Life expectancy in the developed world is continuing to increase. Consequently, this country is experiencing an unprecedented growth in the older population which has been described as a “demographic time-bomb”. What an unhelpful, and frankly disrespectful, turn of phrase! – it effectively reinforces some of the negative connotations of ageing. In any case, people who are older are also healthier in their later years than ever before: “an unmistakable trend towards healthier, longer life; solid scientific evidence of declines in disability among older people” stated the World Health Report in 1998. By 2030 one in 3 people in Europe will be over 60; people in their sixties and seventies now are unrecognisable compared with the pensioners of 50 years ago. Over the years, I have encountered – and challenged – quite a few commonly-believed “myths about ageing”, which I feel are worth exploring further in this blog.
What is the definition of “old age” anyway?
In decades gone past, people’s lives were notionally divided into “ages” – youth (up to the age that most people stopped reproducing), “middle age” (people were no longer considered young, but were still working) and “old age” (basically, the interval between stopping work and death - which may have been sort, and largely spent in ill health). Nowadays, it is perhaps more useful to consider the idea of the “third age” – the time between “middle age” and “old age” where older people have the time to spend on their preferred pastimes and pursuits, are healthy and active, and are finally able to put their own needs as a high priority. One might even call this the “golden third age”, and consider it something to be anticipated with eagerness rather than trepidation.
Certainly I feel, and most people will have had this experience, that older people vary extremely widely in how healthy and active they actually are, and in the attitudes and values by which they choose to live their lives. I think it is important to recognise that a person’s “chronological age” (the number of years since they were born) does not necessarily correlate with his or her “biological age” (how healthy their bodies are) nor his or her “psychological age” (how they behave, and think about the world). Some people just seem to “age well”! This is not, generally speaking, “luck” – read on to learn more!
Myth 1: Older people will inevitably be in less good health than when they were youngerCommon sense tells us that some wear and tear on the body is inevitable over time; everything has a use-by date, and that unfortunately includes parts of our bodies. Most cells in our body continually regenerate throughout our lives, but even this process cannot go on forever, as eventually the telomeres (which protect the ends of our chromosomes from the damage of cell division) will themselves be damaged beyond repair. However, there is much that can be done to slow down the ageing process. You can aim to prevent and mitigate against some of the physical processes of ageing by exercising and eating well, and maintaining a positive mindset. If you expect to get old and ill, you will! Doctors now consider “frailty” (partly determined by the “get-up-and-go test – how quickly can you rise from a chair and make your way across a room?) as a diagnosis – that is to say, it describes a pathological process (something is wrong). There is almost certainly a genetic element to ageing well, but until we understand this better, we need to make the best use of the weapons in our arsenal and fight back against old age.
One of the major problems of older life, that of loss of lean muscle mass and general strength and flexibility can be slowed down significantly by taking an active role on maintaining health – not passively succumbing to the consequences of slowing down. Inactivity leads to old age, not the other way round! Even moderate exercise regimens have been proven. to lead to hugely beneficial changes in older people’s fitness levels. NEVER accept “what do you expect, at your age?” from your doctor – but DO accept that YOU might need to DO SOMETHING (or STOP DOING something) to help you stay feeling well for as long as possible. Your doctor cannot achieve this on your behalf, but will be delighted to help you achieve your health and fitness goals. Certain diseases, such as cancer and heart disease, are more prevalent (commonly found in the population) in older people, so it is worth being very vigilant in reporting any symptoms (particularly pain, lumps, bleeding or weight loss) which can’t easily be explained – but for every older person with a serious illness there are plenty who remain well – usually these are the ones who have been looking after themselves.
Myth 2: Older people will inevitably lose their ability to think clearly
Like frailty, dementia is pathological, not naturally associated with older age. Confusion, poor memory or an inability to think clearly are not “normal”, no matter how old the person. One of the most common reasons for these problems in older people is actually medication side effects, and there are many, many other causes other than Alzheimer’s Disease – cognitive health is very much a “use-it-or-lose-it” commodity. Keep reading, keep questioning, get your doctor to check for anything from vitamin deficiencies to syphilis as a cause for not thinking straight any more. Confusion in elderly people is very common, but is often associated with acute, temporary illness (“delirium”) and can be treated. Too often, older people exhibiting some confusion symptoms are assumed to have incurable dementia without adequately assessing the patient as a “whole person”. People who are worried about their memory and thinking should also have depression ruled out, as it often mimics dementia. Finally, it is worth remembering that alcohol affects older people just as much as youngsters, and they may likewise need help if they are drinking too much.
Myth 3: Older people should expect to be on lots of different medications
There is a very common idea that older people ought to accept as an inevitability that they will having to manage taking multiple tablets, three or four times a day, for ever. I feel very strongly that doctors tend to over-prescribe for older people, with consequences that range from inconvenient to tragic. There seems to be a recurring theme of: older patient experiences a symptom (or reaches an age where a routine screening test result indicates that a medication might be statistically a good idea) – older patient sees doctor – doctor prescribes medication – older patient experiences side effect from medication – doctor prescribes a second medication to counteract the side effect of the first medication – continue ad infinitum (or ad nauseam, as is so often the case). Polypharmacy needs to be addressed as it leads to falls, confusion, reduced quality of life and more stress for carers and older patients themselves, with the risk of serious drug errors as the situation gets more and more complicated. Insist on your doctor explaining to you, properly, what each of your medications is supposed to be achieving for you. Consider asking for your doctor’s support to trial life off the medication. Insist on hearing the options for alternative medications, which might be easier on your system or more convenient to take, or even drug-free treatments.
Myth 4: Older people all need the same sorts of things from life
Imagine if this same idea was applied to, for example, pre-schoolers. How quickly would a flurry of expert opinions pour in, saying that all toddlers are different and express their personalities and preferences in unique ways; that they all have totally different needs and should be approached as individuals? Why would we ever decide that it is appropriate to suggest that older people make up some sort of homogenous group of human beings who can all be lumped into a category and treated the same way? We have already seen that people who share a “chronological age” may well seem decades different in terms of biological or psychological age. I saw a flyer at the weekend advertising “retirement parties” which would allow the older person to pet baby rabbits; I have seen tea-dances and bingo events marketed “for the pensioners” – I then consider my 71-year-old father, who is a professor at Yale University, who goes to the gym four times a week to counteract all the transatlantic flying and fine food and wine, who is a mean poker player but wouldn’t have a clue what bingo is, and who divides his spare time between the black runs in the Alps and bouncing on the trampoline with his granddaughters – the phrase “chalk and cheese” springs to mind.
Myth 5: Older people shouldn’t bother trying to live healthily, as it’s “too late”
This is absolutely NOT TRUE. It is never too late to stop smoking and start eating more healthily; it is never too late to (start to) exercise. Older people may sometimes experience a lessening of the thirst response to mild dehydration, and need to make a special effort to stay well hydrated. Basal metabolic rate might drop over time, but that does not mean weight gain is inevitable as an older person – calories in and calories out are still determined by the choices that individuals make. Look after your feet and skin – in particular, apply high strength sunscreen and watch out for (and report to your doctor) any patches which seem to be changing. Arrange and attend regular check-ups of teeth, eyes, and hearing. A general regular check-up with your doctor to make sure you are staying well is always a good idea, as is participating in any national screening programmes; and you may wish to consider a full, private Wellness Screen. Make sure you are safe driving, and carrying out any other potentially hazardous activities.
Myth 6: Older people shouldn’t expect to be happy or to enjoy life
Depression is not an inevitable consequence of advancing years, and ought to be vigorously screened for and treated – and not mistaken for dementia or other illnesses – and certainly NOT accepted as par for the course. Depression screening questions such as “have you been bothered by feeling down, depressed, hopeless or having little interest or pleasure in doing things?” can help alert health care professionals to the presence of debilitating low mood, but older patients themselves often report feeling flat, tearful, irritable, guilty, worthless or many of the other manifestations of depression. Depression can be brought about or made much worse by loneliness or loss; many older people in the UK are classified as lonely, and bereavement is no less appalling for someone in their 90s as for someone of 19. Doctors and families who care for older people need to challenge them about their mood and reassure them that there is much to be done to improve things. If, as an older person, you are feeling low, please talk to your doctor about it. Many older people have a significant role caring for a dependent adult; this can be a huge cause of stress and is also worth discussing with your doctor, as there may be packages of care which can be offered to relieve the burden. Older people deserve to smile!
Myth 7: Older people can’t learn new skills or keep up with new technologies
They say “You can’t teach an old dog new tricks” – but actually you can, uniquely as a human, continue to learn new skills right up until your dying day. In fact, studies show that taking up a new hobby, preferably one which stretches you and brings you out of your “comfort zone”, enhances mental functioning and memory and can delay any dementia-type processes. Why not try your hand at something you never knew you could do? Challenging the myth of older people’s being intimidated by technology is also important - technology can be very helpful for older people to stay in touch with those they love as well as being fun and educational. So-called “silver surfers” (older people using computers to surf the Web) all over the world are participating in on-line discussion and debate, petitioning, setting up websites and chatting with friends and relatives from next door to Australia. Don’t have a Facebook account yet? Set one up – it’s easy!
Myth 8: Older people can’t be creative or contribute to society after they stop working
Older people in society have a huge amount to offer people of all ages. They have experience and skills as well as mature and capable strategic problem-solving abilities. Many older people demonstrate empathic, holistic and multiperspective thinking – probably simply due to time spent on the plant, and having been through things most younger people will never experience (or, at least, not in the same way) - and can offer unique learning opportunities for those who speak to them. Grand-parenting is a wonderfully rich job in itself; many older people find considerable fulfilment in “giving back” to their communities in such roles as volunteers, magistrates, trustees, governors, school crossing patrollers, curators, etc. – many more enhance our society as well, with interests in creative arts, music, gardening, writing, genealogy and so on. There are many groups and societies to join and to share interests as well as cementing new friendships – ask your GP for more advice, or check out the University of the Third Age (U3A) on-line, or your local adult education centre, for more ideas. Healthy older people represent a significant resource to their communities, societies and economies, and are able to make invaluable contributions – we must tackle the discrimination against older people which might prevent them from realising their fullest potential.
Myth 9: Older people have no real influence in the way the world works
Recent research proves that the so-called “grey pound” has played a hugely significant role in lifting Great Britain out of the recession, with over £350 billion in consumer spending by the over 50s (almost 50% of the total spend in the UK). The previously perceived wisdom that it is the younger, 21-34 years old generation who has the largest disposable income and therefore the group targeted most by advertisers, has been turned on its head by these findings. Clearly, older people have a huge effect on the country’s economic health, and it looks as though we can thank the savvy baby-boomers for getting us all out of a hole. The influence of the older people in society’s decision-making doesn’t end with their financial contributions – it is well recognised in business and politics that a breadth and depth of personal life experience tends to encourage strategic and holistic thinking, and, ultimately, leadership. It’s common sense that most business leaders and heads of state are older – there is no expiry date on the sorts of skills required. In Scandinavia, it is well recognised that older people have a hugely important role to play on the national political scene, and in Denmark specifically there are 5 regional elected Senior Councils whose members both champion the rights of the nation’s senior citizens and regularly meet with government to discuss, and plan improvements to, older people’s services. Only fair, really, that these older people, who will have ordinarily contributed 50% tax for 40+ years, should have a say in what happens to the money!
Scandinavia is not the only place in the world where older age is celebrated and respected as a matter of course. In Greece, old age is associated so strongly with wisdom and closeness to God that abbots and abbesses of any age are addressed as “old man” or “old woman”. Native American Indians are expected to learn from the experiences of the tribal elders, who teach the youngsters how to live. In Korea, within the family unit, there is a fundamental principle, rooted in Confucius’ teaching, of respecting one’s elders; outside the family, too, people are socialised to show deference to older people as authority figures. There are many, many other examples from worldwide cultures. Perhaps we in the UK ought to be following their lead and including older people more in local and national politics? After all, they may not only have much of value to offer, but also more time available to sit on committees and attend meetings – Brighton and Hove has recently followed the Danish example, forming a Senior Council, and no doubt others will soon too.
Myth 10: Older people like to be left in peace and quiet rather than socialising
There is a commonly held misconception that older people, given the choice, would prefer to nod off in an armchair, in solitude, rather than be in the company of others. Family and friends might even leave an older person out of an invitation, believing “it might just be a bit too much” for him or her. This is nonsense! Older people derive just as much enjoyment from social interaction as younger folk; in fact, is it loneliness in older people, rather than too much human contact, which is recognised as being a major factor in contributing to mental and physical ill-health. Sadly, around a million UK older people will go for an entire month without speaking to anyone at all. Please do include older people in plans for social events – one of the great things about getting older is that, if an older person really doesn’t want to come along, he or she will have the confidence to tell you so!
Let’s not forget sex, when thinking about older people and relationships. Society tends to believe that older people just aren’t interested in sex at all; or that, if they are interested, they are either lecherous and depraved (“dirty old man”) or figures of fun (take a glance at the birthday greetings cards designed for older men and see how many make so-called humorous references to failed or embarrassing sexual encounters). In fact, older people usually are interested in sex, and would wish continue to enjoy sexually satisfying experiences until the end of their lives. There is a commonly held misconception that sex is the exclusive preserve of the young and the physically beautiful; this needs to be challenged. There are certain age-related changes to the way our bodies work which may mean we need to accept that sex needs to change too (either partner may take longer to get “warmed up”, for example), but the vast majority of potential obstacles to a satisfying sex life in older age can be overcome – erectile dysfunction (the inability to achieve and maintain an erection) is not an inevitable consequence of a man’s getting older; women can continue to enjoy penetrative sex and orgasm when they are older just as they could in younger life. Studies show that older people who continue to be sexually active are likely to live longer, and be happier too – so there’s no excuse! If there is something holding you back from enjoying sex in your later years, talk to your doctor – chances are there is much that can be done to help.
Myth 11: Older people in society mean we need to provide more hospital beds and nurses
NO!!! We need a frame-shift change of perspective which celebrates and supports healthy older age. We need publicly-funded and fun exercise facilities for older people, with safe and accessible green spaces for us all to get outside in (and benches and clean public toilets would be appreciated by people of all ages). We need clear information for older people about the support services which exist to help them stay healthy and active, and we need these services to be properly resourced and championed as worthwhile initiatives. We need doctors to work alongside their older patients to minimise polypharmacy and drug side effects (supported by switched-on specialist community pharmacists) – I personally would argue that a placement as a junior doctor in a Care of the Older Patient setting ought to be a compulsory part of a GP’s training. We need community initiatives to involve older people in life-affirming projects, where they can see what a positive effect their contribution has on their local community and wider society. We need to ensure that our older people are assured of a sufficient income, and empowered with a sufficient understanding, to make healthy diet and lifestyle choices. We need to challenge the idea that older people are a “burden” on society, and instead celebrate the invaluable contribution that they make to us all – older people ought to be warmly invited to join in and be welcomed. Surely it’s time to prepare for an older population, not as a burden, but as a rich valuable resource in society; people of all ages should look forward to, celebrate, and take advantage of, a longer and healthier life.
Myth 12: Older people don’t like to talk about end-of-life issues
Older people are perfectly well aware that they have, in the words of my amazing step-grandmother, more years to look back on than to look forward to. They are not stupid! Growing older means getting closer to the end of life; that is a given. Many older people give considerable thought to what they want, and don’t want, as and after they die – let’s hear them tell us! Too often, loved ones of older people avoid having end-of-life discussions with older people because it is seen as a taboo, tricky subject which might be too emotional or awkward to discuss – but the way people die lives on in the memories of those who are left behind. Having the “difficult” conversations that so many of us try to get away from means that we can honour the older person’s wishes at the same time as ensuring those left behind feel comfortable knowing that they did the right thing. It’s never too early to think about issues such as organ donation, and there is an argument to suggest we ought, all of us, to have Lasting Powers of Attorney in place while we are competent enough to decide who we want to represent our interests in the event of losing capacity. Having discussions about funeral wishes, wills, resuscitation orders, advance directives and so on, might seem hard when people are still alive; but it’s much harder trying to guess what they would have wanted, after they are gone. Let’s all set an example and involve our loved ones in our thoughts about end-of-life. Your GP can help advise you on any issues relating to end-of-life planning, and can also help with any medical input required for a legal matter such as Lasting Power of Attorney.
Quotes about Getting Older:
Do not mind growing old – it is a privilege denied to many
You don’t stop playing because you grow old, you grow old because you stop playing