Communication should be more focused on staying active

Elderly people living at home were a forgotten group during the corona pandemic. The focus was on infection prevention and acute care. Other kinds of care were sidelined. What lessons can we learn for future pandemics or healthcare-related developments? ‘Communication needs to be more focused on the message: stay active.’

The white paper Lessons from the COVID-19 pandemic regarding frailty and health in older people living at home is a study of the impact of the corona pandemic on health and frailty among older people living at home. Hans Hobbelen is one of the professors involved in the writing. He explains: ‘When the pandemic had been going on for six months, there were signs that elderly care was suffering. We are familiar with the horror of fences around nursing homes. The emphasis was very much on infection prevention and acute care. Other kinds of care were sidelined. We saw a lot of problems that no one paid attention to. In addition, you heard more and more calls for a lockdown to be set up in a more flexible way, so that the elderly may be able to receive their grandchildren. However, there was no movement in the measures. The message was: these are the measures and you have to make do with them.’

Interviews

The research consists of several sub-studies, Hobbelen, professor of ageing and paramedical care explains. ‘We tried to understand what problems there were, how the elderly experienced this themselves and what the solutions would be to prevent this in the future.’
‘Various research methods were used to arrive at the research results,’ says Djoeke Besselink, who is conducting her PhD research within the research group Healthy Ageing, Allied Health Care and Nursing. ‘We use lifeline data for this, among other things. Between May 2020 and October 2021, a study was conducted in which 14,933 elderly people were questioned at seven points in time about their quality of life, physical fitness and feelings of isolation. The study has yielded a wealth of data. In addition, I conducted a qualitative study, for which I interviewed 28 elderly people living at home about their experiences, difficulties and needs regarding their health during the pandemic.’

The future of the eldery

The white paper was developed by FAITH research, a learning community, subsidized by SIA-sprong, in which various organizations are represented such as knowledge institutions, (health) care agencies and mental health care institutions. Within FAITH research, research, education and the business community work together on issues related to themes such as the future of the elderly. The white paper consists of three sub-studies. The first sub-study is about changes in quality of life, physical fitness and feelings of social isolation among older people in the context of changing corona measures. The results of this study show that quality of life and feelings of isolation of older people decreased during the corona measures, but recovered and improved after periods of relaxation of the measures. Changes in physical fitness are characterized by a slight decrease.

Surprising outcome

‘I think it's the most surprising finding of our research, that physical fitness doesn't show the same resilience as quality of life and feelings of isolation,’ says Hobbelen. ‘One possible reason could be that a lot of social activities disappeared during the lockdowns. After that, there was difficulty in starting them up again and sometimes this did not happen at all. This can be the reason why people are no longer physically active. If you have a social activity, you have to go somewhere. If that disappears, you stay in your own environment. The older people indicated that starting up activities they did before turned out to be very difficult.’

‘How can we prevent this?’ Hobbelen wonders. ‘After the pandemic, for example, the Societal Impact Team (Dutch: MIT) was established. MIT advises the government on the social consequences of pandemics and how to deal with them. It is important to assess the impact of the measures. In addition, it is good to weigh the consequences of infection control against the consequences of the social problems that arise. Properly aligning these two things is a good step. In addition, communication should focus more on the message: stay active. The only message that was spread was about preventative measures, such as sneezing into your elbow, keeping your distance and the like. But staying fit is just as important. Therefore, as a government, you have to make sure there is flexibility in the measures. Allow activities to continue, of course adapted to the measures.’

Difficulties and experiences

The second sub-study zooms in on the experiences, difficulties and needs of older people living at home and the network around these people with regard to vulnerability and health during the corona pandemic. ‘Based on the interviews that have been conducted, it is difficult to determine a common thread in how older people have experienced the pandemic and the associated measures,’ says Besselink. ‘The common thread is that there is no common thread. You notice that the experience of older people during the pandemic is rooted in the life experiences before the pandemic. What you see is that people who have had a more difficult life, and already had fewer social contacts before corona, ended up suffering more from the pandemic and the measures. They describe a completely different experience than older people with a large social network.’

Integral consideration

The third sub-study is about the integral consideration of perspectives on COVID-19 measures to prevent adverse health outcomes in older people living at home. In order to prevent these adverse effects during similar situations, it is important to take into account the four perspectives on public health when drawing up public health measures (RIVM, 2014). The research shows that, after virus control from the perspective of 'Perfectly healthy', it is important for elderly people living at home to maintain their own control in order to prevent adverse health effects.

'Deliver tailor-made solutions'

One of the most important lessons is that the elderly are not a homogeneous group and the diversity will only increase in the coming years, says Hobbelen. ‘It is extremely important to provide tailor-made care for the elderly. Policymakers tend to completely erode the differences by saying: every older person would like to live at home longer. That is not true at all. Every older person wants to age healthily. What is needed for this, or what help is available for you as an older person, is important. We saw that during the pandemic as well. The feeling of autonomy is very important for the elderly, even if you are vulnerable or dependent on care. In view of the ageing population, we must not let the costs rise further and we must move towards customisation, especially since we will soon have more elderly people and fewer staff. Vulnerability is multidimensional, it is not only physical but also social and cognitive. During the pandemic, the focus was mainly on the physical aspect and infection control. The social and cognitive aspect was hardly highlighted. When it comes to elderly people living at home, you have to look at all dimensions. That's one of the most important messages from our story.’

Continuation

Besselink would like to follow up on her research. ‘What we've done now is taken a retro-perspective through data. We looked back at what the pandemic did to the health of the elderly. What we still want to do is look to the future. We can extract focal points from the data that tell us which measures are appropriate for protecting and promoting the health of the elderly during an infectious disease outbreak. Are our recommendations realistic, both from a healthcare and a policy perspective? How can you incorporate the lessons learned from the pandemic into a future approach to promote health among older people? I would like to investigate that further.’

In the white paper, researchers provide recommendations on how to prevent adverse developments in health and vulnerability in future situations such as a pandemic.

Read the white paper (Dutch)