Frailty, thy name is old age

‘Getting old is mandatory. Feeling old is optional’

‘Frailty, thy name is woman’ is a well-known Shakespearean saying. Frailty implies being weak, delicate, breakable, and women in patriarchal societies are traditionally considered to possess these physical characteristics, in contrast to their supposedly stronger and more robust male counterparts. However, in our modern times, especially in developed countries where women increasingly participate daily in all types of physical activities and are present in occupations that used to be male preserves, go to gym, are Olympic champions in many disciplines including wrestling, one wonders how far this distinction still holds.

More commonly nowadays, at least from a medical point of view, frailty is associated with old age, to the extent that in some circles it is even being considered as one of the diseases of old age. And since ageing, the cause of frailty, cannot be prevented, there is no cure for it. But this does not mean that we cannot do anything to help such people to cope with the problems that are associated with frailty.

I thought the saying quoted at the beginning of the article appropriate to this discussion. As such things go in our present heavy tech world, it was a post on Whatsapp to a brother-in-law of mine in India on the occasion of his birthday and, thankfully, he is still enjoying good health at his age of a few years past the proverbial three score and ten.

Old age brings about changes

There is no gainsaying the fact that as we age telltale changes as well as more subtle ones take place in our bodies. In fact the subtle ones that we don’t see and occur at microscopic level are the very cause of what becomes visible. The most noticeable one is the aging of the skin which starts to wrinkle because of impaired elasticity and hydration, among other things. Or the hairs that start to grey. Along with these there is progressive weakening of our senses. Vision and hearing in particular start to suffer, and later other faculties get affected too – for example, loss of balance and lowered mobility, diminished muscular power and shortened endurance for physical activities.

One day somebody half-jokingly – but also half-seriously! – remarked to me that God knows what he does when he makes you hear less and see less as you age, because if you were to hear everything that was said about you, why, even by your children sometimes, you would be pained. In fact, said my lady interlocutor, it’s like having a daughter-in-law staying with you: it’s better to see with only one eye and hear with only one ear! Enfin…

However, this said about some of the changes that make one decline as age creeps in, it is also a fact that many people remain well and active for very long as they grow older. Of course this is related to a large extent to improved social and economic conditions of living, which has resulted in an increase in life expectancy in vast numbers of populations across the world. When in days of yore the age of retirement was fixed at 60 years based on actuarial data, it was such a big thing when one reached that quasi-magical moment in one’s life. For then, disease – mostly infection – used to carry away relatively many people before they reached 60, attaining which was therefore considered to be very lucky. The perception of age was also conditioned by this cut-off number. Thus, I remember that as a kid when I was told that so-and-so was 40, I used to think, gosh, so old!

Life begins at 60, but…

But as pointed out above, nowadays with the increased life expectancy, life begins at 60 as the saying goes. Meaning that the majority of people retiring at that age are still in pretty good health, and can look forward to many more years of fruitful and enjoyable living, what with senior citizens groupings organising activities and the State putting many amenities at their disposal, over and above their own resources.

So, sure, these people fall into the category of the elderly, but because of their overall good state of health, they do not necessarily feel their age. And that’s where there is a flip side. In earlier articles I have written about friends and patients whom I have had to advise or treat for problems that arose precisely because they ‘didn’t feel their age’. That is, they thought that they could perform tasks that they were used to when they were younger, such as ‘karchering’ the house, climbing up on a ladder to clean windows or to cut the branch of a tree, or chop a heavy bunch of banana, and so on. They would land up with a fracture of hip or femur, or get a backache.

And I speak from personal experience about what we in medical jargon call performing ‘unaccustomed exercise’: something that you have not done regularly in your prime days because of lack of time and career commitments, and which you therefore looked forward to with enthusiasm when you retire. That was my situation, and within the first few weeks of freedom from the 9 to 4 routine, I was bitten by the gardening bug. Out I went and got myself the paraphernalia, including boots, gloves, garden fork and so on.

And so one afternoon, with the weather in Curepipe beckoning as it does not often do, I donned my boots and hat, and started to dig in a patch of land in my backyard which had been made available when the four-foot deep bamboo hedge was replaced by a brick wall. I soon hit against sizeable remnants of brick and cement where I was expecting soft earth. Never mind, I told myself, here we go! Four hours later, after I had heaved and shoved, and finally planted my seeds, I got momentarily ‘blocked’ in the bent position as I tried to straighten my back. It wouldn’t obey, and then pain and stiffness set in.

I finally did manage to unbend myself as it were, but not without pretty severe pain that had me laid down for a good four or five days – a dose of my own medicine, since backache is a common condition which as an orthopaedic surgeon I am called upon to treat. I had learnt my lesson the hard way, but as compensation I had a super crop of luscious pink radish that I enjoyed over several weeks, including the leaves which, sautéed with slices of the bulbs made a yummy bhaji.

What I mean to say therefore is that we may not feel old – but we have aged. There are constraints on our suppleness, strength and resilience, and we must be aware of them so that we do not overestimate our capacity to do things as if we were twenty years younger. We may feel like that mentally, but the body cannot keep pace. And that is why, when housewives tell me that they cannot do their work as fast as they used to do, or their walking has slowed down, my standard response to them is: tell me in which book is it written that you have to rush through things? And the problem is compounded of course when they have pain because of arthritis in the joints and such other medical problems – which have to be sorted out by their treating doctor.

Preparing oneself to cope

Since we are on this issue of pain, I think it is unfair on the part of certain colleagues to tell their elderly patients that there is ‘nothing that can be done and you have to learn to live with your pain’. Just because you are old does not mean that you have to endure unbearable or disabling pain, that is, pain that prevents you from carrying out your activities of daily living (ADL) which may – in fact should – include leisure activities too. Except for the terminal pain of cancer or of herpes zoster, which frequently can be intractable, provided a correct diagnosis has been made, there is always a remedy available to relieve pain, and no one should be denied relief from this most common of symptom with which the patient presents to the doctor.

Likewise, there are all manner of aids to facilitate coping with disabilities of whatever degree, ranging from simple walking sticks to props in the toilet and so on. But even before we come to that, there are simple commonsense rules of thumb that senior citizens can follow.

Thus, don’t take undue risks such as climbing ladders or working at higher levels when it’s you and the Mrs only who are at home – and immediate help will not be forthcoming should any accident happen!

Be careful with unaccustomed exercise, as regards the amount of effort required or the duration of the activity: curb your passion and be reasonable for your own sake.

There are any number of such simple preventive measures and precautions that we can work out for ourselves, taking into consideration our domestic and social situation. Practicing tai-chi, yoga, daily walks and simple exercises have been shown to help maintain balance and prevent falls that can result in hip fractures, for example. These inevitably need surgery and a period of rehabilitation which varies from individual to individual but can also be protracted in a number of cases, and there is a significant attendant mortality and morbidity despite all the advances made.

Some people go for plastic surgery to remove facial wrinkles or bulges of fat on the upper eyelids, others go for ‘tummy-tucks’ or liposuction that carries its own dangers, still others dye their hair, or use wigs to camouflage baldness, and so on and so forth. I think it’s all right, even desirable, for women to use beauty products, and seek the services of qualified and competent beauticians, but extreme caution is required before they go for more radical procedures. And this is even more important when it comes to the unregulated sector of practitioners who promise miracles with lasers and other devices of questionable application and procedures of dubious validity.

All in all, therefore, we can prepare ourselves to ‘age well’, which is the new philosophy for the expanding segment of the elderly population all over the world. And that’s the good news!

RN Gopee

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