http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1878273/pdf/jcgprac00010-0031.pdf

ELDERLY LIFE: ITS CHARACTERISTICS,

NEEDS AND PHILOSOPHY

J. W. BEATrIn, M.D., M.R.C.P.

Consultant Physician in Geriatrics, United Norwich Hospitals

Elderly life or the period of ageing has many important aspectsespecially

its relationship to life, to itself, that is, its particular

attributes, and to society, and its attractiveness or otherwise as a

subject for scientific study and practice.

Certain quotations emphasize these aspects:

SOCRATES:

From the day your baby is born you must teach him to do without things.

Children to-day love luxury too much. They have execrable manners, flaunt

authority, have no respect for their elders. They no longer rise when their parents

and teachers enter the room. What kind of awful creatures will they be when

they grow up?

BBOSWELL:

Boswell: What I admire in Ramsay is his continuing to be so young.

Johnson: Why yes sir, it is to be admired. I value myself upon this, that there

is nothing of the old man in my conversation. I am now sixty-eight and

I have no more of it than at twenty-eight.

Boswell: But sir, would you not wish to know old age? He who is never an old

man does not know the whole of human life; for old age is one of the divisions

of it.

Johnson: Nay sir, what talk is this?

Boswell: I mean sir, the sphinx's description of it: morning, noon and night. I

would know night as well as morning and noon.

Johnson: What, sir, would you know what it is to feel the evils of old age? Would

you have the gout? Would you have decrepitude?

Seeing him heated-I would not argue any further, but I was confident I

was in the right.

MARGERY FRY (herself an octogenarian):

Intellectually you alter your opinion of yourself as adolescence, maturity,

and old age follow each other, but the knowledge " I am middle-aged, I am

elderly, I am old" has to be recalled into consciousness again and again.

... We certainly do not feel that it (old age) belongs to us in anything like the

way in which outside people classify us by it.... The surprises which most

J. COLL. GEN. PRACTIT., 1963,6, 20

EDERLY LE: Is CHARAC4RIisIcs, NEEDs AND PHILosOPHY 21

people have to confront on reaching old age are of two kinds: " So what we all

said is true, but I never quite believed it could happen to me "-this of the

effects of age visible from without.... Beyond the physical characteristics there

are others, of which we have been well forewarned by the unsparing frankness

of youth.... There is no one point upon which I feel stress needs to be more

constantly laid than this, that the external stigmata of old age must not be

allowed to obscure the lasting divergencies of character; individuality must be

respected. .. .

The doctors (and they exist) who are ever ready with " What can you expect

at your age? " throw away some useful odds and ends of human life.

And finally a medical quotation:

Mental deterioration in the elderly was now a problem of great medical and

social importance, yet it had excited comparatively little psychiatric interest.

There were many seasons for that, mainly based on the tradition of unacceptability

of old age to our general hospitals, and on the beliefs that all medical

problems of the elderly were uninteresting, that diagnosis and prognosis were

uniformly dull and gloomy and that therapy was doomed to failure. Reflection

would show that that was the attitude and outlook towards the elderly in general

medicine twenty years ago.

These four aspects of elderly life merit further examination and

comment.

Its Relation to Life

Senescence or the state and period of ageing is an essential,

integral, physiological, or normal period of life. Following the

first period of childhood and youth when growth and development

predominate over degeneration, there follows maturity or adulthood

when relative stability exists between growth and degeneration and

finally the period of senescence when degeneration predominates

over growth.

Senescence will therefore be experienced by many people. It

must be regarded as inevitable and normal. It must not be considered

as a pathological or abnormal state of maturity. It must not

be feared as being synonymous with decrepitude or mental infirmity.

In other words senescence is not synonymous with senility, the latter

in modern scientific thought implying a condition of abnormality.

Explanation of the characteristics of senescence and preparation

for it however are necessary.

Its Relationship to Itself

Examination of the relationship of ageing to itself implies investigation

and clarification of its attributes.

Incidentally it is preferable never to speak of old age, for in this

mechanical era things old carry the implication of being useless.

Moreover, too many people still refuse to call themselves old, even

when the most tolerant adults cannot possibly adorn them with any

other description. On the other hand, things elderly still have uses

and, indeed, may have added lustre. It is better therefore, to think

of people being elderly and ageing.

Senescence can be defined and is different biologically, psychologically,

sociologically, and clinically from the period of maturity.

If senescence is a normal period of life, different from the preceding

period of maturity or adulthood, then it must have certain distinguishing

characteristics. Being different implies either the possession of

qualities not found in others, or the absence of qualities found in

others, or a marked difference in the nature of the qualities or

characteristics already present in others.

There are certain well recognized biological criteria of ageing or

senescence; for example, morbidity or invalidism increases markedly

in senescence, survival curves show a rapid decline and accident

proneness increases. More important individually is the fact that

marked alterations in functions must be expected; for example,

increasing difficulty in the dark, increasing liability to falls, increasing

deaths from falls, and increasing reduction of mobility long before

any real infirmity may arise. Alterations in the environment,

whether external or internal, are badly withstood. On the other

hand, disturbances of physiological functions are easily produced,

the range of permissible variation is narrowed and minor changes

may produce serious damage.

A whole range of psychological performance tests shows evidence

of deterioration; for example, in accuracy of judgment, in speed of

judgment, in reaction time, in performance time, in the ability to

select from multiple choice situations, in the ability to retrain

without previous allied experience, and in the ability to learn new

material of various kinds. Paced tasks are extremely difficult for

the elderly, especially when the pacing is combined with continuous

bodily activity or movement or muscular work. There is slowing

of sensory processes and central control, of psychological and

somatic adjustment reactions, and of the perceptual organization

of incoming stimuli within the central nervous system.

There is a lack of flexibility of outlook, an increasing inability

to meet and deal with new situations, a resistance to change and a

sacrifice of speed in activity and thought.

Intelligence tests also show declining scores with senescence,

when comparison is made with younger groups, i.e., people of later

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ELDERLY LIFE: In CHARACTERSnCS, NES AND PLOSOPHY2

generations. It has been found that less deterioration occurs with

the tests of more frequently used abilities, such as vocabulary,

general information, and verbal comprehension, than with the

abstract tests.

When can these changes be found? They can be demonstrated

quite easily and clearly in people 60 plus years of age. They are

the effects of alterations in function; some deteriorate steadily from

early adulthood, some deteriorate slowly throughout adult life

and then more rapidly in senescence, and others remain nearly

unchanged throughout adulthood until they show marked deterioration

in senescence.