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Active elderly live independently and avoid social care

Regard functional decline and need for social care as avoidable, not inevitable, urge experts

Louise Prime

Wednesday, 18 October 2017

Greater encouragement of older people to keep physically active would allow them to live more independently and could also reduce the need for social care, saving money, experts have argued in the BMJ this morning. In their joint analysis*, a consultant orthopaedic surgeon and others urge a change in attitude from seeing functional decline and the need for social care as an ‘inevitable’ consequence of ageing to regarding it as avoidable; and they call on national and local organisations to act to encourage opportunities for people to be active, incorporating this aim into built environments and transport.

They point out that the total cost to the UK of social care currently exceeds £100 billion, similar to its healthcare spend, yet we often ignore the evidence that it is loss of fitness resulting from inactivity, rather than the effects of ageing itself, that lead to the need for social care – and that this is avoidable. As the National Institute for Health and Care Excellence (NICE) said in 2015, “disability, dementia and frailty can be prevented or delayed”; regardless of age and underlying health problems, exercise can reverse the decline and keep a person above the threshold for needing increased care.

They note that strength and balance training reduce the risk of falls, and there is growing evidence that recovery of the four attributes of fitness – strength, stamina, suppleness and skill – improves cognitive ability and reduces the risk of dementia, not only in midlife but also in the 70s and 80s. They add: “The physical, mental, and social benefits of exercise can help enable people to live more independently and more autonomously.”

Despite this evidence, 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. The authors insist we must challenge the prevailing attitude that exercise is for younger people while older people should relax.

They say health professionals need to realise the scale of improvement possible in reversing declining ability and fitness, and should advise all patients, including those with long-term conditions, to start an activity and build up frequency, intensity, or time. They recommend that health and care professionals should have better training and support to recommend physical activity like a medicine.

They write: “For people who fear reduced independence, the solution is not to hope for a quick exit from this world but to do enough activity every day and with every diagnosis. The attitudes of health and care professionals need to change too. Functional decline and the need for social care are not inevitable consequences of ageing.”

They also argue that structural changes are necessary in the built environment to encourage people, especially older adults, to become and remain active. Environments that are ‘walkable’ and places that promote active travel have been shown to increase rates of physical activity, they point out; practicalities include even pavements, open spaces, tables and seating in public places, safe cycle lanes, and restrictions on car use.

They conclude: “We need individuals to understand their role in reducing demand for social care by being active. National and local organisations must act to encourage opportunities for people to be active, building this into our new and built environments, transport, and schedules. 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.”

* McNally S, Nunan D, Dixon A, et al. Analysis: Focus on physical activity can help avoid unnecessary social care. BMJ 2017;359:j4609. doi: 10.1136/bmj.j4609

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