Dr R. Neerunjun Gopee

Mellowing gracefully into old age

— Dr R Neerunjun Gopee

As I entered the airport shuttle that would take us to the car park, a middle-aged lady got up to offer her seat to me. Seeing an elderly man with a mostly

bare scalp surrounded by a low rim of white hair, perhaps also looking tired after the flight, may have prompted the lady’s gesture: but her perception of me was the opposite of my own feeling. In fact, I felt fine in spite of the nearly nine hours that had elapsed since the journey began from the time I woke up and got ready and travelled to the airport, and the transit of about two hours between the two legs of the flight to my final destination.

 

This set me thinking about people’s perceptions of those who are growing old, and old age and the ageing process. It also reminded me of a story, which I have referred to before but which I repeat because it illustrates the point nicely, to wit: as a senior colleague was passing by the doctors’ mess in a hospital one day, he heard someone using the expression ça bolomme là. He did not pay any particular attention until he found out later that the reference was to him! When he narrated the incident to me, he was barely reaching his fifties, and he could scarce believe that he was already being lumped in the bolomme bracket. For, he continued, he felt as fit as a fiddle — and for that matter still is, many years later.

And so it is, this difference between perception and reality, which is found in many fields of life. In politics, the gulf is huge, and the reality when uncovered is ugly. Luckily as far as old age is concerned, the picture is rosier. With variations of course. There are still stereotypical grumpy, neurasthenic old men and bickering, neurotic not so old and ageing women, and their tribe will never disappear, maybe even increase. Appearances – sartorial or boosted with make-up – to the contrary, these people are forever finding fault with everybody and everything, never doing a bit of self-analysis in the first place, and always going on about what’s wrong with the world. They think of themselves as perfect, which is only the patina of the artifices used to deck up, and which hides the sucker under the surface. There are a good number around, and everyone is free to find them out for themselves and make their own adjustments should they be obliged to be in contact or to interact with such people.

This digression was necessary to highlight the fact that there are many more who are at the other end of the scale, taking things in their stride, accepting things with grace and, to use a well-worn term, philosophically. Besides the fact that I am myself in the senior citizen category, and from time to time have a burst of existential concern, my interest in the subject matter is both professional and social, and inevitably in the course of my occupation as a medical and health professional I come across much published material dealing with the topic, and the associated ones of well-being and happiness. In fact in recent years there has been an explosion of writing on these subjects, often repetitious and clearly with a commercial focus, and a proliferation of books has accompanied this growing and rather sudden interest.

From the medical angle, we have long been aware about the phenomenon of ageing, and it is common knowledge too that ageing is accompanied by a diminution of physical abilities such as hearing and seeing, weakness, slowness in walking and so on. As an article put it, ‘as people move towards old age, they lose things they treasure – vitality, mental sharpness and looks.’ Needless to say, the attempt to correct these has resulted in lucrative businesses of supplements for old age and cosmetic surgery to improve looks (but what changes internally??) — all aggressively marketed, involving great cost to the consumer and of doubtful benefit in the long run.

What is more important is that there are known and identified medical problems of ageing, such as arthritis which results in pain, and difficulty in walking if the lower limbs are affected, mental conditions some of which can be more serious such as extreme forms of impairment of memory, and diminishing function of vital organs such as the heart, the kidneys, the digestive system. Much is already being done in terms of treatment and rehabilitation of many of these conditions, and there is ongoing research about the known issues to gain new understanding that may lead to better treatment options and thus improve the quality of life. But also, in common with what is happening in all fields of medicine and health, there are new conditions being discovered for which, again, similar work is underway. This is all a part of the routine medical process, and doctors are well aware of the specifics of the diseases affecting the elderly, representing as they do a certain continuum of what they already deal with in less older patients.

However, the good news is that a majority of these conditions are preventable: barring inherited abnormalities or unavoidable incidents (such as accidents), neither physical nor mental decline is inevitable as one advances in age. This is not the place to go into details, but suffice it to say that solid evidence derived from an increasing number of valid scientific and medical studies indicate that a combination of by now very familiar lifestyle factors can allow anyone to reach old age in a pretty good state of health. They are: attention to diet, regular exercise – which has benefits across the board, on all the organs of the body – avoidance of tobacco and refraining from alcohol abuse. Commonsense would tell us that an early start is likely to give us a significant advantage, although it is also documented that reversal of some damaging changes (for example, in arteries of the heart or in tissues of the lungs) with improvement in one’s general state of health can take place if one takes the necessary corrective steps later in life, such as starting exercise or stopping smoking.

But why wait? Isn’t it better to prevent than to treat? Prevention is eminently possible and cheaper than treatment which is, besides, very costly nowadays. I am sure that most people know that; the intriguing question is why do only so few put that knowledge into practice? Imagine how much healthier the world’s population would be if more people followed the simple maxim ‘prevention is better than cure,’ and more prosperous too because of the savings on health costs that would be the natural consequence of this state of better health all around.

Another question now arises: does ‘successful ageing’ – a term that has become fashionable – equate to physical good health and mental alertness? A little thinking will make us realize that they are necessary but not sufficient conditions, for we are social animals, and we like company, and again studies have demonstrated that old people who have strong family support and stable friendships do better than others who don’t have them. Unless one deliberately chose to live like a recluse, what good would it be to be physically and mentally healthy and yet be lonely, bereft of family or friends, or have no other social interactions or similar occupations which alone give at least some meaning to life? It is no doubt with this dimension in mind that the World Health Organisation, at its very outset, gave a definition of health which to this day stands good: ‘Health is not merely the absence of disease, but a complete state of physical, mental and social wellbeing.’

So far so good, but there is more than just successful ageing: as one ages, one must also gain in maturity, develop greater understanding of people and their behavior, have less tendency to be impulsive and choleric, be able to cope better with adversity, learn to be forgiving, be willing to extend help when and where possible and have an overall balanced approach to life with selflessness predominating over selfishness. In other words, become wiser, and this is what adds grace to one’s life and personality; one may therefore, at this stage, speak of ‘graceful ageing,’ and the wisdom dimension inevitably brings with it serenity, which in turn allows one to discover the happiness within.

In an article published in this paper on 7 February 2011, ‘Who would be wise?’, we had pointed out that the elements of wisdom include: ‘rational decision making based on general knowledge of life; prosocial behaviours involving empathy, compassion, and altruism; emotional stability; insight or self-reflection; decisiveness in the face of uncertainty; and tolerance of divergent value systems.’

Nurturing these elements would allow one to truly mellow gracefully into old age, and like a ripe fruit which is loved and relished, so too those who have achieved such a state receive respect and affection in equal measure. In the Hindu scheme of life, this is the stage of ‘vanprasti,’ which comes after the two stages of ‘brahmachari’ (life of studentship and acquiring self-discipline) and ‘grihasti’ (family life), each approximately of 25 years, before one passes to the stage of sanyasi’(withdrawal from the material world). The ‘vanprasti’ is expected to detach himself more and more from personal concerns, becoming more like a mentor to his family and to society at large – which in effect means becoming wiser in the sense defined above.

And when the time comes, like the ripe fruit that quietly loosens itself of its attachment to the tree, the old person, now vanprasti or, if lucky, sanyasi, departs from the world with a sense of duties fulfilled. And thus the Mahamrityunjaya (victory over death) mantra

Om TriyambakamYajamahe, Sugandhim pushtivardanam, urvarukamiva bandhanath, mrityorma amritaat…

which one recites as one makes the journey towards release from the cycle of births and deaths that keeps us in bondage to the material world.

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