Our attitude to the elderly is breaking the NHS

‘You must stay at home’ - Rt. Hon. Boris Johnson, Prime Minister of the United Kingdom, 23 March 2020. To paraphrase his hero, never in the field of human endeavour has a Prime Minister spoken five so poorly considered words that would impact so many.

It's not as if likely problems with this approach were unknown: in January 2017, Dr. Amit Arora wrote a blog note on the topic of ‘Deconditioning Awareness’ for the NHS England website, of which the ‘experts’ advising the PM must surely have been aware: ‘Time to move: Get up, get dressed, keep moving’; it explains, in layman’s terms, why restricting the mobility of the elderly is a bad idea. 

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The NHS is at breaking point: that we know. The reasons given are many and varied, but the underlying cause is that old chestnut, bed-blocking. Patients, many elderly and vulnerable, cannot be discharged home without full engagement of necessary social care support. This takes time; during that time said patient takes up a hospital bed. 

Why are so many patients needing social care support? That is a question that the media, and politicians, seem reluctant to answer, perhaps because it would show up their inadequacies, their fears of old age, and that the enthusiasm with which they embraced lockdowns has had consequences. We are told that it’s something to do with ‘the pandemic’; they’re right there. Boris’s words on 23 March 2020 are, undoubtedly, a major cause of the problem. 

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Viv, of course, is the person I do most of my caring for, she’s not elderly and we don’t live in a property designed for the elderly. However, I am now also involved in helping and supporting my 89-year-old-mother, who, after hearing Boris’s words, and, unlike me, dutifully stayed at home throughout the lockdowns in 2020 and 2021. Home, for her, prior to June this year was a one-bedroomed bungalow on what was once a sheltered accommodation unit in South Cambridgeshire; the council failed to replace the warden upon their retirement over a decade ago, preferring to sell off the warden’s house instead to raise a few quid, no doubt funding a bonus for one of the executives, so the residents had to fend for themselves rather more - but that’s not relevant to the matter in question. 

My mum’s mobility had gradually declined over the last couple of years - the period of lockdowns, this being put down to ‘getting old’, not only by herself, but by the council support team and the local GP surgery. She ended up having a minor fall, followed by ten days in hospital, during the last eight of which she was a fully qualified and catheterised bed blocker. She left hospital labelled incontinent and unable to walk, to go into a care home, where, with help from staff, family and a (private) physio, she is surprising herself and everyone at the way she is regaining balance and mobility. She already can go to the loo on her own, which, if you think about it, is quite an improvement in quality of life over having two people stand and watch your every (bowel) movement.

It’s this experience that has primarily triggered my interest in how mobility issues are clogging up the NHS, post-Covid. 

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Politicians and media types know very little about how or where most of the elderly, disabled and less fortunate spend their lives. Society as a whole has a view that, as you get older, you should move into a small home: houses, apparently, are for families. The elderly should, we are told, live in small bungalows or flats, perhaps in a sheltered development, of a type once managed by local authorities, but now (over)sold by the likes of McCarthy & Stone or Sanctuary. These properties, built in their thousands since the 1950s, typically consist of a - according to the Sanctuary website - ‘self-contained flat consisting of a kitchen, lounge, bathroom and bedroom/s, a studio flat or a bungalow’.

What troubles me is that few of the individuals approving developments of ‘housing for the elderly’ seem to understand their true needs, and that, fundamentally, is one of the reasons the NHS is so full of elderly people with mobility issues. Those designing and approving such developments are, of course, relatively young and reasonably active - they work; they will move around the office, or walk from home to the station, or whatever, as well as performing some movement through necessity (walking to the loo, for instance) or leisure activities. The elderly have fewer reasons to move, and, if they live in a small flat or bungalow as described by Sanctuary, any movement they do for necessity will not work their muscles very much.

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Then consider the effect of that compounded with ‘you must stay at home’: going outdoors was almost the only exercise many elderly people were getting prior to the pandemic. Months spent doing little other than sitting at home, in a small bungalow or flat, have had a devastating effect on mobility of the elderly; at the end of the lockdowns they were left weak, and with poor balance (for exercise is necessary to maintain balance, as well as strength). Continuing confusion and fear over the ‘pandemic’, spread, among others and to their shame, by some sections within the NHS, makes matters worse, and discourages them from leaving home even though they no doubt realise they should.

It only then takes a minor injury for them to end up in hospital, where, with avoidance of falls a management priority, they are discouraged from moving around; catheterised and padded they are left, lying on a bed, for a number of days with barely any time spent on their feet, let alone walking. When they are finally medically ‘fit for discharge’ they can’t stand; they join the thousands (a figure of 10,000 was reported in December 2021) reported to be blocking beds, awaiting social care provision.

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So what can be done? Strangely, there are some obvious changes that could be made to current thinking that, in the medium term at least, would have a significant effect on the number of elderly people suffering mobility issues, and would improve their quality of life. Here are a few:

1. Society must stop accepting that mobility issues are inevitable as you age. TV adverts for rising chairs, mobility scooters and such like all normalise the idea that, as we get older, we can’t walk as we used to. That is not inevitable: we need to keep using our legs, keep moving, to retain the ability to move.

2. Many aids - rising chairs and mobility scooters being two - that replace the work of muscles should come with a health warning, that sustained use of these devices may impair the user’s mobility in the long term.

3. The idea that the elderly should live in tiny bungalows or flats must be challenged. Stairs are considered to be a risk, but they give rise to the need to work leg and back muscles in a way that walking on the level doesn’t: with proper handrails, and used carefully, stairs need not be a hazard. (Viv’s 92-year-old aunt lives in a two bedroom house, with only an upstairs loo, and she manages to get around towns and cities surprisingly well.)

4. Housing developments targeted at the elderly must provide spaces where their day-to-day lives will involve some walking. Think of cloisters or pleasant corridors; sat in their warm, cosy (but tiny) bungalow or flat they won’t want to go outside if the weather is poor - as it is for perhaps six months of the year in the UK. There needs to be somewhere safe for them to walk twenty, fifty, or a hundred yards without getting cold or wet, and, if possible, this needs to be part of their daily routine. 

5. Hospitals must encourage patients to exercise, to retain their balance and their ability to walk.

6. We - everyone - need to stop doing things for the elderly, like going shopping for them, but instead help and encourage them to do these things themselves - perhaps walking with them, at their pace, to the local shop to ensure they are safe.

7. Streetscapes must be made easier for the less mobile to negotiate: Living Streets claim that 50% of older people ‘say they would be more likely to walk outside if the pavements were clear of vehicles parked on them’ ; it's not just pavement parking, but bad surfaces, overgrown bushes, advertising boards are among clutter that makes it difficult for the less mobile to walk around outside their homes. (Some developments, including the one on which I live, feature ‘shared spaces’, the idea of which is that pedestrians should have priority over vehicles over the whole width of the street - unfortunately, even the latest Highway Code does not explain the rules for ‘shared spaces’.) 

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In the meantime, politicians and the media need to look critically back at the decisions made, and instructions given,  by Government, and ‘experts’, not only during the pandemic but over many years. Shutting older people away in shoebox-sized apartments may seem a way of solving the housing crisis, but wouldn’t you want to be able to enjoy life when you’re older - or would you prefer the problems of immobility, lying on a bed for most of the day, having your bum wiped by a stranger to clean off dried faeces, and never going out? 

Do we care about our elderly or don’t we? Do we care about the NHS or don’t we?