The pandemic not only had direct health impacts but also affected health behaviours through its multiple lockdowns and restrictions. Routines were lost and with that, so were some of the healthier behaviours once previously adopted by many people. Older adults, with their higher risk of frailty and multiple comorbidities, faced significant challenges in maintaining their health. Consequently, health behaviours were very difficult to maintain during the pandemic and obesity rates began to rise.
Harrison et al (2021) have shown that there was a reduction in physical activity since the onset of the COVID-19 pandemic. A recent study by Liu et al (2023) discussed the effects of the pandemic on health behaviours, finances and depressive symptoms among the older population. They noted the significant effect of COVID-19 on the health and wellbeing of older adults. The team used the National Health and Aging Trends study (NHATS), which links to the NHATS COVID dataset. NHATS contained data of over 65-year-olds on an American insurance plan. Liu et al (2023) explored the associations between health behaviours, financial problems and symptoms of depression by using a structural equation model and found that, in comparison to males, female participants were walking less, had changed their eating habits, were sleeping less and also had a reduced alcohol consumption since the start of the pandemic.
When compared to White participants, non-White participants were found by Liu et al (2023) to have more significant financial difficulties; they walked less, did less vigorous activity or exercise and had more significant eating and sleeping changes when compared to their health behaviours before the pandemic. The issues with finances were found to be most significantly associated with symptoms of depression as well as a more sedentary lifestyle. Sedentary behaviours were positively associated with depressive symptoms and active behaviours were negatively associated with symptoms of depression (Liu et al, 2023).
A sedentary lifestyle and associated depressive symptoms were a change in behaviour among older people during the pandemic and contributed to weight gain. A common theme noted by the researchers was that 37% of older adults were watching more TV as a result of the pandemic.
The authors noted the disparities regarding race and gender. They noted the significant burden on older women which involved a loss of sleep, exercise and healthy eating routines when compared to men. This was likely because women are usually caregivers, suffering additional stress while they cope to deal with the demands of looking after grandchildren, helping their children and assisting with the provisions of home schooling. Older men, on the other hand, reported drinking more alcohol, which may be in response to stress triggered by the pandemic. White older adults tended to engage in more exercise and walking.
Older people who already faced disadvantages through having marginalised identities were noted to potentially experience exacerbations of mental health outcomes. Liu et al (2023) noted that their study is limited in not exploring this in greater depths and recommended that this aspect be thoroughly explored in future research. They also recommended that future studies combine both quantitative and qualitative data in a mixed methods approach so that social inequality could be thoroughly explored from the perspective of someone with multiple identities linked to race, culture and other factors that may influence how someone thinks, and therefore behaves, which results in certain health behaviours.
The rise in obesity is concerning as it contributes to a range of problems at any stage in life and can cause older adults to be more vulnerable. The prevalence of obesity is increasing in developed countries and many older adults are already categorised as obese. Obesity increases morbidity and reduces quality of life in older people (Chapman et al, 2008).
Sakai et al (2023) recently analysed predictive physiology associated with chronic pain, examining the role of skeletal muscle and fat mass in the representation of chronic pain in older adults. They found that the prevalence of chronic pain increases with age and noted that chronic pain has previously been associated with sarcopenia and obesity. Sakai et al (2023) found that age-related skeletal muscle loss and fat gain are linked to inflammation, and this association between pain and inflammation, skeletal muscle and fat, may be linked to causing chronic pain. They therefore assessed skeletal muscle and fat mass in 214 people aged over 65 years, who had a non-specific chronic pain affecting the lower back, neck or knees ongoing for the last 6 months. The results were compared to a control group without chronic pain. The team found that skeletal muscle mass index was, in fact, significantly lower in those with chronic pain, while the body fat was higher. Older people who became obese in the pandemic, for example, would therefore potentially be at a higher risk of chronic pain; they may already have a lower muscle density considering their higher fat mass.
The team calculated that the muscle-to-fat ratio (MFR) was much lower for participants with chronic pain than in the control group, and concluded that the MFR is a useful index to predict chronic pain. The MFR could therefore be used as a measure in exercise therapy for sarcopenia. Exercise is already prescribed for sarcopenia, and Sakai et al (2023) noted that it could be used for reaching a higher skeletal muscle mass in the lower extremities that is greater by three times for men and two times for women, in order to prevent geriatric chronic pain. This is an important consideration given the health behaviours of people with a sedentary lifestyle would have promoted a lower muscle mass and higher fat mass among older people during the pandemic. Exercise therapy incorporating the MFR measure for aims of treatment may benefit the geriatric population by helping to aid pain control or prevent pain altogether. These factors may be easily modifiable through something as simple as exercise therapy, which in turn, helps to modify the sedentary health behaviour, fat mass and muscle mass while treating sarcopenia.
Many patients may not realise there are free services or low-cost services in the local community that are specialised to help their age group to get fit. Age UK runs many exercise classes which vary in availability across the country. Age UK (2022), for example, offers dance classes including Latin and ballroom, freestyle or even line dancing. Not only does dance help an older person get fit, but it can help cognition as well. Other classes on offer include seated yoga and pilates, which can aid core strength, flexibility and balance. Seated exercise classes are very popular according to Age UK (2022) and are good for posture and balance, which may help those who are less mobile. Strength can calso be increased where hand weights or resistance bands are used. Tai Chi also helps posture and balance, while also enhancing one's ability to relax and aids mental wellbeing. Another option is a walking club. There are many organised by Age UK and other charities. They help people socially connect and get fit at the same time, which would help someone who has become more isolated and less mobile over the pandemic due to health behavioural changes.Age UK (2022) even offer walking football. Another option is Zumba Gold; there are many Zumba Gold classes and these can be found on the Zumba website (Zumba, 2023).
Overall, it is unsurprising that people became less fit and less happy during the pandemic. It is clear that health behaviours changed; older people were seen to live in a more sedentary way. Sedentary lifestyle is linked to obesity, which rose in the pandemic. Depressive symptoms are linked to these factors and people should be encouraged to engage in new health behaviours. Local classes suitable for older people are a perfect way to increase strength, fitness and balance while encouraging social connection and promoting emotional wellbeing.