As the UK’s roadmap to ease out of lockdown is announced, Stephen Collins considers the impact that this lockdown has had on older populations

“It’s a long time to be left all alone with your thoughts,” says a patient—a man in his late 80’s returning for review in our frailty unit. He looked visibly thinner than when we last saw him two months ago. “I’d normally be out meeting friends all the time, and now I don’t even know what day of the week it is.”  

Loneliness, dehydration, confusion, memory loss, weight loss, frailty, falls, broken bones, undetected infections, dementia progression, depression. The secondary effects of lockdown isolation on older people are extensive. The UK government have just announced plans of how we will gradually ease out of lockdown over the next few months. While this is undoubtedly cheering news, we must not lose sight of how hard the past few months of this third, strict lockdown have been on older populations. As we start to loosen restrictions, we must do so cautiously so as not to risk having to return into stricter lockdown measures again. Older, frailer people, who may live alone, have spent much of the past few months confined to life within the four walls of their homes.      

The mental health impact of lockdown on all ages has been widely discussed, but it is uniquely problematic for the frail older population as they tend to experience social isolation for longer periods of time with a larger proportion of them being asked to shield, and many do not have the resources (access to, or understanding of, online technology for video communication) to help mitigate the negative effects of social isolation. [1-3] 

Frailty is a complex, multi-faceted branch of medicine. And as a result, the ripple effect on our older population triggered by prolonged periods of isolation goes much deeper than what might first be seen on the surface.

A survey, taken in July 2020 by the Alzheimer’s Society, showed that 82% of almost 2000 respondents experienced deterioration in their dementia symptoms during the first spell of national lockdown, with a lack of social activities, gradual loss of daily skills, and the loss of ability to interact coming up as recurring themes in the responses. [4]

While the frail older population are undoubtedly some of the most vulnerable to rapid decline if they contract covid-19—with dementia and Alzheimer’s disease the most common pre-existing conditions in covid-19 deaths during the first UK lockdown—we must take note that, over that same time period among non-covid cases, there was a 52.2% increase in the number of dementia and Alzheimer’s related deaths compared to the five year average. [5,6]

We are now almost a year since the beginning of the pandemic, and although it looks like restrictions may start to loosen, we will likely have some form of restrictions in place for a while yet. While older people with covid-19 remain more likely to become sick, more likely to be admitted to hospital, and more likely to die from covid-19 than other age groups, now might be a constructive time to take stock and consider whether the consequences of strict lockdown isolation are contributing to old-age morbidity and mortality as much as, if not more than, covid-related illness alone, and what we can do to mitigate this going forward. [7]

In addition to the negative effects of lockdown on older people mentioned already, patients with Parkinson’s disease have noticed worsening of cognition and psychiatric symptoms following isolation, mortality from musculoskeletal injuries in trauma patients has risen, and some older, disabled people have even cancelled essential care packages out of fear of picking up the virus from care visitors [8-10].

In recent months I have seen patients who have lost a considerable amount of weight from not having meals prepared and delivered as regularly by their families. Some patients have told me that low mood sometimes means that they can go days at a time without setting foot outside. All social gatherings and community groups have been indefinitely cancelled, and the mobility of some has gone from daily walks without any aids before lockdown to only moving short distances with a frame indoors.

While there are clear public health benefits in having short periods of lockdown, it is crucial that efforts are made to minimise the duration of these, ensure older people have access to sufficient food, household essentials, and medications, and to promote home-based activities and support services that can help prevent loneliness, deconditioning, and depression [11]. 

As we look to the vaccination programme to help ease us out of this pandemic and hope for a gradual return to “normal” life, we must make sure that we do so in a way that minimises the harm caused by our covid-19 containment strategies and see that nobody, in particular the most vulnerable in our society, gets left behind.

Stephen Collins is an elderly care doctor working in the Frailty Unit at Causeway Hospital, Coleraine. Twitter @stevo_collins 

Competing interests: none declared

References:

1. Lucy Webb. COVID‐19 lockdown: A perfect storm for older people’s mental health, Journal of Psychiatric and Mental Health Nursing. 2020 Apr 30. 
2. Gabrielle Martins van Jaarsveld, The Effects of COVID-19 Among the Elderly Population: A Case for Closing the Digital Divide. Frontiers in Psychiatry. 2020 Nov 12. 
3. Vahia IV, Jeste DV, Reynolds CF. Older Adults and the Mental Health Effects of COVID-19. JAMA. 2020; 324(22):2253–2254. doi:10.1001/jama.2020.21753 
4. Alzheimer’s Society. The impact of COVID-19 on People Affected by Dementia, July 2020. Available at: https://www.alzheimers.org.uk/media/31741
5. Office for National Statistics, Deaths involving COVID-19, England and Wales: deaths occurring in June 2020. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19englandandwales/deathsoccurringinjune2020 
6. Office for National Statistics, Analysis of death registrations not involving coronavirus (COVID-19), England and Wales: 28 December 2019 to 1 May 2020. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/analysisofdeathregistrationsnotinvolvingcoronaviruscovid19englandandwales28december2019to1may2020/technicalannex
7. Kerr AD, Stacpoole SR. Coronavirus in the elderly: a late lockdown UK cohort. Clin Med (Lond). 2020; 20(6):e222-e228. 
8. Janiri D et al. COVID-19 Pandemic and Psychiatric Symptoms: The Impact on Parkinson’s Disease in the Elderly. Frontiers in Psychiatry. 2020 Nov 27. 
9. MacDonald DRW et al. Effects of the COVID-19 lockdown on orthopaedic trauma: a multicentre study across Scotland. Bone & Joint Open Vol. 1, No. 9. 2020 Sep 8. 
10. Uibu, K. Carers for family members withdraw from support services to limit contact during coronavirus pandemic. ABC News. 2020 Apr 2. Available at: https://www.abc.net.au/news/2020-04-02/carers-cancel-support-services-during-coronavirus-pandemic/12113056 
11. Wand, A., Zhong, B., Chiu, H., Draper, B., & De Leo, D. COVID-19: The implications for suicide in older adults. International Psychogeriatrics, 32(10), 1225-1230. 2020 Apr 30.