by Dr Penny Flett
Presented at the Perth Day of Ideas, Holmes a Court Gallery, Saturday 2nd August 2003
Thank you, Helen, and thank you everybody for having me here. I regard this as a real privilege, the pleasure is mine, listening to other people and taking home some very stimulating ideas.
Helen has suggested that this may begin with a personal experience about fear, by way of introduction.
I am obviously going to speak about ageing this morning because that is my passion in life. I think it would be fair to say that the ultimate fear of ageing is probably, for most people, this great unknown called Death. Death is something that all of us come to grips with to a greater or lesser extent at varying times in our lives. Doctors are not very good, necessarily, any more than anyone else about coming to terms with death.
The experience I will recount to you is a lesson about death, taught to me as a young geriatrician by a very old lady. This lovely person was 102 when I met her in a geriatric ward, and I looked after her until she died at the age of 104 years.
I marvelled at this woman, she was very, very frail, she wasn't able to walk a great deal on her own, but she commanded the attention and respect of everybody in the whole place. She had a very large family, many, many descendants, and she was constantly knitting for the latest great grandchild or great great grandchild that had arrived in her dynasty, I suppose you would call it. Her other great passion was sport, and she never missed a moment of sport on the radio or the television. She was the source of all information. If you wanted to know who just scored what point in the tennis or the football, she was up-to-the-minute.
One day, she came down with a serious chest infection and I went to see her. She said, "Listen, dear, don't you think I am going to die this time, you give me some antibiotics, I have got a few more things to do, and besides I want to know what happened in the tennis match". So she and I agreed that she would be treated and she recovered. This happened two or three times over the couple of years that I looked after her. Then came a time when she became very ill and we had our usual conversation. This time she said to me, "My dear now I am ready to go". Her lesson to me about death, I think about still, was extraordinary. She taught me that death is not to be feared, dying maybe, depending on what you think and what views you have about where you may or may not be going afterwards, but death itself is not to be feared.
Ageing. What is there to be feared about ageing?
It seems to me that there are two main issues.
The first is that ageing is in the future, for all of us. However old we are, there is more life to be lived, and that means growing older. The future can be a problem, it's an unknown quantity, and some people naturally fear the unknown. I believe that fear of the future is bound up with not having control.
Many think they have no control over the future. My view is that this is not entirely, or necessarily true. We dread disease, we dread dementia, we dread decrepitude. We dread dependency and all the indignities of old age that we think inevitably accompany old age. Never make assumptions.
The second issue, compounding these fears, is the stereotyping of old people. These stereotypes are very powerful, and pervade society. I don't have to tell you old people are grey, they are wrinkled, they are doddery, they are incapable, they don't contribute and, by and large, they are just a plain old burden on society.
Usually I have a go at Bismark at this stage because over a hundred years ago he invented the old age pension. We have slavishly followed the practice of pensioned retirement ever since. (We forget that when Bismark set this up, people didn't actually live much beyond 65, so he was on a pretty safe wicket.)
I thought I would illustrate the long time practice of our society to perpetrate stereotypes, by quoting a little Shakespeare. You may remember he describes the seven ages of man. I will read the sixth and seventh :
"'.The sixth age shifts
Into the lean and slippered pantaloon,
With spectacle on nose and pouch on side,
His youthful hose well saved, a world too wide
For his shrunk shank, and his big manly voice,
Turning again towards childish treble, pipes
And whistles in his sound ''".
And the seventh''
"'..Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything".
What a dreadful prospect. A marvellous picture, we could never be so good at stereotypes today!!
In our twenty-first century, it is said that 'baby boomers' are actually ignoring their old age. It would appear so, the over 55s are behaving as if it will never happen, but I don't for one moment believe that we are not, deep down, a little frightened of it. Our society automatically assumes that old age is about residential age care in nursing homes. Let me hasten to tell you it is not.
The media know how to push the buttons and I think the button that they push is the guilt. They play on the collective guilt of society, that we value old people so little that we take them out of society and put them somewhere else, where we can't see them. We have actually been doing this for at least a hundred years, first in benevolent asylums, now in nursing homes. Even though standards in nursing homes are improving substantially all the time, and the quality of buildings, amenities and service is so much better than before, we are still removing frail old people from society, and making them invisible. And when something goes wrong it is the best button which can be pressed so quickly. The media can horrify us all, and keep the guilt and the stereotype going. I think it is the easy way out.
That is the dark side, now to the bright side. I want to clarify a few facts, before I turn to some comments about the future.
First it is necessary to clarify what is 'old age'.
My favourite definition of old is that it is 15 years older than you are, whatever age you are. Remember when you were five you thought someone who was 20 was really quite old. When you were 20, 35 was almost middle aged. When you got to 35, well 50 was beyond imagination'.that was definitely the older generation! And so on.
Taking this further, another old lady taught me this lesson. She said, 'You must realise that all old people are not the same. I am 70 and that lady over there is 85 or 90. She is a different generation from me, she's old enough to be my mother'.
Every age brings its own challenges and joys, and its own satisfactions. So old age is a chronological fact. Most people, especially old people, don't think of themselves as the age they actually are. My own experience is that I have enjoyed each decade of my life much more than the one before and I hope very much that I continue to do that. It is not whether I am fortunate enough to have money or not have money, or to live in the right house or not live in the right house, or have a job or not have a job, it is all the different experiences of life that come with each passing year.
The next reality that happens with advancing age is the series of losses that will inevitably be experienced. Most of us in this room know people of our own age who have died, have had cancer, have met with some tragedy and that is a significant loss. Many of us may have lost family members, parents, grandparents. These are losses we increasingly sustain as we age.
Employment can be problematic. Re-employment in middle life can be very difficult. For many, the loss of a job, including voluntary retirement, spells the end of a recognised role in life. Unless retirement is well planned, this loss can be a very hard one to come to terms with.
Once into retirement, living on a fixed income for the rest of your life is a very tough call. Not being able to go and purchase what you wish can be a loss in itself. Obviously with advancing age we lose youth. If we value youth then that is a loss. There are the physical changes of ageing, loss of muscle power, and the ability to react quickly. We also lose time, the time we have left. It is well worth remembering that after retirement many of us have enough time left to take up a second career, or at the very least, learn a whole new set of skills. Ultimately, the final loss is death.
So ageing does bring with it losses, and I think it is important to prepare for those. Think about them and deal with them if you can before they happen so that they are not so cumulative and dreadful. It is also a fact that depression in old age is rife. Perhaps this is a direct result of increasing losses, without compensation, without preparation, and without support. (It is also a fact that the suicide rate in old men is actually greater than the suicide rate in young men).
Peeking into the future, the ageing population will have significant impact on the health system. While only five percent of old people live in nursing homes, it will probably not be affordable to keep up this level of provision. Care in the home will be much more the order of the day.
Dementia will increase as the population ages and expands. Unless research finds a way to alleviate the incidence of dementia, by the middle of the century half a million Australians will have dementia, and will need specialised care. Governments are beginning to really think about old age. It is important to point out that future rising health costs are not due to the ageing population, but are driven much more by the cost of high technology medicine and pharmaceuticals.
On the bright side, it behoves us to realise that the baby boomers are going to be putting back into society a very large amount of money, before they take out money for their care. Baby boomers will have a completely different attitude from that of the current elderly or past elderly. "We" have a stack of money, it is readily accessible and we are spending it all on ourselves, on our grandchildren, on tourism and goods. "We" will also save the government a great deal of money by our volunteering, our caring for relatives, and a multitude of other contributions to society.
Let us look at the future. I believe the future is ours to design, if we are smart enough. We have to approach the future in a thoughtful way, and not fear losing control. We can actually choose what we want it to be. Kofi Annan, the Secretary General of the United Nations, exhorted us to make a future for ourselves which is truly intergenerational, a "Society For All Ages", when he declared 1999 to be The International Year of Older Persons.
We must invest in the future and begin the discussion and conversation. We have to invest in some very good leadership to shift some deep-seated cultural attitudes, so that we revalue older people all over again, and respect their wisdom and their experience. We work to develop a future in terms not only of Government systems, but care and service systems, and support for people to live their own lives even if they are slowing down. People must be empowered and able to live as useful contributing members of society, regardless of age. I believe we have an opportunity this century to move beyond technology and industry to a place where we can all learn to look after each other again, no matter whether we are young or old.
Dr Penny Flett Ph. (618) 9202 2809 CEO,
Brightwater Care Group (Inc) Fx. (618) 9202 2803
PO Box 762 Mob. 0417 989 782
Osborne Park WA 6916 e-mail: firstname.lastname@example.org