well. I enjoy my current age since the research is very exciting and even if a bit slower I just get on with it. I collaborate and get grants mainly from drug companies. We have seven scientific papers in preparation, one of which has just been rejected but at my age I get less upset when things go wrong. We have a project that will only be finished in about ten years—not sure I will still be here. I do think that euthanasia raises difficult problems but I do think we have the right to choose when to die.
We live longer today than at any time in history. Over a sixth of people living in the UK are expected to celebrate their 100th birthday. Mortality has been considerably postponed, as a result not of revolutionary advances in slowing the process of ageing, but of progress in improving health. Ageing itself has undergone a dramatic change over recent years. In the industrialised world in the twentieth century there was an unexpected and unprecedented growth in the older population—some 30 years were added to life, an increase greater than in the previous 5,000 years. This was due to improved healthcare, food and sanitation. There are now more people aged over 65 than under 16 in the UK. And the number of people aged 85 years or more doubled between 1983 and 2008.
In the UK, there are currently around 10 million people who are over 65 and 1.3 million over the age of 85, of whom 422,000 are men and 914,000 women. Women have outlived men throughout history. We humans generally live longer than our ape-like relatives, and have an extended period of juvenile dependence—this may be related to getting food, which is difficult for the young. The elderly are, in this sense, repositories of knowledge. But while there have been many individual exceptions—such as St Augustine, who lived to 75, and Michelangelo, who died at 88—for most of human history the average lifespan was short. In London in 1800 you could expect to live to just 30, in 1900 to 42, in 1950 to 61, and now to about 80, women for a few more years than men.
The recent increase in the number of the old and very old has major implications for how they live and are cared for. Ageing can thus have major economic impacts, particularly if the number of the aged becomes greater than the number of the young needed to support them. It is thus essential that we understand both the biological basis of ageing and how the old are treated.
Why do we age? The Ancients mainly thought that it involved the loss of some key factor in the body. The scientific study of ageing began with Francis Bacon in the seventeenth century, but it was only after cells were recognised as determining how bodies functioned that scientific research into ageing could properly progress. Even doctors eventually became interested in ageing, and geriatrics was established. Peter Medawar proposed an evolutionary theory, and there was the surprising discovery that cells aged in culture. Evolution and sex play key roles in understanding why we age: evolution is concerned only with reproduction, so does not care if we age after having successfully reproduced. Ageing is not programmed in our genes like normal growth; on the contrary, there are genes which try to prevent it. Another surprise is where our great progress in understanding has come from: it has been the investigations of ageing in a simple nematode worm and flies, as well as in mice, that have been so productive.
These studies have identified some of the molecular mechanisms responsible for ageing, and even raise the possibilities of extending life still further, but whether this is desirable unless age-related disabilities can be avoided is a key question. How long could we live? How long
Our ancestors were no less aware of ageing than we are, and were interested as to its cause and how it could be prevented. In the oldest known document about ageing, dating from 2,500 BC, an ancient Egyptian official named by Ptahhotep drew a gloomy picture:
How hard and painful are the last days of an aged man. He grows weaker every day; his eyes become dim, his ears deaf, his strength fades; his heart knows peace no longer; his mouth falls silent and he can speak no word. The power of his mind lessens and today he cannot remember what yesterday was like. All his bones hurt.
It still strikes an all too familiar note.
There are important myths that we should bear in mind when we wish to extend longevity, notably that of Tithonus, who lived long but aged horribly. Efforts to disguise ageing by altering a person’s appearance go back a long time, and Cleopatra certainly tried. There is now a multi-billion pound cosmetic and surgical industry devoted to limiting the physical ravages of getting old. The most common cosmetic surgery treatments are for face, breasts and fat; it is sexual attraction that seems to matter most. But some older people are joining in, even if the many facial creams for getting rid of wrinkles have only a minor effect in spite of all their claims.
Both ancient and current views about ageing are on the whole negative. There are of course significant differences in how different societies treat the old, as for instance in China or the US, but the way the old are viewed in our society is not as positive as we oldies would like. The old tend to be stereotyped as ‘warm but incompetent’; and I do not like to be thought of as an ‘old fogey’. As they age, people may become wiser, but at the same time are thought less competent in their jobs—even though, surprisingly, surveys do not bear this contention out. The old are now less welcome in public arenas such as politics. They are also often mocked in the press. The result is that the positive aspects of ageing are grossly neglected, and there is a failure to recognise that many of the elderly are quite happy with being old. As Mark Twain put it: ‘Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.’
There is, nevertheless, a lot of sympathy for the old and many people try to help them. In 1940 a group of individuals‚ as well as governmental and voluntary organisations, came together to form a committee to help old people and it soon gained national recognition. With the birth of the welfare state in the 1950s‚ government money became available to fund local work with older people and the committee became completely independent of government and took a new name—Age Concern. It became a national agent for schemes run by local groups, and drew attention to the plight of older workers who were unable to return to work because of long-term unemployment or redundancy. In spring 2010 Age Concern England joined together with Help the Aged to form Age UK, a new charity dedicated to improving the lives of older people.
Age UK combats ageism in all its forms, both social and as manifest in the treatment of the health of the old. Some of those responsible for medical care seem to see little point in spending much money and effort in keeping the old with serious illnesses alive. Age discrimination is present in many current societies—the compulsory UK retirement age being an obvious case—and when this occurs in a medical setting the results can be very serious and damaging.
But what really matters is how the old are treated. The worst cases, fortunately rare, are those where the old have been put to death when they were no longer thought to be of value to a society. Many of the old are lonely and poor. Most of the elderly want to stay in their own homes, and this can require support from others as well as money. Many of the old will end up having care at home, or living in a care home or nursing home. The money for this is partly provided by the state but there are complaints that it is inadequate, and many have to sell their homes. There are also problems with respect to professional care; many cases of incompetence and neglect are reported, even in hospitals. Dementia patients do especially badly.
The economic realities of an ageing society are only just beginning to impact on us. There are those who oppose extending human life partly because it is bad for the young, and because there are negative economic implications. A society in which the old greatly outnumber the young faces many challenges. Who will support all those elderly, and pay all their health costs? Countries like Japan and China face similar problems.
Ageing makes one think of death: how one should prepare for death, and how one should die. Most people want to die at home—I certainly do—but most people don’t in fact do so. Do we die of old age? There is no good evidence that we can die of old age, and it is rarely put on a death certificate. In the US the use of these words alone is forbidden. Then there is the question of the best way for the old to die. Suicide is not uncommon, but euthanasia would be far preferable and the law preventing it must be changed; the old should have the right to choose how they die, while taking into account the pain loved ones feel for the dying.
