Blanket cocooning for over-70s has done more harm than good
Telling healthy older people to lock themselves away has been counterproductive
Tony McGrath (76) cocooning at his home in Drumcondra, Dublin. Photograph: Fran Veale
As we start to move beyond the Covid-19 pandemic, critical reviews will begin of how the crisis was handled. Today I concentrate on the Government’s public health measures aimed at protecting the over-70s. The blanket over-70s “cocooning” measures were ill-advised because of their predictable negative impact on physical and mental health, eroding the emotional and cognitive resilience older people need to handle stress and adversity, and also discriminatory on age grounds.
My intention is to focus on lessons we might learn, not to point the finger of blame. Covid-19 sprang on us suddenly, threatening to overwhelm health services and kill many thousands of people. Government had to remain calm, lay down clear guidelines and win public confidence. The resulting spirit of partnership successfully slowed down the progress of Covid-19.
Cocooning makes it almost impossible to maintain adequate mental stimulation and social contacts
But some judgment calls made under such pressure will inevitably be mistaken, and the blanket guidelines for all over-70s were one such call. In a nutshell, cocooning, advocated by government for all over-70s, largely served only to remove the four pillars that support good health in older people. These pillars are: (a) activities that maintain good mental/cognitive function; (b) maintaining good social contacts; (c) maintaining good exercise regimes and (d) healthy eating – as outlined by Doreen Rosenthal and Susan Moore in their book The Psychology of Retirement (2018).
Cocooning means isolating yourself at home for weeks on end, cutting off real-life social contacts and not leaving the house except perhaps for a walk in the garden. Obviously cocooning makes it almost impossible to maintain adequate mental stimulation and social contacts, weakening emotional and mental resilience, and also making it very difficult to exercise and maintain healthy eating habits.
Emotional and mental resilience (ability to handle stress and adversity) is fostered and maintained by setting one’s own goals, learning new skills, social activities, and staying actively involved in the world. This gives a sense of autonomy, competency and mastery, increases will power, self-esteem and problem-solving ability.
While it is undeniably true that over-70s with “underlying medical conditions” are particularly at risk of poorer outcomes if they contract Covid-19, the problem is that all over-70s are lumped together, the healthy and the unhealthy, with little attempt to stratify risks. This is unjustifiable, as explained by health adviser Camilla Cavendish in theFinancial Times earlier this month. For example, one study in the Journal of Applied Physiology of a group of septuagenarian joggers found they were 30 years biologically younger than their sedentary peers.
So, while cocooning has a role in protecting over-70s with underlying medical conditions, the negative effects of cocooning healthy over-70s, draining their resilience and making them vulnerable to the widest range of ailments far outweigh any putative protective effects.
The Government didn’t simply advise cocooning for over-70s – it allowed the impression to go forth that it was mandatory
The Government should have strongly advised cocooning only for those with serious underlying health conditions. Healthy over-70s, having been provided with all relevant information, should have been trusted to make their own sensible decisions. This policy would have spared us the surge of general morbidity that will surely arise now in the over-70s as a result of cocooning.
But the Government didn’t simply advise cocooning for the over-70s – it allowed the impression to go forth that cocooning was mandatory, only admitting it was voluntary when occasionally questioned closely in press briefings. Many healthy over-70s were convinced cocooning was mandatory and behaved accordingly.
Mandatory cocooning for over-70s would be discriminatory on the basis of age, which is prohibited under the Equal Status Acts. As Senator Michael McDowell pointed out in The Irish Times recently, there is no basis in law for having different rules for the over-70s.
Cocooning was an impressive-looking capstone in the overall arch of Covid-19 guidelines, helping to make restrictions imposed on other sectors more acceptable. Older people are not seen as a sector that aggressively asserts its rights, and so it was tempting to allow the idea of mandatory cocooning take hold.
As I write, Tennis Ireland has ruled that all over-70 tennis club members will not be allowed in their clubs when the sport resumes on May 18th. Such herding of older people must stop. Many lessons will be learned from our Covid-19 experience. The importance of older citizens reclaiming their autonomy must surely be one.
William Reville is an emeritus professor of biochemistry at University College Cork