The World Health Organisation states that in many countries, older people are facing the most threats and challenges from covid-19. Although all age groups are at risk of contracting covid-19, older people face significant risk of developing severe illness if they contract the disease due to physiological changes that come with ageing, reduced immune function, and greater number of underlying health conditions. [1] For these reasons, many governments around the world have been strongly urging older people to stay at home for an extended period of time in self-isolation (“shielding”), to reduce their risk of infection, in particular those who are immunocompromised or have chronic conditions. Even as some countries start to ease lockdown measures, the toll of shielding for high risks groups continues.    

The physical distancing restrictions have direct implications for older people, including limiting the activities they can engage in, loss of freedom, reductions in social engagement, including access to even the closest family members. Older people are often dependent on the support from communities and carers in maintaining their daily routines, staying active, and access to essentials of daily living such as healthy food, personal care items and medications. Consequently, physical distancing measures are likely to result in increased stress and social isolation among older adults. Levels of loneliness and social isolation are already greatest among older people, linked to factors such as loss of friends and family, cognitive decline, increased levels of disability, loss of social roles, reduced inter-generational living, greater social and geographical mobility, and the increase in living alone, and now as a result of physical distancing to reduce covid-19 spread. [2] Loneliness and social isolation can pose significant health risks, including hypertension, cardiac diseases and evidence of adverse impacts on mental health is particularly strong, including outcomes such as depression, anxiety, schizophrenia, suicide, cognitive impairment, and dementia. [3-5]

Finding ways to stay socially connected is even more important for this age group as many do not have easy access to digital platforms. Clear guidance, with a positive focus on what older people can do to maintain and improve their physical and mental health and contribute to their families and communities, is needed. We strongly recommend that public health messages, in addition to the important messages relating to minimising the spread of covid-19, focus on how to optimise older people’s quality of life and wellbeing. 

Recommendations to maintain psychological wellbeing should emphasize the importance of staying connected to others at a distance (e.g., via the telephone or internet), getting sufficient sleep which is important to immune function, and to reduce feelings of anxiety, having a schedule to maintain a sense of normality while in isolation, conducting meaningful activities every day, ensuring access to accurate and up-to-date information from verified and reliable sources, and also disengaging from the 24/7 news cycle and focusing on something other than the crisis. [7,8] Self-care should be encouraged, such as enjoyable activities and hobbies, practising relaxation, meditation and mindfulness, and it may also be helpful to reinforce to people that physical distancing is a service to the community as enabling meaningful contribution is one way to maintain wellbeing. Accessing telehealth consultations should be encouraged by all, so older people continue to meet their healthcare needs. It is important to remember that not all older people have access to the internet so regular telephone contact may be particularly important.

Maintaining physical activity is vital for physical independence and longevity and is also important for the immune system. [9, 10] Although restrictions of people’s movements are currently in place there are several ways to keep active at home using various simple and safe exercises that target movement, function, strength and balance. For example, practicing transfer and functional daily tasks/movements such as sit to stand, stairs climbing, standing on the toes, upper body reaching movements (with the addition of simple weights such as cans). Going for a walk if possible and breaking any prolonged sitting is also important to reduce sedentary behaviour. Exercising with a partner (e.g., family, friend, pet) may motivate and encourage people to be active. While this may not be physically possible due to physical distancing restrictions, there are other technological options (over the phone, via videoconference, or other social media options) that can create further engagement and socialisation. 

Adequate nutrition is a key determinant of health and function in older age [11]. Changes in dietary intake and requirements occur as a normal part of ageing, with decreased energy requirements due to declining physical activity and metabolic rate, but increased requirements of specific nutrients (such as protein, which is important to maintain muscle). Older people should be encouraged to supplement their intake of fresh food with produce with longer shelf-life, and to ensure varied protein sources (such as canned fish, beans and peas and choosing wholegrain products where possible). Many older people with mobility issues or lack of transport rely on support from carers or family to assist with food shopping. Therefore the provision of special arrangements for older people such as home delivery to reduce carer burden and support food security for older people during this time is recommended. The effect of social distancing on older people may also mean reduced exposure to sunlight may occur, increasing the risk of Vitamin D deficiency. Spending time outdoors with skin of arms and face exposed to sunlight should be encouraged. 

While the above strategies are useful for the whole population, older people are at highest risk from covid-19, and it is crucial that we, as a society, support their isolation as a measure against infection, but to also support their mental and physical wellbeing during these challenging times. Focussing on the wellbeing of older people in our communities during this unprecedented time represents a huge opportunity for public health, with social and economic benefits. We need to stay apart, together.  

Anita MY Goh, National Ageing Research Institute, Melbourne, Australia

Josefine Antoniades,  National Ageing Research Institute, Melbourne, Australia

Catherine Milte, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia

Briony Dow, National Ageing Research Institute, Melbourne.

Pazit Levinger, National Ageing Research Institute, Melbourne, Australia  

Competing Interest: None declared.

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