A concerted effort to encourage older people to keep active can help them live more independently and reduce the need for social care, argue a group of public health experts in the BMJ.
Led by Scarlett McNally, Consultant Orthopaedic Surgeon from Eastbourne District General Hospital, the group include Oxford University’s Dr David Nunan, Departmental Lecturer and Senior Research Fellow in the Nuffield Department of Primary Care Health Sciences and Anna Dixon, Chief Executive of the Centre for Better Ageing.
The total cost of social care (including local authority, self funding, and informal care) is over £100bn, which is similar to the annual amount the UK spends on healthcare. Yet regardless of age and underlying health problems, “exercise can reverse the decline and keep a person above the threshold for needing increased care.”
They argue that the effects of ageing are often confused with loss of fitness - and it is actually loss of fitness that increases the risk of needing social care.
Figures show that a quarter of women and 20% of men in the UK report doing no activity at all in a week, let alone the recommended minimum 150 minutes to maintain health.
Yet they point to evidence showing that middle aged and older people “can increase their fitness level to that of an average person a decade younger by regular exercise.” Furthermore, evidence is growing that fitness improves cognitive (mental) ability and reduces the risk of dementia.
The prevailing attitude that exercise is for young people while older people should be encouraged to relax “needs to be challenged,” they write. “Gyms, walking groups, gardening, cooking clubs, and volunteering have all been shown to improve the health and wellbeing of people at all ages with long term conditions.”
They also call for changes to environments and expectations “to make exercise possible for middle aged and older people, including open spaces and facilities for active travel.”
Health and care professionals need better training and support to recommend physical activity like a medicine, say the authors. For example, older patients admitted to hospital spend over 80% of their time in a bed and more than 60% reduce their mobility. Yet this can be tackled by a focus on rehabilitation and support to maintain activity by health and care professionals as well as family and friends.
“We need individuals to understand their role in reducing demand for social care by being active,” they write. “The gap between the best possible level of ability and actual ability can be reduced at any age, no matter how many long term conditions the person may have.”
The increase in the level of ability “may not only restore the person to the ability they enjoyed 10 years earlier, it may make the crucial difference between living well at home or being dependent on social care or residential care,” they conclude.
Focus on physical activity can help avoid unnecessary social care.
McNally S, Nunan D, Dixon A, Maruthappu M, Butler K, Gray M.
BMJ 2017;359:j4609 https://doi.org/10.1136/bmj.j4609