The most senior members of the British royal family attended the Remembrance Sunday ceremony in London, but there was one conspicuous absence: Her Majesty The Queen. After taking a two week break to “rest,” all indications were that she would attend this somber event that she has almost never missed during her long reign.

But this morning she pull out at the last minute citing a “sprained back.”

As the memorial at the Cenotaph is one of the most critical dates on the royal calendar, her nonattendance increases concerns that her health situation is perhaps more dire than reports first indicated.

On April 9 of this year, Her Majesty lost her husband Prince Philip after 73 years of marriage. For any couple to have been married for so long is a gift, but many times when one dies the other follows in rather quick succession.

Many hoped that this would not be the case for The Queen, who remains busy and engaged with her people and the work of being the head of state. She has many things going on that could distract her from loss, more than most elderly individuals.

But her long recent absence due to health reasons calls that into question.

When The Queen returned to royal engagements after mourning her husband, she appeared to do so with gusto. She attended seemingly several in quick succession earlier this fall, but perhaps her dedication to duty was more than she could handle at the age of 95.

In late October, Her Majesty cancelled a trip to Northern Ireland at the last minute and later spent a night in the hospital. She was encouraged by physicians to take a two week break in order to “rest,” but reportedly had every intention of attending the Remembrance Sunday ceremonies.

However, about two hours before the event was scheduled to begin, she pulled out, with the palace citing a back sprain.

The Palace said: “The Queen, having sprained her back, has decided this morning with great regret that she will not be able to attend today’s Remembrance Sunday service at the Cenotaph. Her Majesty is disappointed that she will miss the service.

“As in previous years, a wreath will be laid on Her Majesty’s behalf by the Prince of Wales. His Royal Highness, along with the Duchess of Cornwall, the Duke and Duchess of Cambridge, the Earl and Countess of Wessex, the Princess Royal and Vice Admiral Sir Tim Laurence, the Duke and Duchess of Gloucester, the Duke of Kent and Princess Alexandra will be present at the Cenotaph today as planned.”

Though obviously this is a cause for concern, one royal source reported to The Times of London that it was “unrelated to her doctor’s recent advice to rest.”

Hopefully that is actually the case, but the palace has come under criticism recently for initially hiding the fact that Her Majesty had visited a hospital in October. Many were frustrated that such an important situation had been initially hidden from the public, who they believed should have been made aware of a health situation requiring hospitalization.

In her absence, the three most senior royal ladies stood on the balcony together, with Catherine, The Duchess of Cambridge, in the middle, a place usually reserved for The Queen when there are three together on the balcony. While most likely done for ascetic purposes, as Catherine is taller than both Camilla, The Duchess of Cornwall and Sophie, The Countess of Wessex, it’s also a reflection of how the next generation will soon be taking over.

Soon it shall be Prince Charles, Camilla, Prince William and Catherine as the senior leading members of the royal family. Prince Harry and Meghan Markle, who could have had a major role, left in 2020 in pursuit of the bright lights of Hollywood. The rest of the members, like the Earl and Countess of Wessex, Princess Anne, the Kent’s, the Gloucester’s and other working royals will likely find themselves set somewhat adrift as Charles concentrates on his vision of a slimmed down monarchy.

Hopefully, Her Majesty will make it to her Platinum Jubilee, but these health struggles reflect her age and a significant moment in history. Hardly anyone in Britain remembers a time when Her Majesty wasn’t Queen, even simply switching from “God Save the Queen” to “God Save the King” will take some getting used to for the British people.

But even for a monarch, time marches on and it will be interesting to see how a new chapter unfolds in the United Kingdom under the rule of King Charles III.