Covid-19 has reshaped the way we live and brought unexpected changes to all our lives. Even though the national lockdowns and shielding advice have helped to keep older people safe, there have been consequences for health and wellbeing. Older people as a cohort have generally followed the rules and stayed at home. Evidence from the Age UK charity shows many people say they feel less confident, and others have become so afraid to leave home that they have not been out since March 2020.
The Prime Minister has published a roadmap to help us get back to doing some of the things we enjoy. Most older people will have received at least the first part of their vaccine to protect against coronavirus. Hopefully, as vaccinations are rolled out and restrictions are lifted, older people will develop more confidence to leave the house by themselves and re-engage in social activities. However, many are finding themselves less physically able, sad, lonely and bereaved, and are missing their partners, families and friends. Their worlds have become very narrow with lunch clubs, community groups and community hubs closing so suddenly.
If older people are to blossom again and live well, many will need support from health and social care, voluntary organisations and their local community. Some will not be able to make the first step and will need encouragement. We must all work together to make it a reality.
Primary care nurses are best placed to identify older people who are struggling to remain as independent as they were before lockdown began. They can carry out assessments to identify risk and suggest interventions or treatments before patients deteriorate further. The team must also include assessments of self-neglect, mental health needs, loss, grief and bereavement, as outward signs of these conditions can go unnoticed.
Most older people are likely to have some aspect of deconditioning – the loss of functionality – after months with reduced levels of activity. This will have affected all aspects of physical fitness, strength, stamina and skill. It may manifest as loss of muscle mass, including loss of leg strength, which can limit mobility and increase the risk of falls. In severe cases there may be functional decline, increased frailty and immobility. It is essential that we:
- Assess if the older person has noticed a decline in their ability to be as active as they were. Is there a decline in their muscle strength?
- Find out if they are worried about their balance. Have they had a recent fall, are they reluctant to walk?
- A falls assessment should be undertaken and referral to a falls prevention service.
Many people will be able to improve deconditioning if you support them to gradually increase exercise and confidence, increasing their walking and social connections. Local communities and volunteer organisations may be offering supported shopping trips, physical exercise training, exercise sheets and online help.
Loneliness and a lack of a sense of belonging or purpose can quickly lead to depression. Recognising loneliness and isolation can be tricky as older people are generally stoical. Older men particularly find it hard to admit if they are struggling.
Here’s how to address this:
- Ask specific questions about loneliness and symptoms of depression. If the patient is clinically depressed, make the appropriate referral so that they can receive the right assessment.
- Find out about changes in behaviour, a change in their routine, neglect of their appearance or personal hygiene, or unintentional weight loss.
- Provide information to help them make local social connections. Find services designed to tackle loneliness where they can chat with likeminded people. Voluntary organisations can arrange telephone catchups, helplines, online events, newsletters and other services to keep people connected.
As people age they experience many losses. Accumulated losses can translate into feelings of bereavement and grief. Not being able to see important people can also feel like a bereavement. The lack of physical contact brought on by the restrictions has been very hard.
Long-term partners have been separated when a person has been taken to hospital. Others have not been able to visit care homes. Some have known their loved ones have died without being seen, touched, or hugged prior to death. Further difficulties have been caused by restrictions on the numbers of people attending funerals and wakes.
The absence of these important aspects of death and dying may have a significant impact on the natural grieving process and on the health and wellbeing of the bereaved. Most older people have been touched by a Covid-19 loss. Primary care staff are well placed to know when patients have been bereaved and can provide important support.
Older people are often stoical about dealing with death and are slow to ask for help. They may be more prone to becoming clinically depressed and need to be identified and offered treatment. There may be support available from charities via telephone and online bereavement sessions.
4. Eating well
Research indicates that before the pandemic one in 10 older people living in the community were at risk of becoming malnourished. It is likely that over the past year this level of risk will have increased. For individuals there are many factors that can lead to malnourishment, including chewing and swallowing difficulties, sore mouth, loose teeth and ill-fitting dentures. Mental health problems and worries can also contribute. Older people living with long-term health conditions are more likely to experience disease-related malnutrition. Ways to help include:
- Assess what support they need with shopping, eating and drinking. Ensure they have aids and tools that can help.
- Arrange assessments with speech and language therapists to help with swallowing difficulties.
- Provide information. The malnutrition task force has free resources and practical ideas.
- Refer to dietetic services if indicated.
- Ensure they have good dentition – a good set of teeth.
Keeping hydrated ensures that bodily functions work well. Older people have lower fluid levels.
- Remind patients to have at least eight drinks a day.
- Bust the myth that drinking more during the day will mean more trips to the loo at night.
6. Caring responsibilities
More older people are providing informal care than before the start of Covid-19. The level of responsibility they have taken on is considerable and many carers are exhausted.
- Ensure informal carers are identified in medical records and that they look after their own health.
- Ensure that home assessments for equipment have been undertaken.
- Provide information for carers to engage with other carers for support.
Some older people have difficulties accessing their medication, in particular with re-ordering, delivery and taking the right medication at the right time. The normal checks and balances on medication management, including reviews, have not always continued throughout lockdown.
- Ensure that routine medication monitoring such as blood tests have been done.
- Ensure patients are ordering and taking all their prescribed medicines.
8. Help them start re-engaging with life
Older people may need to build up their confidence to leave the house and go on walks and outings. Many are worried about attending GPs and hospital appointments. Encourage them to:
- Build up to going for a walk, walking short distances, chatting to people along the way and feeling a sense of achievement. Little and often is key.
- Make sure that foot care and nail cutting is done and that shoes fit well to make walking easier.
9. Help them do new things
As restrictions ease it is a good time to help older people broaden their horizons. You can signpost them to information such as University of the Third Age or a telephone befriending service to get used to chatting again. Age UK and its partner charity The Silver Line offer free friendship services. There are also volunteering opportunities available for anyone wanting to become a befriender so telephone befriending can benefit both sides.
10. The last word – develop wellbeing
Building up wellbeing must be the most important message to help older people feel positive and in control of their lives. Raise self-esteem by:
- Supporting older people to reconnect with their social networks.
- Encourage them to be as active as possible.
- Support them to learn new skills to help develop a sense of purpose.
- As spring arrives, urge them to enjoy the moment.
Malnutrition Taskforce and Age UK report: Let’s talk about death and dying 2017
Age UK information hub on loneliness ageuk.org.uk/information-advice/health-wellbeing/loneliness/
Age UK information hub on mental health ageuk.org.uk/information-advice/health-wellbeing/mind-body/mental-wellbeing/mental-health-and-physical-health-are-interlinked/