Being older does carry a risk... but so does staying at home
Blanket isolation for all over-70s could lead to a pandemic of a different kind, says Sir Muir Gray
People in their 70s and beyond live dangerously. But what is riskier – to be 70-plus, or to be 007? It is obviously the former, because James Bond carries on merrily and has never even been in hospital, whereas people who are 70-plus face many health risks, which become greater every year and whose number have, of course, increased yet further with the emergence of the coronavirus.
But chronological age is a crude measure of risk, as I know from my previous job as director of national screening and from setting up age-related screening programmes as director of the Optimal Ageing Programme (livelongerbetter.net). People who are 70-plus are at higher risk of death from corona, a risk that increases further with every birthday.
Yet even more important, perhaps, is that older people are more prone to infections that could permanently reduce ability and quality of life, shortening healthspan as well as lifespan. However, within any age group, there is a huge range in both fitness and the prevalence of disease, largely related to wealth. Someone in the top quartile of one age group is at the same level of fitness as the average a decade younger.
So as the BMA and Royal College of GPS request that the lockdown be eased for healthy over-70s – and with one union warning such a blanket lockdown is “discriminatory” – there are other options for coronavirus risk assessment rather than age.
One of the simplest is the number of diseases that a person has – and the simplest way to determine that is to measure the number of pills they are on. I have a stent for heart disease and lung disease from growing up in the fogs of Glasgow before the Clean Air Act, so have been prescribed six drugs. That could be used as a measure of risk.
However, the ageing process is not the principal reason for the increase in risk of contracting coronavirus. Since 1948 – when the World Health
Lockdown will lead to a deconditioning pandemic unless we do something now
Organisation offered its definition of health as “not merely the absence of disease or infirmity, but a state of complete physical, mental and social wellbeing” – risk factors to good health have changed, and two new ones have crept up on us almost by stealth: inactivity and isolation, often linked to immobility, as a result of one or more diseases, often accentuated by vision and hearing problems.
It is important to aim to increase healthspan as well as lifespan, and taking steps to reduce the risk of coronavirus infection by staying away from others is an important step in doing that. But staying at home carries significant risks of its own by increasing isolation and inactivity, which increase the risk of dementia, frailty, disability, dependence on others and, in a word, wellbeing.
There are three dimensions of wellbeing – physical, namely the strength, stamina and suppleness of the body; cognitive, namely the ability to think logically; and emotional, namely, how one feels. All of these are significantly affected by inactivity and reduced contact, particularly if one is living alone. In medicine, this is now called the deconditioning syndrome and its effects can be seen after only a week in hospital in people in their 80s and beyond. Lockdown will lead to a deconditioning pandemic unless we do something about it, namely launch a reconditioning programme.
So what should be done? First, until immunity tests or vaccines are available, all you can do to decrease risk is keep distant, and the older you are and the more long-term conditions you have, the higher the risk. But, like everything, there is always a balance of risk – and there are significant risks associated with lockdown.
The simplest approach is to give this advice to people and let them decide. Whatever the Government decides or enacts, given my age and pre-existing medical conditions, I will certainly be staying at home at least until an antibody test is developed.