as active as they were before lockdown, and try to get back to those levels of activity.”

Getting the message across around resilience

Alongside this, the report recommends tackling the anxiety and low mood that a number of respondents report, suggesting that ‘super bubbles’ (spanning, say, two different households) could provide more interaction. But, it also points out, there is also a huge role for professionals (as well as relatives) to ‘reinforce messages around resilience’: including diet but also going beyond this.

“We want them all – GPs, pharmacists, the Chief Medical Officer – to be saying ‘now that we have more of a handle on it, and we understand the pandemic much better, it’s really important that people are supported to be active again,” Giles concludes. “It will also put them put them in a better position to recover, should they be unfortunate enough to get the virus.”