After we re-opened clinic, some of the older patients I have cared for over many years were slower to return and some of the changes over the 3-4 months since I saw them last were pretty upsetting.
A combination of muscle wasting/sarcopenia, rounded posture, shuffling gaits, unsteadiness, pale skin, depression….lockdown has not been good for the older population.
One word would describe it: Fragile
I want my patients to be as resilient as we can get them – Physically, emotionally and metabolically.
I try to help and advice in all 3 areas – I provide physical care to help posture, improve the proprioceptive inputs to the brain and encourage physical activity.
We talk about the need for adequate protein and fats and filling the “nutrient gap” between what the foods can give them (and what they can absorb) and what they need to stay healthy, with supplements.
We talk about social stuff for social contact, and groups to get involved with.
They need to find their “moai” (life long friends), which helps them have “ikiagi” – a reason for living. (if you have no idea what I am talking about you can read a newsletter from last year about the Okinawa Islanders and why they lead such long happy lives. )
The lockdown has stopped their physical activity and isolated them in a way that we have never seen before.
Seems to me that they are now in a vicious cycle from a combination of lack physical exercise, lack social contact (zoom really isn’t the same as face to face), lack of sunlight making vitamin D, fear creating a stress response that is driving inflammation up and immunity down.
These all interplay, but at the root of ageing is inflammation and its effects throughout the body and brain.
Inflammation makes older people fragile.
It does this via a number of mechanisms.
Vitamin D also plays a critical role in setting inflammation levels
and has a role to play in maintaining muscle mass
Sadly by the time you are elderly, your skin really isn’t very good at making vitamin D (and that is if you can get an older patient into the sun without being fully clothed).
When it comes to mood, fear is a great way to push up the inflammation levels and there is wide agreement that mood and behaviour is directly linked to inflammation.
What once would have kept us safe as hunter-gatherers now via the mainstream media alters our behaviour via our brain chemistry in response to inflammation.
We cannot “defeat” a virus by hiding from it, it is still here and older people need to find a way to carry on life in a modified way that allows them to keep fit and active, but also stay safe.
Consider their medications also, statins are known to reduce muscle strength and increase the risk of falling.
ACTION TO TAKE
– Get older patients outside in the sun, walking, moving, engaging and eating a diet full of real/whole foods.
– 3-5000 iu vitamin D will get most elderly patients into the optimal vitamin D zone of 125-175 nmol/L.