In the context of the pandemic, being old is seen as just one more comorbidity. It should not be
By Dr R Neerunjun Gopee
One of the major concerns related to the Covid-19 pandemic has been about the elderly population. Not only have they suffered from a higher mortality from Covid infection than the rest of the population that also caught it, they were also not well looked after. There were even accusations of neglect, which has been a recurrent charge laid against the management in homes for the elderly in several countries. But specifically, as regards Covid at least initially there were allegations, in the UK for example, that they were deliberately not being given the due care that they deserved. Resources were concentrated on the younger age groups.
« The proportion of old people in all countries has increased, with the result that ‘such changing demographics will profoundly affect all aspects of society’ because ‘an increasingly older population risks overwhelming the health and social care services. Moreover, as people age, they are more likely to develop a range of diseases, both physical and mental. Caring for those thus afflicted is a burden that many societies simply do not have the resources to deal with. Beyond the spheres of health and care, an inverted population pyramid has other repercussions for society, affecting everything from pensions to housing… »
This prompted the authorities elsewhere to take a fresh look at the problems of what is now termed ‘aged care’, and recently a whole issue of The Conversation, an Australian online resource, was about this.
Interestingly, the terminology used has also been changing. The elderly has given way to senior citizens or ‘troisième âge’; we no longer grow old, we age, a noun has become a verb in the… age – or era – of smartphone messaging and texting in its own peculiar shorthand, with sounds implied rather than made explicit by the combination of alphabets as we of a certain generation had been used to. Thus, my preference for ‘ageing’ in lieu of ‘aging’…
And so, we come to how we should go about ageing in such a way that we remain as fit as possible in doing so. One of the major reasons for the aged to have the higher mortality referred to above is that they have comorbities, that is, they have disease conditions which make them more vulnerable. In the main these are what in modern medicine have come to be lumped in the category of NCDs or non-communicable diseases, all now well known to the layman because they receive a humongous amount of coverage in the media. They include diabetes, high cholesterol levels, obesity, high blood pressure and heart disease due to narrowing of the arteries, kidney disease, dementia and Alzheimer’s disease, cancers of various types, and so on.
However, even for those who do not have any of these NCDs, the normal process of ageing itself is associated with a number of problems that used to be considered as natural and about which nothing could be done – such as becoming frail, tendency to lose balance and fall sustaining injuries that include fractures, slowing down, annoying or debilitating impairment of faculties of hearing and seeing. The list is long, and can be forbidding too.
But, from my own personal experience and my professional vocation as a medical doctor, I long since realized that one could certainly age otherwise, and in a number of earlier articles in this paper I have written about this and given examples that would inspire others to take better care of themselves. This has the double benefit of keeping the person in good health, consequentially reducing the burden on the health services of one’s country.
In this context, therefore, I was happy to learn that the well-known UK medical journal The Lancet – which as medical students and doctors has been part of our lives as it were – has this month launched a new publication aptly titled The Lancet Healthy Longevity, announced in a write-up ‘Health For All, For Longer’, whose first paragraph reads as follows:
‘The coronavirus disease 2019 (Covid-19) pandemic does not affect everyone equally. While anyone can contract Covid-19, accumulating data suggest that older people or those with pre-existing comorbidities are far more likely to have severe complications or die from the disease. While researchers scramble to unravel the mechanisms of action underlying the disease’s wide-ranging effects, news that the disease hits older people hardest has been received without demur: it is widely accepted that to be old is to be fragile. Indeed, even in so-called normal times, everyone expects more things to break as people age: bones, hearts, brains. In the context of the pandemic, being old is seen as just one more comorbidity.
It should not be.’ (italics mine)
The operative words for me are ‘It should not be’, and I rather like this quasi-imperious assertion which concords with my own experience of ageing and of dealing with aged people, with whom I have had innumerable opportunities both to share experiences, to advise and treat, and to learn from as well. Looking back, and in light of the advances in the sciences of the ageing phenomenon, perhaps I should not be surprised at the resilience and optimism that I have encountered among many an old person, not to mention the ‘philosophical’ dimension of the more mentally active among them, the wisdom that comes with the mellowness that accompanies the twilight years of most – but not all, unfortunately!
As the Lancet editorial notes, ‘We accept growing old and losing our vitality as an inevitability of life. To do so is to overlook the fact that ageing is, fundamentally, a plastic trait—influenced both by our genetic predispositions and many (controllable) environmental factors’, going on to add that ‘the rate of ageing is not fixed. Fragility, vulnerability, and poor health need not necessarily follow advancing age’. Experiments have shown that as some ‘animals live longer, they also have a longer youthspan– the proportion of their lives in which they retain the trappings of youth such as peak mobility, immunity, and stress resilience.’
And the editorial postulates that we human beings can also enjoy such a youthspan as we live longer, this having been made possible by the marked improvements that have been brought about by rising standards of living and advances in the medical and health sciences. As a result, the proportion of old people in all countries has increased, with the result that ‘such changing demographics will profoundly affect all aspects of society’ because ‘an increasingly older population risks overwhelming the health and social care services. Moreover, as people age, they are more likely to develop a range of diseases, both physical and mental. Caring for those thus afflicted is a burden that many societies simply do not have the resources to deal with. Beyond the spheres of health and care, an inverted population pyramid has other repercussions for society, affecting everything from pensions to housing. Conversely, society has so much to gain if it can enable people to be productive and active members of social and economic life for longer.’
Calling this ‘an unprecedented crossroads in global society, raising fundamental questions about how we live as individuals, and collectively’, the journal makes a clear case that ‘we have a choice’ which will benefit us both individually and collectively (i.e. our societies) in that we as we age can ‘experience longer periods of good health, a sustained sense of wellbeing, and extended periods of social engagement and productivity’.The outcome will be that we will thus not have ‘a higher burden of illness, disability, and dependence on others’.
We can surely, knowingly make that choice…
* Published in print edition on 27 October 2020