First published in the NASGP Newsletter in June 2021
There’s a TV series on Netflix which, despite its cringe-making title I think you’d find uplifting, but bear with me . . .
The sixth age shifts
Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side;
His youthful hose, well sav’d, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound.
When Shakespeare put these thoughts in the mouth of Jacques in As You Like It, he was probably thinking of people in their fifties. Now fifty is the prime of life, though the age at which patients are admitted under the geriatricians varies: in 1986 when I did my house jobs, it was eighty in Cornwall and sixty-five in Acton – and the Cornish I saw were in better shape than the Londoners.
With luck, decent living conditions and good maintenance people in rich countries can preserve their teeth and their vision into their 70s, 80s, even 90s. But it requires commitment. I have just been to the dentist for the first time for nearly two years and come away with a large bill and a gold star. So it was worth the rigorous two minutes with an electric toothbrush, the interdental brushes and the flossing (ugh) twice a day.
Maintaining adequate acuity as your cornea and lenses age involves eye-tests (free), new specs (far from free) and, if necessary, cataract extraction (fortunately free in this country).
We know that our sense of taste deteriorates with age, though most people don’t notice until they have lost it. And then they realise how much taste contributes to the quality of life, as many covid-19 sufferers have found. They may recover their sense of taste with time and exercises. For the elderly, once it’s gone, it’s gone.
Jacques didn’t mention hearing, but technology has moved beyond the ear trumpet – though that did seem to be the solution for an elderly lady on the ward in Truro.
There are exercises to stave off or recover from joint replacement, to counter osteoporosis and to maintain balance and cardiovascular health – my 95-year-old godmother used to go to classes entitled Gentle Jerks.
Then there are the pelvic floor exercises. No longer just for leaking ladies. Getting in touch with your perineum is apparently empowering, both on the political stage and in the bedroom, as French President Nicolas Sarkozy is said to have discovered in 2009.
The myth of the Fountain of Youth is as old as it is widespread. If only sliding into an idyllic warm pond kept us fit and healthy. “It’s only ten minutes a day” they say for each of these maintenance exercises, but all the ten minutes add up to a significant daily commitment. Committed though I am to invest in maintaining my health, I am not sure that it is my obligation to society to do so, especially if swimming in icy water, however beneficial for the body’s defences, is required.
What about mental agility? “Young people are just smarter” believes Mark Zuckerberg. True, the young may think and learn more quickly, but old dogs can learn new tricks, and productivity, social skills and problem-solving all improve with age. Maybe some day even Mr Zuckerberg will acquire wisdom and discover that older people are generally more resilient and happier than young whizz-kids and middle-aged strivers. Just don’t reinforce his stereotype by putting a modest episode of nominal aphasia down to a ‘senior moment’.
So, we can reach retirement age still full of energy. What then? Go on working? Learn Russian? Tackle AZED crosswords? Build dry-stone walls? Join the backpackers on the Inca Trail? Carrying on a vigorous physical and mental life is now an option until genomic instability, cellular senescence and mitochondrial dysfunction have exhausted the body’s repair kit and we drop off a cliff into extreme old age.
American academic Daniel Klein thinks that chasing eternal youthfulness means we miss the gentle pleasures of maturity and wisdom. He instances the group he sees outside the kafenion in a village in Greece. A former professor, retired to his home village, winds down his life chatting and drinking with the fishermen and farmers he was at school with. An idyll few of us could make a reality.
And increasingly unrealistic in countries like India. The traditional supportive multigenerational family structure has been idealised, but the reality was often less than comfortable. In Satyajit Ray’s 1955 film Pather Panchali an elderly woman is forced out of the village by a relative for whom she is just an extra mouth to feed.
If you find ageing and the aged depressing, watch four feisty theatrical dames reminiscing on film in Nothing Like a Dame. Despite some inevitable infirmities, they are a tonic. And Judi Dench has a message about taking histories from the elderly. She was stung by a hornet and went to A&E: “A paramedic who looked about seventeen walked in and asked ‘What’s our name?’ So I said ‘Judi’, and he said ‘Have we got a carer?’” Dame Judi was so incensed she told him off in no uncertain tones: ”I’ve just done eight weeks of The Winter’s Tale at the Garrick Theatre.”
I hope all doctors these days ask their patients less patronising questions about their lives. It is often relevant to their illness and their chances of recovery. And it turns them into people.
That’s something that My Love on Netflix does. Watch the six fly-on-the-wall documentaries about couples who have been together for 40, 50, even 60 years. The couples have very different backgrounds: a depopulated mountain village in Spain, abalone sea-farmers in South Korea, a lesbian couple living in a favela in Rio de Janeiro. They all face a problem of old age – a wife’s cancer diagnosis changing the carer into the cared-for in Japan, climate change forcing the younger generations to move from the rural Indian village to jobs in the city, a six-generation family business threatened by falling sales of maple syrup in Vermont. But the couples are strikingly similar in their relationships, weaving in and out of shared and separate tasks, finishing each other’s sentences, voicing each other’s thoughts, bidding each other an affectionate goodnight as they snuggle up together before switching off the light. They are heart-warming reminders of what old age can be. And we as GPs have a role in supporting that.