According to research conducted by Levy, Slade, Kunkel, and Kasl in 2002, the average lifespan of those with high levels of negative beliefs about old age is 7.5 years shorter than those with more positive beliefs. In other words, ‘ageism’ may have a cumulative harmful effect on personal health. But what is ageism – and what is its impact, both for society and healthcare?
Although it may at first seem paradoxical – that a fear of old age actually brings our twilight years nearer – it does make sense. If one’s self perception of the ageing process is more positive, then dealing with these inevitable changes will be that much easier. Despite this, in our youth- and beauty-obsessed culture, old age can look very frightening. It appears, like Shakespeare’s grim vision of the ‘last scene of all’ as a:
Second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
– Jacques’ speech from ‘As You Like It’, Act II, Scene VII (1599)
As is evident, ageism (the stereotyping and discriminating against individuals or groups on the basis of their age) can be directed just as much against the self, as others. Yet we all know that old age can be, and indeed is, so much more than this. It should be cherished just as much as any other time of life.
The many dimensions of old age have been valued in societies around the world, throughout recorded history. For instance, in a passage from the Insinger Papyrus from Egypt’s Ptolemaic period (c. 305-30 BCE), it was stated that ‘old age’ (anything above 40 years old!) was what ‘Thoth has assigned to the man of god.’ The attainment of old age was evidence of special divine favour, and (as is common across many societies), old people were well-respected both for their experience and wisdom. Similarly, in the English ballad ‘The Ages of Man’ (c. 1775), although failing health is acknowledged:
Age did so abate my strength,
That I was forced to yield at length.
It is also noted that:
My neighbours did my council crave
And I was held in great request.
Akin to such views, perhaps the pendulum in our society is swinging back at last, away from anxious (and unhealthy) aversion, towards a greater realism and warmer acceptance of age. Not a week seems to pass without old age making the headlines – whether it is the latest demographic data on our ageing society, the contested budgets and policies for the care of older people, a famous novelist calling for euthanasia as defence against the ‘silver tsunami’, or polarised debates about assisted dying. Whilst this may seem initially negative in tone (and a great deal of it is) – it does foster debate, awareness, and public understanding of the issues surrounding ageing. Nowhere is this more evident, than in the medical profession.
During the past century, life expectancy in many parts of the world rose from 50 to 80 years. As more and more people live longer in their old age, the impact on general practitioners, medical wards, operating theatres, and community initiatives grows. For accurate diagnosis and treatment, older people who are ill need more intensive examination and more tests than younger people. Add to this the complexity of increased incidence of adverse effects of drugs, and the need for specialist medical and nursing care in high technology hospital environments becomes obvious.
If we approach these problems in a positive, constructive manner, the whole of society benefits – not just ‘the old’. Geratological medicine is concerned with quality of living, but is not centred on prolongation of life at any cost. To every life an end must come, and ensuring that the end is comfortable, calm, and dignified, and that families and loved ones are not left a legacy of guilt and regret, is part of the duty of a geratological team.
The medical understanding of ageing has evolved as well – now generally defined as ‘what sets the morbidity process into action.’ Behind the news, a debate about ‘successful’ versus ‘usual’ ageing is ongoing, and flourishing. Such debates revolve around the concept identified by Cicero’s Cato Maior de Senectute (‘On Old Age’) – that old age, if approached properly, harbours opportunities for positive change and productive functioning. Much ink has been spilled in the quest to define these terms, perhaps usefully, but a workable conception of ‘successful’ ageing, when it emerges, will have to take account of current issues surrounding disability, dying, and our attitudes towards age.
The task for geriatricians remains the optimal treatment of all aspects of ageing: social as well as clinical. In terms of clinical, educational, research, and spending priorities there have been new developments in emergent models of care – with better evidence for the treatment of many geriatric conditions, and the greater importance of social and ethical issues. Our task today is to better understand, and therefore better treat the problems associated with age. If such positive attitudes are maintained – of both society’s and our own self-perception – we can all look forward to those extra 7.5 years!
Featured Image Credit: ‘The Three Ages of Man’ by Titian (c. 1512), Public Domain via Wikimedia Commons.