Growing old, staying well: Frailty, lockdowns and ageism

During 2020, there were 5,038 Covid deaths among people aged over 75 in Scotland - accounting for three quarters of all registered deaths from the disease.

The over 75s accounted for the vast majority of Covid deaths in Scotland during 2020 and beyond (Image: Scottish Government)

Skelton stresses that policymakers faced a "difficult" dilemma in the face of a virus which - particularly before vaccines - was "lethal" to elderly people, but said that on balance restrictions had gone too far.

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She said: "We've almost got a pandemic of frailty now because people just de-conditioned so much in that period where they weren't seeing their family and friends and going out shopping and all those sorts of things.

"That incidental activity has a major impact on people's physical function when they're older.

"We will, and we are, seeing more falls and more fractures in every setting - homes, hospitals, care homes - because of that couple of years of reduced activity.

"It's such a difficult one because older people were so vulnerable to [Covid], but the issue is that people should have some sort of choice.

"There are ways of still being out and about and still maintaining some social distance, but the thing about 'don't go anywhere, stay in your home' - it created a real fear.

"What we've got now are people who are very socially isolated, anxious, they've lost all that physical function because they weren't keeping their muscles active.

"At the same time they weren't following up when their long-term conditions were getting worse - they were worried about being a burden on the NHS - so long term conditions have all become worse as well.

"It will be a decade I think before we can get back to where we were pre-Covid in terms of levels of frailty."

A woman visits her mother in a care home during the pandemic (Image: Getty)

Skelton is speaking to the Herald on Sunday ahead of a major international conference on global ageing.

Thousands of delegates from 48 countries worldwide will descend on Glasgow over three days, from Wednesday, to discuss everything from end-of-life care to "age inclusive" urban planning.

READ MORE: Hundreds of hospital wards closed due to Covid outbreaks 

Skelton is due to deliver the final keynote speech on Friday and is keen to get across the message that falls and frailty "are preventable and reversible".

"Frailty is not a one-way street - we do not have to just get frailer," said Skelton.

She said that not enough is done at present to intervene when older adults are "transitioning" into frailty or to emphasise the vital importance of exercise in keeping people stronger, healthier and more independent for longer.

"We all know we should be eating five fruit and veg a day, but physical activity just isn't on the agenda.

"It's not the first thing that ever comes out of a GP's mouth.

"It's all about pills, alcohol, giving up smoking, but physical activity has the strongest evidence base for maintaining an active, successful ageing.

"You might well still get your medical condition but the symptoms won't bother you as much, and you won't be as incapacitated by them if you're physically active."

Prof Dawn Skelton (Image: GCal)

Skelton emphasised that this has to encompass a mix of activities including both cardiovascular and strengthening exercises, as well as balance work - even something as simple as trying to stand on one leg for a few minutes every day.

Among her biggest bugbears are seated exercise which "does not reduce falls, full stop" and the tendency of service providers to truncate evidence-based exercise programmes to five weeks instead of the year that is actually proven to be effective.

"If it was a cancer treatment, you wouldn't dream of short-cutting, but for some reason we have this thing with falls that you can cut corners and do a little something, somewhere to help somebody become less frail - or fall less - because it's not a medical condition, it's a 'syndrome of ageing'.

"There's this lack of respect for a whole generation of people who have paid their taxes, worked, and yet as soon as they retire it's like they become invisible - I just think it's wholeheartedly unfair.

"If we could ever get to the point where we properly fund social care, we could see such a huge difference here - but at the moment the NHS is picking up the inadequacies of any prevention work."

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The need for more people to age well is an increasingly pressing one worldwide, both for the sustainability of health services and economically as pension age inevitably creeps up.

At present, average men and women in Scotland live in good health only until the ages of 60 and 61 respectively, but the size of the population aged over 65 is projected grow by a third by 2045.

Globally, by 2050, the number of people over 60 is forecast to double to 2.1 million while the numbers of over-80s will triple to 426 million.

The number of people over 80 worldwide is set to triple (Image: PA)

For the first time in world history, the number of people over 65 is already outnumbering children under five - many of whom can now expect to live to 100.

Sir Geoff Mulgan, a professor of collective intelligence at University College London and a former director of policy at Number 10 under Prime Minister Tony Blair, says one of the biggest obstacles we face in adapting societies to this unprecedented shift is the "complete unwillingness" of younger generations to imagine being old.

He said: "Lots of people think about their parents or grandparents care needs, but there is a desperate unwillingness to think about yourself and what your own future might be like in 40 or 50 years' time.

"We can easily think about ecological disasters or the technological future, but if you ask people 'what's your picture of the care system or the welfare system a generation or two from now?' even very well-informed people utterly struggle to have an opinion on that."

Projected changes in the Scottish population by 'pension age', working, and children (Image: NRS)

In Dubai, the "museum of the future" has become the number one tourist attraction and Mulgan - who will speak at the global ageing conference on Thursday - said the UK should follow suit by creating more spaces dedicated to celebrating, debating, and positively imagining what the world of tomorrow could look like, including in relation to care and ageing.

This taps into themes he explored in his 2022 book, 'Another World is Possible'.

It is "dishonest", he says, to pretend people can continue retiring in their 60s given changes in life expectancy - but this is should not be seen as something negative.

He said: "I was very encouraged by a piece of work which asked people over 65 what is the most fulfilling activity you have in your life and paid work came top.

"People wanted to be useful. All of the framing of ageing as a crisis and a disaster is insane."

READ MORE: Care homes closing 'every week' amid funding crisis

However, Dr Donald Macaskill, the chief executive of Scottish Care - which is helping to stage the conference - said he and others in the sector are aware of a growing ageism.

He said: "I was appalled recently by some of the responses to the possibility of a new strain of Covid and lots of social media comments that this is an 'opportunity to have a Baby Boomer harvest'.

"That's the sort of stuff we had at the start of the pandemic. It's really become almost culturally acceptable to have that attitude."

Macaskill will deliver the opening address to conference when it inaugurates September 7 as the world's first International Day of Care and Support for Older Persons.

Dr Donald Macaskill (Image: Newsquest)

While there are pressing concerns here in Scotland - particularly around care home closures and social care pay - Macaskill says the conference is focused on the "bigger picture".

He said: "One of the big topics is, how do people want to age and how do they want to live their lives when they are no longer able to be an independent as they might be?

"That gets into the role of technology in enabling people to live longer, but many of the contributions are really calling for a radical redesign of our built environment and how our economic strategies approach old age.

"Ageing in the UK tends to get narrowed down to 'how we can afford for people to get older?', whereas people like me and many of the contributors will be saying 'how do we maximise the potential of older age?'.

"Let's stop regretting the fact that we've got an ageing population and that people living longer is a bad thing.

"Our forebears dropped off their mortal coil at 50 - I'd rather continue a bit longer."