Ageing in a post COVID world
Authors: None The Lancet Healthy Longevity
Journal: The Lancet Healthy Longevity (2021)

On Jan 15, 2021, the UK Government's House of Lords’ Science and Technology Select Committee published a damning report into the state of healthy ageing in the UK. Although the report focused on the UK, many of the issues raised are universal. The Committee found that there “has been a lack of leadership and planning” for the 2017 Ageing Society Grand Challenge which aimed to “ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest”. Instead, “minimal progress” has been made, with people “living longer, but many of those extra years…spent in poor health.” And this is not taking into account the impact of the COVID-19 pandemic which has led to disproportionately greater numbers of excess mortality in older people. Many of the societal and medical issues flagged in the report have been exacerbated by the pandemic. For example, the need to promote and support lifelong digital skills training, including providing such support to a large proportion of the current older population, is reflected in the barriers technological illiteracy is causing in vaccine access even in high-income countries. An article in the New York Times, also published Jan 15, emphasises the difficulties in obtaining the COVID-19 vaccine for older people in New York. Because the USA does not have a central health-care service provider, vaccine delivery is fragmented, with providers and payee systems all requiring complicated online registration, despite older people being much less likely to be technologically engaged. In the USA, many older people have had to turn to friends and family for support in figuring out the online systems to obtain the vaccine, a development which runs the gamut of being frustrating for some, creating damaging feelings of dependency for others, or, worst of all, leading to some people missing out on the vaccine entirely. Another issue raised in the Report (which has been worsened by the pandemic) is inequalities of healthy ageing outcomes. As in almost all parts of society, ethnicity and socioeconomic status dictate widely varying outcomes, including in access to enabling technology, palliative care provision, and health-care engagement. The 10-year follow-up to the Marmot Review—an assessment of health equity in England—which was published in February, 2020, found that “there are clear socioeconomic gradients in preventable mortality” with the poorest areas of England having the highest rates of preventable mortality. An August, 2020 assessment by Public Health England found that “[the pandemic] has replicated existing health inequalities and, in some cases, has increased them.” The House of Lords Report ends with many calls for action, many of which are admirably nuanced calls for further research into ageing. One emphasises the under-funding of research into the basic mechanisms of ageing, as opposed to age-related diseases, which they find might have contributed to poor translation of basic research into clinical medicine. Another flags the routine exclusion of older people from clinical trials, even those trials which directly address ageing and age-related diseases. Finally, there is a call for further interventional studies to establish which social and environmental factors can affect health in older age. While these recommendations are welcomed, none of the findings and recommendations laid out in the Report are new to those in the ageing research community. Furthermore, they are issued against a concerning backdrop in which care rationing has become necessity in some parts of the world as health-care systems become overwhelmed by the pandemic, with some countries deciding on health-care allocation by patient age. The British Geriatric Society has launched a ‘Fair Care’ campaign, one strand of which emphasises that older people have as much right to treatment as any other. For the Report to have the effect that it should, policymakers need to follow good intentions with legal frameworks, funding, and willpower. There is no us and them, no young and old: we are all in a continuum. Achieving older life should be something that we aspire to and celebrate, not fear. The pandemic has made ageing well harder. But a society that treats all its members equally and fairly irrespective of age will also be one that comes back stronger from all adversity. The time to invest is now.