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Dublin: 17 °C Friday 3 July, 2020
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'Older people are not a passive vulnerable group. They are a vital part of Irish society'

The Irish Longitudinal Study on Ageing group offers sound, evidence-based advice to those who are remaining at home during the Covid-19 crisis.

Prof Rose Anne Kenny & Dr Mark Ward

THIS PERIOD OF cocooning is challenging, there’s no point dressing it up as anything else. It’s a strange and shocking new way of life, for now. Many people of cocooning age are fit and active, with no underlying health conditions, so the idea of staying home over several weeks is a huge challenge. Not everyone has a garden, and not everyone has family or community support. The older adults of Ireland have been patient in their approach to this new reality, which is to be applauded.

We believe however that it is possible to turn our circumstances around such that cocooning is productive rather than something that could lead to physical and emotional poor health.

There are a number of ways that an individual and a community can mitigate against the possible negative consequences of cocooning and turn the experience into a positive one. The following are evidence-based recommendations for cocooning that we hope will help:

Laughter

Most of the time when we laugh it has little to do with humour but more to do with social engagement and social bonds. We use laughter and humour to manage situations, to display our willingness to engage and to show those present that we are on the same page. Laughter is important in humans and in animals for social bonding and has probably been around for millions of years.

So, if you bring more laughter into your life, you can most likely help others around you to laugh more and realise these benefits as well. By elevating the mood of those around you, you can reduce their and your stress levels and perhaps improve the quality of social interaction you experience with them, reducing your stress level even more. 

What happens when we laugh to make us feel so good- be in no doubt- laughter does make us feel good. We are all familiar with the expression ‘to love a good laugh’. Laughter alters the level of stress hormones. 

It reduces adrenaline levels, the fight or flight chemical. Laughter also reduces cortisol- which is key in the body’s stress response, thus stabilising blood sugars, playing a role in glucose metabolism and insulin levels, regulating blood pressure and working on immune function and inflammation. Laughter increases the level of health-enhancing hormones, like endorphins and dopamine – ‘feel-good’ chemicals.  So make sure you share a good laugh at least once a day. 

A healthy diet

The diet from the Blue Zones – areas which have the highest confirmed numbers of long-lived people who are independent and healthy much longer than elsewhere – are predominantly plant-based. The Blue Zone diet is 95% plants, high fish content, very low in red meat, moderately low in dairy and eggs and very low in sugars with no processed foods.

The Mediterranean diet has also been associated with a reduction in cardiovascular diseases, cancers and arthritis, all of which have been linked to impaired background chronic inflammatory states related to immune systems.

The Mediterranean diet is again high in vegetables, fruits, nuts, fish and olive oil with little red meat. Foods that have been particularly recommended to boost flavonoids and polyphenols, all related to immune system enhancement in laboratory and animal studies, are blueberries, dark chocolate, turmeric, oily fish, broccoli, sweet potatoes, spinach, ginger, garlic, green tea, sunflower seeds, nuts and red and yellow peppers. A general rule is the more colourful your vegetable and fruit plate – the better for immune responses. 

Vitamin D

Vitamin D plays an important role in immune responses to infections and in the prevention of chest infections and reduction in antibiotic use in winter and spring. Deficiency of Vitamin D is common – estimates from the TILDA study state that almost one-third of the over 70s who are ‘cocooning’ are deficient (115,536 people).

Deficiency can be remedied by adequate intake in foods and by supplementation. Vitamin D is made in the skin from 10-15 minutes per day of sun exposure – in Ireland this vital vitamin is only made from late March to late September.

Vitamin D is not made during the winter, and the amount that we make in summer depends on sunshine, weather and other factors. It is available in foods such as oily fish (salmon, mackerel etc.), eggs, liver and fortified foods such as cereals and dairy products. Sufficient daily intake is inadequate in Ireland. Taking Vitamin D supplements remedies this deficiency.

Yet, despite the high frequency of deficiency, supplement use is low in Ireland, particularly in winter and spring.  

Those most at risk of deficiency are people who are housebound/confined, who get little sun exposure or eat inadequate amounts of fortified foods.  Other high-risk groups are people who are obese, physically inactive, have asthma or chronic lung disease.

Although supplements remedy any deficiency and are available without a prescription, supplement use is low in Ireland and particularly low in men. Only 4% of men and 15% of women take supplements. Recommendations are that adults over 50 should take supplements in winter and all year round if sun exposure is inadequate.

Those ‘cocooning’ should take supplements – between 400-1000 IU per day, given the wider implications for improving immune responses and clear evidence for bone and muscle health. Cocooning will of necessity reduce usual physical activity. Muscle deconditioning occurs rapidly in these circumstances and Vitamin D will help to maintain muscle health and strength in the current crisis. 

Keep physically active

Physical activity is widely recommended as an essential component of a healthy lifestyle. At all ages, consistent recommendations are that adults take part in at least 30 minutes of moderately intense activity on five days per week up to a total of 150 minutes per week.

The activity can be accumulated across multiple sessions of at least 10 minutes. Furthermore, adults over 70 should add muscle strengthening and balance exercises on two days a week to their physical activity program. There are a number of such exercise programs available online. A reduction in exercise can lead within a couple of weeks to deconditioning and muscle weakness.

Walking is the most common and accessible activity for older adults and brisk walking for 150 minutes a week is sufficient to meet physical activity guidelines. However, this is not possible under the current cocooning restrictions. Alternative exercise programs should, therefore, be employed. These will vary according to circumstances.

If you have a garden do brisk walking around the garden for 30 minutes each day. If a garden walk is not possible, then try brisk walking around the house or walking briskly up and down the stairs. Muscle strengthening exercises include raising legs, lunges, floor exercises working gluteal muscles, and using weights for upper limbs. Balance exercises include standing, eyes open, on one leg, increasing standing period each day – ensure you have support nearby for stability.

Purpose 

An important psychological strength is having a purpose in life. Purpose is about reflective activities in which individuals perceive their existence to be meaningful and to include goals for which they live. 

Having a purpose in life leads to better cognitive function and less likelihood of developing depression and even dementia. High levels of purpose in life predict longer healthier lives. Like so many of the factors which are associated with a healthier longer life, purpose is linked to biological mechanisms, such as inflammatory markers, hormones, cardiovascular and other physiological functions as well as to brain structure and brain function.

So set targets and goals for your day. Try something new to add variety to each day – there are many tasks that individuals can map out to ensure the day is filled with ‘purpose’. You will feel much better after completing tasks and make a list for next day tasks.

Variety is important. Vary the day. New challenges will provide purpose and variety. Some suggestions are gardening, cooking, knitting, painting, learning new social media skills, etc. People who are cocooning should make contact with friends and family.

The cocooned are not a passive vulnerable group but rather are, in the main, the principal contributors to volunteering and make a significant contribution to the Irish economy. Think of new ways to continue contributing. Future Ireland needs you more than ever. 

Control

Try to take control of your circumstances. The cocooned are not a homogenous, vulnerable, passive cohort. It is challenging to hear constant ‘ageist’ reports from the media and reference to derogatory terms like ‘the elderly’. 

Ageist attitudes are hard to avoid and at present pervasive. This is at a time when the main contenders for the Presidency in Washington are aged 73, 77 and 78; speaker of the house, Nancy Pelosi is 80 and President Putin is 68. 

Take heart though, because the current ageist attitudes have energised a growing lobby of champions against ageism and advocates globally for inclusivity and human rights at all ages.    

Professor Rose Anne Kenny is Chair of Medical Gerontology at Trinity College and a Physician and Director of Mercer’s Institute for Successful Ageing, St James’ Hospital. She is also Principal Investigator for TILDA – The Irish Longitudinal Study on Ageing.

Dr Mark Ward is a Research Fellow with The Irish Longitudinal Study on Ageing at Trinity College Dublin.

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Prof Rose Anne Kenny & Dr Mark Ward

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