Elderly pay the price of lockdown

There can rarely have been a more distressing correspondence on this paper’s letters page than those describing the consequences of lockdown for their elderly relatives in care homes. “My 100-year-old mother has gone from being an amazingly lucid old lady to a demented one living in a fantasy world,” writes one gentleman, who has only recently been permitted a weekly socially distanced visit for just half an hour.

The rationale for this draconian visiting policy is, of course, the extreme vulnerability of the elderly to the lethal effects of the plague – where the average age of those who have succumbed is an (astonishing) 84. The combination of their frailty and proximity would account for why like some terrible avenging angel, it has swept through so many care homes.

The further possible contributory factor would be the high prevalence of polypharmacy, with most residents taking half a dozen (or more) different pills. This can cause or exacerbate the decline in physical functioning of later years predisposing people to dementia, recurrent falls and poor appetite.

Specifically, Dr Michael Goldstein, writing recently in the Quarterly Journal of Medicine, notes the cholesterol-lowering statins “might have deleterious effects on the manifestations of Covid-19” by increasing the levels of inflammatory protein “that are significantly associated with increased mortality”.

Perhaps the apocalypse of Covid that has descended on care homes might prompt a long overdue re-evaluation of their near universal prescription in the elderly.

Painkiller disbelief

The recent edict from the grandiosely titled National Institute of Health and Care Excellence discouraging family doctors from prescribing the popular painkillers paracetamol, ibuprofen and codeine on the grounds they confer “little benefit” has predictably prompted disbelief.

“This has worrying implications,” writes a woman who finds paracetamol “invaluable” for her long-standing fibromyalgia, especially as other more potent analgesics have unacceptable side effects. Yorkshire man Richard Bowes, recently retired from a long career in the pharmaceutical industry, suspects this is a ruse to cut back on the NHS drug bill. He has always purchased his paracetamol and ibuprofen (“I cannot play golf or be active without them”) from his local supermarket. Lidl apparently is the cheapest.

Excruciating puzzle

This week’s medical query comes courtesy of Mrs PP from Nottingham, who is gripped at monthly intervals by an excruciating pain on the right side of her chest radiating to her back and under the arm that “literally takes my breath away... with no other symptoms than the fear I am about to die”.

Bizarrely, this always occurs around the same time – 9pm – compelling her to walk around the house for a couple of hours before it settles. The following day she is left with the feeling of a big bruise in the area involved. She is otherwise “exceedingly fit”, other than requiring a mastectomy for breast

Over-prescribed: most people in care homes take at least half a dozen pills cancer five years ago with no evidence of recurrence. She would be very grateful for any insights into what might account for this very puzzling affliction.

Weight for it

Finally, the relative contribution of gluttony versus sloth to expanding waistlines, as recently mentioned in this column, has prompted a reader to recall his experience.

Between leaving college in 1969 and starting work as a civil engineer, he spent six months labouring on a major road construction project in Switzerland inserting foot-long steel dowels into wet concrete, entailing much lifting, bending and sweating.

During this time he ate and drank more than ever subsequently in his life – three hefty meals a day, vast quantities of smoked sausage and bread buns, litres of beer and schnapps. By the end he was a stone lighter and has remained sylphlike ever since.

The average age of those who have succumbed to Covid-19 is an (astonishing) 84