Aging something that faces all of us but a reality that few think of when they are young. At the risk of stating the obvious it is an inevitable process that no-one escapes. Those of you who know me personally will know that I have had grey hair, a marker of advancing years, for a very long time starting in my thirties. My age, in addition to the grey hair, chronologically places me at the upper end of the spectrum of life expectancy for male South Africans.
In January this year I needed readmission to hospital for the repair of an incisional hernia, a consequence of my previous admission to hospital for abdominal surgery over a year ago. Fortunately on this occasion it was only for six days in contrast with the almost month-long stay on the previous occasion. During these six days I shared for a time a two-bed ward with an elderly man, possibly not much older than myself. He was admitted with terminal cancer and, separated from me by a single curtain and no more than a meter, died peacefully during the night prior to my discharge. An experience that certainly focused me on my own mortality!
In March this year I was invited to attend my school’s annual “Old Boys” dinner by a classmate who reminded us that over 30% of our class were no longer with us. While this is a function that I generally avoid it seemed a good idea to get together while we still can. Amongst the half dozen from my class present on the evening, two had been treated for cancer, one had undergone cardiac bypass surgery and another had required bilateral hip replacements. On the basis of this on my drive home after the event I regarded myself as fortunate despite my recent sojourns in hospital!
There are various theories as to the cellular mechanism of ageing which I will not entertain here. Ageing or senescence is a complex process defined as the “progressive time-related deterioration of the physiological functions needed for survival and fertility”. The ageing process is both non linear and different for each individual. Variations may be genetic but are significantly influenced by the physical and social environment in which we live. Life expectancy has progressively increased in many countries due to improved living conditions and healthcare. In fact even several decades ago I would not have been expected to live beyond seventy or even 65.
One somewhat bleak view of ageing or “senescence” is that it is a default state and that after offspring have been born and raised an animal can die. In advanced societies senescence and the diseases of ageing have become more common leading to the medical speciality of geriatric medicine. People with the phenotype of ageing, greying hair, wrinkling of the skin, joint stiffness, osteoporosis, loss of muscular strength, memory loss and deteriorating eyesight amongst others have become more common as populations age. More people die from cancer and cardiovascular diseases rather than infectious diseases as they did in the past.
In my mid seventies and formally retired for almost a decade, although until recently active as a consultant and board member of various entities, I have time to reflect on ageing and how the elderly are regarded by most of society. This year two men, older than I, vie for the presidency of the United States at an age when in the past it would have been highly unlikely that even one would been alive to do so. Despite this, the stereotype of the older person as somehow unable to cope with the world of today remains. Similarly, the views of older people are often brushed aside and ignored whereas in the past elders were people to whom difficult and complex issues were referred to benefit from their experience and wisdom.
The Bob Dylan song, an anthem in my youth, “The Times They are A-Changin” includes the lyrics “Don’t stand in the doorway, Don’t block up the hall” …. “Your sons and your daughters, Are beyond your command.” It would be interesting to know how the now 82-year old Dylan views the politically loaded words of his song written in his mid-twenties reflecting the generational and political divide in the United States of the 1960’s. I know that my views in my mid twenties as regards the views of my elders were often similar to that of Dylan. As a result now in my seventies I realise what sage advice I ignored, which if heeded then may have influenced the course of my life. I am reminded of an ironic quote that the my father attributed to Winston Churchill, although I cannot find any reference for it, “The younger generation is degenerate and always will be!” This in my view sums up the eternal divide between youth and age and one of which one becomes increasingly aware as one ages!
A Churchillian quotation, part of a speech to the British Parliament in 1948, that I can reference is that “Those who do not learn from history are doomed to repeat it”. Whether personally or in a broader context the ability to learn from the past is an attribute often lacking in individuals, groups and nations. I am left wondering whether in a world dominated by the immediacy, biases and inaccuracies of social media, views and lessons of the past have become blurred. Accepting that the elderly do carry biases sculpted by their live experiences, it does seem crucial that their views and experiences are valued and not discounted. The stigma of physical and mental infirmity in the elderly should not devalue the important role older people can and should play both in families and in the broader society.
In my mid-seventies I am fortunate to be healthy and physically active. I have a loving and supportive partner and many interests. Through this website I am able to interact with others based on my life and work experiences. In writing my book, published in 2021, I documented my experiences over 40 years in healthcare in South Africa which provides food for thought for those now entrusted with addressing the challenges of health services in this country and beyond.
In the almost 90 posts on this website over the last three years I have shared my views on many topics, health related and others. I am grateful that so many, from many countries, have read my posts and interacted with me during that time. I am privileged to live in an age that enables me do so through the vehicle of the internet. I look forward as an “elder” to continue to do so as long as I am able and as long as I feel that I remain relevant to do so.
In the words of Dylan Thomas written in 1952,
Do not go gentle into that good night,
Old age should burn and rave at the closing of the day;
Rage, rage against the dying of the light.
… and in the most positive manner I will do all of these things!
