For centuries the cathedral was the most important building in any city, displaced in the 19th Century by the railway station as religion gave way to industrial and scientific power. In the 20th Century the railway station was in turn displaced as the most significant building by the hospital which epitomised the new power of life and death.
Amazing things have happened in hospitals over the last 50 years, from hip replacement to organ replacement and transplantation. However like all advances in human life there is a downside and the downside relates to the distinguishing feature of the hospital – the bed.
The Academy of Medical Royal Colleges published a report in 2015 called Exercise the Miracle Cure not only promoting the benefit of activity as a therapy in its own right but also emphasising the dangers of bed rest. While accepting rest has a part to play in the acute phase of illness this passes very quickly and what has emerged is that in the high pressure world of the hospital people, particularly people with multiple health problems, very quickly have their acute problem diagnosed and managed but are then tucked into bed and kept out of the way, because they cannot be discharged, while the staff have to cope with the next wave of acute cases at the other end of the ward. The result is what has been called the deconditioning syndrome, a side effect of hospital admission and a consequence of inactivity.
Although less dramatic, the proposed 4 months of isolation at home will have an immense deconditioning effect also. The policy is aimed at people over 70 and people under 70 with long term conditions but we now know that
· the older you are the more activity you need
· the more long term conditions you have the more activity you need
For people who are already housebound, the period of quarantine may not be so dramatic physically but it will have cognitive and emotional impact if it means that even fewer people visit. But for people who have been out and about spending 4 months at home could have a major impact on their ability and fitness, covering all 4 aspects of fitness - strength stamina suppleness and skill. For some the widening of the fitness gap will mean that they drop below what has been called The Line during this 4 month period as shown in the figure below:
For others they may be able to stay above The Line but they will have gone a significant distance towards it as a relative 4 months of reduced activity. Of course it will be possible to regain ability after the period of isolation but one of the features of ageing is loss of resilience so people in their 70’s, 80’s and 90’s will find it more difficult to regain lost fitness although there is no upper age limit to this process.
It is important to appreciate also that there will be a loss of cognitive and emotional wellbeing as a result of isolation and loneliness and this will increase the risk of dementia.
All of life is balancing risk and we certainly need to reduce the risk of Corona virus infection but 4 months isolation without giving people information, encouragement, support and motivation to maintain and indeed increase fitness while at home will increase the risk of needing social care in the years to come.
We therefore need a major learning and activity programme aimed at people over 70 and that will have to be delivered digitally. The aim should be not only to reach people as individuals but to reach them in groups.
Sir Muir Gray’s findings are supported by evidence from the UCLH.
To find out more about how you can use this period of isolation to your advance, why not have a look at Muir’s new course on Wellbeing: