LONDON: While the ageing of society has become one of the givens in today’s world, less is made of the lived experience of the very elderly in society.
And although there is some suggestion that the much trumpeted steady expansion of the human lifespan has begun to slow down, the numbers of very old people continue to grow.
Despite this, debates about the resourcing of universal health and social care tend not to examine the costs associated with extreme ageing. Yet the problem of chronic conditions and multiple morbidity is greatest among octogenarians and nonagenarians.
Very old age, if commented upon, is presented as if it were a kind of extreme sports competition.
Centenarians are celebrated simply for reaching 100. Nonagenarians hit the news when they run a mile, climb a mountain or pilot a plane. Otherwise, silence reigns.
Yet the focus of most social care is on people aged 80 and over – a group for whom care is needed because health cures have failed them.
The morbidities and infirmities that beset the extremely aged are not so much ignored as abandoned to the efforts of medical services and social care.
There are a number of ways that such “hyper-ageing” can be approached and understood.
One view celebrates the fact that the more and more people can expect to live for 100 years or more. Another sees it as an apocalyptic disaster, as agedness “swamps” the resources of society needed to maintain itself.
Yet another view juggles between the successes of more years of healthy active life and the failings of more years of living with disability and infirmity.
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DISEASE AND DISABILITY CONTINUE TO AFFLICT THE ELDERLY
Across the world, the burden of disease has been receding. But this is more the case for illnesses affecting younger people and those that are likely to lead to death, rather than disability.
By contrast, conditions that are degenerative and disabling more often than causing death remain largely unchanged.
Rates of osteo-arthritis, for example, which disables but does not kill you, have been rising over the last 25 years. Rates for Alzheimer’s disease, which disables more than it causes death, have also grown but in a less pronounced manner.
Although some chronic conditions affecting older people, such as chronic obstructive pulmonary disease, which kills and disables you, have been falling, the really large falls in disease prevalence have been in conditions affecting the young, such as cases of diarrhoea and related common infectious diseases, which have dropped remarkably.
In Denmark, one of the few national surveys of nonagenarians was conducted around the turn of this century. The researchers found that the majority contacted had some disability and that women were more often affected than men.
The same researchers also observed that “about 10 per cent of the octogenarians and more than 55 per cent of the centenarians live in nursing homes, while dependency rises from approximately 30 per cent to 70 per cent, and the prevalence of dementia rises from approximately seven per cent to 50 per cent”.
In the UK, one study of 85-year-olds found a median number of five diseases per person, with more than half suffering from hearing impairment, just over half from osteoarthritis, and just under half suffering from high blood pressure. Just under a quarter had some form of cancer.
Yet, less than 5 per cent told the researchers that their health was poor: Most said it was good.
THE SILENT ISSUE OF INEQUALITY IN OLD AGE
This last point emphasises how extreme ageing presents issues that easily go unremarked upon. Its problems are largely confined within the individual household or in long-term care institutions.
Wider society scarcely acknowledges these problems and most of those on the receiving end, whether carers or people being cared for, are simply too overwhelmed to do much about them.
Although not closed off to the public, the nursing home remains more present in the imagination than in most people’s everyday experience.
The social networks of the frail elderly, whether living at home or in a nursing home, tend to be so much smaller than those of the rest of the population.
Most people over 80 live alone. They often have only a few people to talk with.
Meantime, stories of abuse, or TV footage of the inside of the nursing home paint a grim picture to all who watch, read or hear them.
These isolation and neglect of these spaces help preserve the distance between an “us” who are, if we are ageing, ageing well clear of such scenarios, and a “them”, who are not.
To be old and frail is not an identity to be acclaimed and the old and frail are generally unable or unwilling to represent themselves as such.
For many of these people, life can be difficult. Estimates suggest that chronic pain “in people aged 85 years or older is common”, affecting the majority of people from this age group.
Aged lives of quiet desperation are sadly not rare, nor are most lived in the heroic terms of the marathon-running nonagenarian that hits the news.
In drawing attention to this, we are not attempting to promote further victimhood. What we hope to achieve is to cast a little light upon the darker side of our ageing and of our ageing societies. Old age should not be sought out just for the sake of it.
Paul Higgs is Professor of Sociology of Ageing at University College London. Chris Gilleard is visiting research fellow in psychiatry This commentary first appeared on The Conversation.