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Why ‘ageism’ is bad for your health

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:

Image Credit: ‘Les Aages de Lhomme et a Qvels Animavx il ressemble’ (Late Sixteenth Century), Public Domain via Wikimedia Commons.
Image Credit: ‘Les Aages de Lhomme et a Qvels Animavx il Ressemble’ (Late Sixteenth Century). Public Domain via Wikimedia Commons.

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.

Image Credit: ‘Old Age, Youth, The Hand’, by debowscyfoto, CC0 Public Domain, via Pixabay.
Image Credit: ‘Old Age, Youth, The Hand’, by debowscyfoto. CC0 Public Domain, via Pixabay.

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.

Recent Comments

  1. Simon Kenwright

    Although lip service is paid in this blog to issues of quality of life over longevity this is not its main thrust.The recent paper in Age and Ageing (1) is very relevant in relation to longevity in those over 85. This large study from Finland looked at whether those aged 85-96 , still living in the community , wanted to live to be 100. Only a third wanted this – and for some this was contingent on good health. Some had a feeling of their life being “completed” anyway. Contrast this with the paper by Levy et al where patients recruited included those from 50 upwards , with fairly small numbers in the subdivisions at different ages. If we want to know the views of the elderly we need to concentrate on the elderly – not their views in younger life nor of their relatives who so often have mixed motives.
    Living life to the full and fighting the ageing process has a profound appeal to many of the older folk I know, but is often based on a recognition that growing old is a grim business associated with declining abilities – or are these something which should be referred to as “maturing skills”? A negative view of ageing is quite compatible with maintaining a longer quality of life. Apart from the considerable effort involved in maintaining skills , some see quality aspects as so important as to decline tablets which may impair this quality even to the point of not always taking their tablets – aimed at lengthening life. This seems especially so when NNT (numbers needed to treat to gain the anticipated advantage) are discussed. Similarly when age is taken into account in discussing the long term advantage of certain unpleasant screening tests the overall benefit may not equate well with the discomforts and inconvenience involved. A good example is the realisation that for the very old the longevity achieved from regular renal dialysis equates broadly with the time being dialysed. There is a vast range of behaviours between those who (to continue the Shakespeare quotations) “will be a bridegroom in their death and run int’t as to a lover’s bed” and those who enjoy old age running into a lover’s bed in old age in a more literal sense. In fighting the bad ageism of some attitudes of a few years ago we should not become so judgemental that we lose sight of the old being individuals – each with his or her own set of beliefs and philosophy. The present ageism takes many forms : from the failure to see the enormous range of how individuals see their later years to doing things to the elderly because they are elderly. The pressures towards the latter were a factor in my own retirement. A group such as SOARS (Society for Old Age Rational Suicide) – now “My Death My Decision” – just emphasises how far there is a lack of trust in our medical system. Perhaps this reflects a specialty that has moved from “Care of the Elderly” to the science of gerontology ?
    Now in my late seventies I am having to learn to weigh carefully the advantages and disadvantages of suggested interventions ,taking into account future possibilities as well. I am increasingly reminded of some of the philosophy I received from my parents and grandparents – old age has its tribulations to help us to see the alternative as not so bad. And in the way they turned their backs on longevity as the main determining factor when the crunch came in old age. The loss of a will to live in the very elderly is an entity distinct from depression, despair, grief or sadness (2) and we should be wary about forcing preconceived views on this potentially vulnerable group over and beyond compassionate care.

    1. Age and Ageing Helena Karpinnen et al (2016) 45(4) 543-549
    2. Age and Ageing Helena Karpinnen et al (2012)41(6) 789-94

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