‘The minute a man ceases to grow, no matter what his years, that minute he begins to be old’
Our bodies change as we age. Looking stooped, for example, is a common sign of ageing. Most medieval pictures of the old show a bent back and a stick, and this continued into the twentieth century. In ancient Roman times, Virgil complained that ‘all the best days of life slip away from us poor mortals first: illness and dreary old age and pain sneak up, and the fierceness of harsh death snatches us away.’ Plutarch too had a gloomy image of old age, likening it to autumn. When children are asked how they can tell when people are growing old, they list physical attributes. Here we look at the major and minor physical health changes that are linked to ageing.
Ageing is not a disease, but is a multi-factorial process that leads to the progressive loss of functions. We are all too well aware of normal bodily changes as we age. We initially get a bit slower and then a little grey and bald, and then wrinkles come and memory goes. Cross-sectional studies of ageing tend to depict an essentially smooth and progressive decline of physiological function with increasing chronological age. However, although the young have high functional values and the very old low, between these limits values are widely scattered. There is no simple linear relation between age and functionality. When I meet some old friends whom I have not seen for some time I sometimes say, ‘Shall we start at the top or the bottom?’ We then tell about the pain in our foot, and work up the body to describe how our brain has declined.
One of the fairy tales collected by the Brothers Grimm in the early nineteeth century, ‘The Old Hound’, illustrates changes brought about by age:
A hound who had served his master well for years, and had run down many a quarry in his time, began to lose his strength and speed owing to age. One day, when out hunting, his master startled a powerful wild boar and set the hound at him. The latter seized the beast by the ear, but his teeth were gone and he could not retain his hold; so the boar escaped. His master began to scold him severely, but the hound interrupted him with these words, ‘My will is as strong as ever, master, but my body is old and feeble. You ought to honour me for what I have been instead of abusing me for what I am.’
Another of Grimms’ fairy tales, ‘The Duration of Life’, collected from a peasant in his field in 1840, presents a pessimistic outcome but adds a playful teleological explanation:
When God created the world he gave the ass, the dog, the monkey and man each a life-span of thirty years. The ass, knowing that his was to be a hard existence, asked for a shorter life. God had mercy and took away eighteen years. The dog and the monkey similarly thought their prescribed lives too long, and God reduced them respectively by twelve and ten years. Man, however, considered the thirty years assigned to him to be too brief, and he petitioned for a longer life. Accordingly, God gave him the years not wanted by the ass, the dog, and the monkey. Thus man lives seventy years. The first thirty are his human years, and they quickly disappear. Here he is healthy and happy; he works with pleasure, and enjoys his existence. The ass’s eighteen years follow. Here one burden after the other is laid on him; he carries the grain that feeds others, and his faithful service is rewarded with kicks and blows. Then come the dog’s twelve years, and he lies in the corner growling, no longer having teeth with which to bite. And when this time is past, the monkey’s ten years conclude. Now man is weak headed and foolish; he does silly things and becomes a laughing stock for children.
There are few if any organs in our body that do not decline in their function with age, and many deaths are due to age-related illnesses. But not everything is bad news. A major study by ELSA (English Longitudinal Study of Ageing) in the UK is designed to find out about the health of the elderly, and participants are interviewed every two years. It is encouraging and impressive that 60 per cent of those aged 80-plus describe their health as good to excellent. But that does mean that 40 per cent have health problems. The study also found that while arthritis is age-related, joint pain and back pain were not, and were no more common among the elderly than the young.
The study looked at the proportion of people who remain free of certain diseases, including four eye diseases, seven cardiovascular diseases and six other physical diseases. Around half of those aged 50–54 still had none of those diseases, but only around one in ten of those aged 75–79. Wealth and education lead to longer physical functioning, possibly because both lead to better personal care. Money matters: people in the richest part of London live 17 years longer than those in the poorest parts. Individuals who are 50–59 years old and from the poorest fifth of the population are over ten times more likely to die earlier than their peers from the richest fifth. The poor are more likely to be unhealthy, despite a fairly even distribution in the quality of healthcare between different wealth groups.
In a different study, it was found that participants with a high IQ as a child were more likely to have better lung function at the age of 79. This could be because people with higher intelligence might respond more favourably to health messages about staying fit.
Disability and frailty are common problems for the elderly. Those who are ill experience ageing very differently from those who are well. There are 75-year-old joggers and 75-year-olds who are very frail. Frailty is a condition associated with ageing whose symptoms include weight loss, decreased muscle mass and strength, weakness, lack of energy and reduced motor performance. The condition seems to spring from a general weakening of the body, including the skeletal, muscular, blood and hormonal systems. The most commonly used measures of disability are reports of problems with the basic activities of daily living such as mobility, looking after oneself by preparing meals, shopping, managing money and taking medication. While disability indicates loss of function, frailty indicates instability and the risk of loss of function. The frail person is at increased risk of disability and death from minor external stresses. Frailty may also be identified by particular clinical consequences such as frequent falls, incontinence or confusion. In many cases a single factor, such as undetected cardiovascular disease, can be the reason why people become frail. Instead of having classic symptoms such as a heart attack or a stroke, people may have partly blocked blood vessels in the brain or the legs, the kidneys or the heart, which can result in exhaustion or mental confusion or weakness or a slow walking pace. It has been found that those people who had a positive outlook on life were significantly less likely to become frail.
As we age, our cells become less efficient and our bodies become less able to carry out their normal functions. Muscles lose strength, hearing and vision become less acute, reflex times slow down, lung capacity decreases, and the heart’s ability to pump blood may be affected. In addition, the immune system weakens, making it less able to fight infection and disease. Heart pumping giving maximum oxygen consumption declines about 10 per cent every ten years in men, and in females a bit less; maximum breathing capacity declines about 40 per cent between ages 20 and 70; the brain shrinks and loses some cells; kidneys become less efficient and the bladder gets smaller; muscle mass decreases by about 20 per cent between 30 and 70 years, though exercise reduces this; and bone mineral is lost from age 35; sight may decline from 40 and hearing declines when older. These changes in our bodies with age are not due to ill health but are, alas, normal, and they can cause health problems.
Once adults reach 40, they start to lose just over 1 per cent of their muscle each year. This could be due to the body’s failure to deliver nutrients and hormones to muscle because of poorer blood supply. Tendons, which connect muscles to bone, and ligaments, which hold joints together, become less elastic and are easier to tear. We also get slower in physical activities, as I know all too well. The good news is that one in five people aged between 65 and 74 are doing recommended levels of exercise. But physical labour can also have negative effects—lawyers and priests over 55 die at lower rates than blacksmiths and ironworkers, and at even lower rates when over 75. Mammalian muscles can regenerate, but in mice the old muscle regenerates poorly. Joining the muscles of old and young mice together resulted in the old muscle regenerating better, and the young a bit worse.
Men and women between 60 and 96 years of age who suffered from loss of body mass and strength, and who did a moderate amount of strength training twice a week, had a significant increase in muscle after eight to twelve weeks. Long-term physical activity postpones disability and sustains independence, even for the chronically ill. Regular physical activity can also help to prevent some important conditions in the elderly that may lead to disability including osteoporosis, type 2 diabetes, cardiovascular disease, anxiety and depression. It can also reduce the risk of falls and therefore subsequent fractures. A goal to work towards is 30 minutes of at least moderately intense physical activity on at least five days of the week. Joan Bakewell, 77, of whom more later, told me, ‘I am not as able as I was and do have some aches and pains, but I have a fetish for staying fit and have done pilates exercises twice a week for fifteen years. I did not want my posture to go, as I noticed I was beginning to stoop.’
Most human deaths are attributable to an age-related disease and so, not surprisingly, becoming a centenarian is associated with having avoided common diseases until advanced in age. A period of not having good health for the elderly will usually involve some seven years for men, and ten for women. Coronary heart disease, stroke, cancer, osteoporosis, diabetes and dementia are just some of the conditions that more and more people will be battling with in later years. The figures will continue to go up as people live longer than ever before. Obesity increases the likelihood of death from all causes, particularly coronary artery disease and stroke. In addition to these diseases, obese patients suffer an increased incidence of arthritis. The conditions associated with obesity are also associated with ageing. The proportion of intra-abdominal fat, which is related to increased morbidity and mortality, progressively increases with age. Targeting weight loss in the elderly can therefore reduce morbidity from cardiovascular risk factors, and also arthritis.
The leading causes of death in the United States have changed dramatically. In 1900 the top three causes of death were all related to infectious diseases, but by 2009 the leading causes of death for all ages were diseases of the heart and cancer, which together account for 50 per cent. The top four causes of death for persons aged 65 and older—diseases of the heart, cancer, brain dysfunctions related to disease of the blood vessels supplying the brain, and respiratory diseases—were the same as for all ages. In the UK the main causes of death are heart disease and stroke. There is an elusive distinction between the effects of ageing, and having a disease when old, but it is generally accepted that fundamental to ageing is an increasing vulnerability to diseases such as heart disease.
Coronary heart disease is the leading killer of older people and half of all heart attack victims are over 65. Participating in light to moderate physical activities significantly decreases mortality rates in elderly patients. Heart disease is the result of the heart’s blood supply being blocked or interrupted by a build-up of fatty substances in the coronary arteries. Over time, the walls of arteries can become furred up with fatty deposits, a process known as atherosclerosis. When the coronary arteries become narrow due to a build-up of these fatty deposits, the blood supply to the heart will be restricted. A heart attack occurs when blood flow to an area of heart muscle is completely blocked. This prevents oxygen-rich blood from reaching heart muscle and so causes it to die, and then circulation of the blood fails. Without quick treatment, a heart attack leads to serious problems and often death. While men have markedly higher rates of coronary heart disease in middle age than do women, women’s rates of coronary disease begin to rise sharply after menopause.
Failure of the blood supply can also cause strokes. A stroke occurs when the blood supply to the brain is disrupted in some way and the brain cells are deprived of oxygen and other nutrients, causing some cells to become damaged and others to die. The effects of a stroke depend on where the brain was injured, as well as how much damage occurred. The after-effects of stroke are very varied and depend on how and where nerve cells die. Most of the damage caused to the brain is the result of dying nerve cells releasing toxins that damage even more of the brain. A stroke can impact on any number of areas including the ability to move, see, remember, speak, reason, and read and write. Every year about 150,000 people in the UK have a stroke—that’s one person every three and half minutes, every day. A study of elderly stroke victims in a working-class region of London found that many regarded it as a normal crisis in their lives. Although strokes can happen at any age, the vast majority occur in people over 65 years old. However, a new study shows more and more Americans suffering from stroke earlier in life than ever before, indicating that stroke is no longer just an affliction of old age.
Cancer is fundamentally a disease of the elderly, the incidence of cancer in those over 65 being ten times greater than in those younger. Nearly three quarters of cases are diagnosed in people aged 60 and over, and more than a third of cases in people aged 75 and over. More than three quarters of cancer deaths occur in people aged 65 years and over. Although there is a higher number of cancer deaths in the over 65s, cancer causes a greater proportion of deaths in younger people. Among elderly men, cancers of the prostrate and colon are the most common, while for women it is breast cancer. About 80 per cent of all breast cancers occur in women aged over 50.
The relationship between cancer and ageing is quite complex. Genomic instability, DNA damage, is a hallmark of most cancers, and is also a hallmark of ageing, as we will see. There have to be a number of changes to the genes within a cell before it turns into a cancer cell. It then takes time for further changes to occur for the cells to become malignant. The relationship to ageing is probably related to the increased time cells have to develop abnormalities that increase the risk of cancer, and also the increase in time that they are exposed to a cancer-inducing environment. A surprising statistic is that the potential gain in life expectancy which could result from the complete elimination of mortality from cancer in the US would not exceed three years if one were to consider cancer independently of other causes of death.
Cells can respond to new situations by increasing their growth in ways that do not necessarily lead to cancer, but have other effects. The prostate in older men is all too good an example. This is due to increased proliferation of the epithelial cells and fibroblasts, and an increase in size of the smooth muscle. This results in increased urination as the prostate protrudes into the bladder. Why this should occur with age is just not known, and it all too often can develop into a tumour. But not all abnormal increases in growth are cancerous, thankfully.
Decline of the immune system with age is serious. In the elderly, many alterations of both innate and acquired immunity have been described. This process is responsible for increased susceptibility to infectious diseases such as flu and pneumonia, as well as being at the root of the biological mechanisms responsible for inflammatory age-related diseases. In the USA 90 per cent of deaths from flu and pneumonia are in people aged over 65 years.
Osteoarthritis is a type of arthritis and some 8 million people in the UK suffer from it. It affects mainly older people starting at around age 45, and is caused by the breakdown and eventual loss of the cartilage that serves as a cushion between the bones of the joints. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. People with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis (there are over a hundred types), osteoarthritis affects only joints and not internal organs. More than half of the population aged 65 or older would show X-ray evidence of osteoarthritis in at least one joint. Both men and women have the disease. It is due to a combination of factors, including being overweight, the ageing process, joint injury, and stresses on the joints from certain jobs and sports activities.
Osteoporosis is a silent disease in which bones become extremely fragile. The bone mineral density is reduced, and bone structure is disrupted. If left untreated, it can progress painlessly until a bone breaks, typically in the hip, spine or wrist, and these breaks are extremely painful and can take a long time to heal. It is claimed that one in every two women and one in every four men over 50 will break a bone due to osteoporosis. Gout, however is not age-related.
Falls are amongst the most common and serious problems facing the elderly. They can lead to death, reduced function and admission to a nursing home. About half of the over-65s have a fall each year and the numbers increase with age. Cognitive impairment and dementia increase the risk of falls and the risk of fractures to bones is greater. Balance problems and dizziness are considerably more common the older the person—three out of five women aged 80 and over experienced one or both of these at least sometimes, compared with only one out of five women in their 50s. Repeated falls can lead to the need for long-term care. Difficulties with walking and climbing stairs are all too common amongst those over 75. More than 2,300 older people fall every day and 80,000 of those who have fallen during the year are afraid to leave their homes. Exercise programmes can help in preventing falls.
Older people have an abnormal gait when walking, and this is evident in about one third of those over 65. The characteristics include slow speed, short step length and large variability, narrow stride width, and stepping frequency. Uneven pavements—in London one in five pavements is in a poor state of repair—can be hazardous. Elderly people could one day be relying on a bodysuit, rather than a Zimmer frame, for support. Scientists in Japan are developing the ‘Michelin gran’ Lycra suit which is covered in pairs of inflatable ‘muscles’ which assist the wearer’s real muscles. When they inflate, they help the wearer move their limbs with more strength and stability.
Type 2 diabetes is most often seen in older adults, with half of all cases diagnosed in people of 55 and over. It is by far the most common form of diabetes, and occurs when the body produces insulin but the cells no longer respond by allowing entry of glucose, especially in muscle, fat and liver cells. About 90 per cent of patients who develop type 2 diabetes are obese. Both being overweight and lack of mobility promote the disease.
There are many false ideas about the sexual activity of the elderly. It has been said that sex among the old is a well-kept secret because the young would not believe it if they were told. In fact there is little evidence for a significant age-related decline. The level of sexual interest and activity among people over the age of 65 is as diverse as the individuals who make up that population. A recent survey in the US of married men and women showed that nearly 90 per cent of married men and women in the 60–64 age range are sexually active. Those numbers drop with advancing years, and a bit less than one third of men and women over the age of 80 are still sexually active. A recent survey found that men enjoy five extra years of an active sex life—up until the age of 70—compared to women, who were less likely to make love after the age of 65, mainly because they had married older men and their partner had died. Those who are healthy in older age are twice as likely to enjoy a high libido and more likely to have regular sex, that is once or more a week. Even so the male sexual response tends to slow down with age.
There is, however, significant erectile dysfunction and impotence in those over 70—about one third suffer from this. Physical illness is a common reason for ending sexual activity, and medications such as antidepressants, statins and benzodiazepines can have similar effects. By the age of 65, about 15 to 25 per cent of men have this problem at least one out of every four times they are having sex. This may also happen in men with heart disease, high blood pressure or diabetes, either because of the disease or the medicines used to treat it. A man may also find it takes longer to get an erection and his erection may not be as firm or as large as it used to be. The amount of ejaculate may be smaller. The loss of erection after orgasm may happen more quickly, or it may take longer before an erection is again possible. Some men may find they need more foreplay.
It is well-documented that older women experience fewer sexual problems than men as they age. Most healthy women can expect unimpaired sexual activity to the end of their lives, if that was their pattern earlier. Normal changes in the older woman include a decrease in length, width and elasticity of the vagina. Recent studies, however, indicate that the older woman has no physical limitation in her capacity to achieve and enjoy orgasm. But there are some limitations. The decline in the female hormone, oestrogen, which occurs after menopause, can result in decreased vaginal lubrication. The loss of lubrication can often result in painful intercourse, but fortunately this condition can be easily treated with creams. Diana Athill, an award-winning writer over 90, wrote that she has given up sex and says she doesn’t miss it. ‘It’s like not being able to drink wine—at first I thought that was a terrible detriment, but once you can’t drink something, and it makes you ill if you do, you don’t mind giving it up… One reads from time to time absolutely obscene articles about senile sex—about how if you really go on trying hard enough, using all kinds of ointments, it can work, but for God’s sake! It’s supposed to be fun! If you need a cupboard full of Vaseline, you might just as well stop.’
Changes in our skin giving rise to wrinkles in the face are a major sign of ageing. A study of the basis of their formation using gene technology claims to have identified more than a thousand genes and their proteins that are involved. One pathway results in the loss of water, while another is the breakdown of collagen, a molecule that gives the skin strength, and a third is damage from sunlight. With ageing, the outer skin layer thins, even though the number of cell layers remains unchanged. The number of pigment-containing cells decreases, but the remaining ones may increase in size—age spots—in sun-exposed areas.
Ageing skin is thus thinner, pale, and more translucent. Changes in the connective tissue reduce the skin’s strength and elasticity, especially in sun-exposed areas. It produces the leathery, weather-beaten appearance common to those who spend a large amount of time outdoors. The blood vessels under the skin become more fragile, which in turn leads to easy bruising, but most bruises go away without treatment. The skin glands produce less oil with age and while men experience a minimal decrease, usually after the age of 80, women gradually produce less oil after menopause. This can make it harder to keep the skin moist, resulting in dryness and itchiness. The fat layer, which provides insulation and padding, thins, and this increases the risk of skin injury and reduces the ability to maintain body temperature in cold weather. The sweat glands produce less sweat and this makes it harder to keep cool in hot weather, and so increases the risk of becoming overheated. Growths such as warts and other blemishes are more common. Skin-healing can sometimes fail completely in later life, causing a wound to become chronic. Statistics suggest that at least one in twenty people over the age of 65 have a non-healing skin wound. At particular risk are older people with diabetes, and a distressed emotional state can impair healing even further.
Eye diseases like cataracts, glaucoma and macular degeneration cause loss of vision and are major problems in old age. Cataracts are areas that distort light as it passes through the lens of the eye. As we age, protein in the lens of our eyes can clump together and cloud the lens. Glaucoma is an eye condition in which the fluid pressure mounts inside the eye; this pressure can harm the optic nerve. It is often hereditary and worsens with age. Both cataracts and glaucoma can be treated. Macular degeneration is a disease that causes progressive damage to the central part of the retina that allows us to see fine details. In the USA 30 per cent of patients aged 75 to 85 will have macular degeneration There are genes which increase the risk, and diabetes and high blood pressure also increase the risk of eye problems. There is also presbyopia, the typical ‘long-sightedness’ of middle age, in which people find it more and more difficult to read small print. To begin with they cope by holding the reading material further and further away.
About one-third of Americans between the ages of 65 and 74 have hearing problems and about half the people who are 85 and older have hearing loss. In the UK there are more than 6 million deaf and hard-of-hearing people aged over 60. Tiny hairs inside your ear help you hear as they pick up sound waves and change them into the nerve signals that the brain interprets as sound. Hearing loss occurs when the tiny hairs inside the ear are damaged or die. The hair cells do not regrow, so most hearing loss is permanent. Another type of hearing loss results from damage to other parts of the inner ear. Tinnitus can occur with many forms of hearing loss, including those that sometimes come with ageing. People with tinnitus may hear a ringing or some other noise inside their ears. The good news is that hearing deterioration tends to halt at around the age of 70.
We visit the dentist more as we age. Teeth provide a good model of wear and tear as an ageing process. With age our teeth appear to get darken, due to changes in the dentine beneath the surface enamel. The enamel itself can become worn down from years of chewing, and this causes teeth to become more sensitive. The teeth themselves also become dryer and more brittle, which makes them more likely to break or crack during normal chewing, and old fillings may start to fracture. Gums can start to recede, especially if there is a periodontal disease or they have been subject to too-forceful brushing. Receding gums can increase the risk of tooth decay.
Approximately a quarter of men begin balding by the age of 30 and two-thirds begin balding by age 60. One hypothesis suggests baldness evolved in males as a signal of ageing and social maturity, showing that aggression and risk-taking decrease. This could enhance their ability to raise offspring to adulthood. Most of the hairs on a person’s head are in an active growth phase, which may last anywhere from two to seven years. At the end of this stage the cells causing growth, which are stem cells, die, and the hair falls out. The average scalp contains about 100,000 hairs and roughly 100 hairs are lost every day. Baldness is due to the failure to replace lost hairs and has a genetic basis, but stress can also cause hair loss.
The greying of hair can also occur at quite a young age but commonly begins in the mid-thirties. The blackness of hair is due to special dark-pigment-producing cells, melanocytes, entering the growing hair, and greying is due to their absence or failure to produce dark pigment. For unknown reasons, hair stem cells have a much greater longevity than the melanocyte stem cells, so greying can occur before baldness. Stress hormones may impact the survival and activity of melanocytes, but no clear link has been found between stress and grey hair. Genes can affect both baldness and greying, and twin studies showed that female greying is genetic.
If all this information sounds depressingly negative, it may be worth remembering ‘The Old Man and the Three Young Men’, a verse fable by La Fontaine, one of the most widely read French poets of the seventeenth century, which gives strength to the old:
But all three youths die from accidents.
And in most areas of physical activity, not least sport, there are positive and encouraging examples of physical ability with increasing age. Do those in various sports truly begin an unstoppable physical decline in their twenties, or is this more of a question of reduced motivation? ‘How old would you be if you didn’t know how old you were?’ asked Leroy Paige while playing major league baseball as a pitcher into his late fifties. Ageing is relative—the 60-year-old tennis player may be in better shape than the 20-year-old couch potato. I still regularly play both doubles and singles.
Not long ago it was ‘time to hang it up’ when an athlete hit 40, and one was definitely regarded as being over the hill at 50. Now it’s more like 75. This refers to those who are training and trying to improve their performance, not the average couch-lounger. Some have kept training as they got older, and others have started competing in middle age. One study showed year-to-year performance declining after 50, but at a rate that was barely noticeable until about 75, when the decline became undeniable. Male and female senior athletes’ performance declined approximately about 4 per cent per year over 35 years of competition—slowly from age 50 to 75 and dramatically after 75. The decline in the sprint was greater than in endurance for women, especially after 75. Marathon runners decline about 2 per cent a year between 30 and 40, 8 per cent between 40 and 50, then 13 per cent 50 to 60, and finally there is a 14 per cent decline between 60 and 70. But in 2003 the Canadian long-distance runner Ed Whitlock ran a marathon in under three hours at the age of 73.
There are other amazing exceptions to decline of athletic ability with age. Luciano Acquarone was a marathon world-record holder at 59 years with a time of 2:39, and a 60-year-old runner from Japan who ran it in 2:36. There is a 73-year-old lady who tries to swim, cycle and run three times a week as it makes her feel young and live longer, and she will even enter the Hawaii Ironman triathlon. A great example of strength with age is Ranulph Fiennes, who climbed Everest at the age of 65, and six years earlier ran seven marathons in seven continents on seven successive days. Ruth Frith at 100 set a new world record in her age category with her shot put of just over 4 metres—longer than the throws of competitors decades younger—at the World Masters Games in Sydney in 2009. She trains five days a week, pressing 80lb weights
‘Old soccer players never die, they just achieve their final goal.’ Roger Milla was 42 years old when he played in the 1994 World Cup for the Cameroon national team. He achieved international stardom at 38 years old, an age at which most footballers have retired, by scoring four goals at the 1990 World Cup. Many football players are in their prime in their 30s.
Snooker requires both mental and physical skills. Ray Reardon, who claimed six world snooker titles, reached the 1982 world final at the age of 49, only to lose to an inspired Alex Higgins. One of his greatest moments came in 1988 when, aged 56, he thrashed Steve Davis, winner of five world crowns. Golfers too can continue through the years. Tom Watson at 59 only just lost the 2009 British Open, and there was a great deal of positive news coverage that someone of his age could be so successful. One old golfer was still driving himself to the course at 101, and only recently moved into assisted-care living at Arizona Grand. At 100, he could still break 40 for nine holes, and he didn’t start riding in a cart until a hip problem caught up with him at 98.
Declining health and capability that accompanies age may be made worse by prolonged exposure to an unhealthy environment and lifestyle. Older people rather consistently rate their health as good, despite evidence suggesting that they are more likely to suffer from a variety of health problems. Many older people take a holistic view of what ‘health’ means, including wellbeing and social factors, and in general take a positive view. Older people who accept negative images of ageing are more likely to suffer with health problems—they are also, because of their negative attitude to ageing, more likely to attribute their problems to the ageing process, and therefore do not seek the necessary medical assistance. Some older people may also minimise their health problems as a deliberate method of denying negative age-related stereotypes. In addition, some older people are reluctant to visit medical professionals because they feel, unwisely, more comfortable trusting their own common sense.
Heart-felt perils await people who hold disapproving attitudes about the elderly, a new study suggests. Young and middle-aged adults who endorse negative stereotypes about older people display high rates of strokes, heart attacks and other serious heart problems later in life, compared with ageing peers who view the elderly in generally positive ways. Yale University psychologist Becca Levy found that those who viewed ageing as a positive experience lived an average of seven years longer. This means that a positive image had a greater impact than not smoking or maintaining a healthy weight. Levy says that patronising attitudes and ‘elderspeak’—speaking to elders as if they were children—can affect their competence and lifespan. There are claims that optimism and coping styles are more important to successful ageing than physical health. But do keep doing exercise. Also note that there is a little evidence that being bored can result in heart problems and an earlier death.
We will look later at the possible cellular basis of the changes in our bodies as we age, but now turn to mental changes and illnesses associated with ageing.