You’re Looking Very Well
Lewis Wolpert
We now live longer today than at any time in history. In the UK, more people are aged over sixty-five than under sixteen and by 2050, over a third of the developed world will be over sixty. How should we deal with this phenomenon? What are the scientific reasons for ageing? And can—or should—we prevent it?
Lewis Wolpert, distinguished biologist and octogenarian, explores the scientific background and the implications of our ageing population. In this engaging investigation, he tackles every aspect of the subject from ageism to euthanasia to anti-ageing cream and, through it all, tries to better understand his own ageing. Witty, frank and often inspiring, Lewis Wolpert is the perfect guide to ‘looking very well’.
Lewis Wolpert
YOU’RE LOOKING VERY WELL
The Surprising Nature of Getting Old
Acknowledgements
As always I have had a lot of much-needed help. I am greatly indebted to Alison Hawkes for her editing and comments throughout my writing of the book. I am also indebted to Julian Loose, my editor, and Kate Murray-Browne at Faber for their comments and encouragement. My thanks also go to my agent, Anne Engel, and to all of those who gave up their time to talk to me.
1. Surprising
‘Old age is the most unexpected of all the things that can happen to a man’
— Leon Trotsky
When we are young we do not think about being old; it is simply not part of our agenda. So when we age we are not prepared for it and it can be quite a surprise. It has come as a shock to me. How can a 17-year-old, like me, suddenly be 81? The only obvious features, if I do not look in the mirror, are that I now walk so slowly that most people dash past me on the pavement, and I have retired from my university job. I find it hard to come to terms with both. But I also forget names, words and faces. I recently forgot several things I had meant to do, and was worried that this was age-related and might indicate the start of dementia. I intended to ask my psychiatrist at my next appointment related to depression. I went to see him and then laughed when I remembered, as I cycled home, that I had forgotten to ask him.
I never thought much about ageing, but Shakespeare’s memorable description in As You Like It doesn’t offer a particularly positive view:
All the world’s a stage
And all the men and women merely players;
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurse’s arms;
Then the whining schoolboy, with his satchel
And shining morning face, creeping like a snail
Unwillingly to school…
The sixth age shifts
Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose, well sav’d, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans every thing.
I decided I wanted to understand ageing, not least because it seems so different a topic from the one I have spent most of my life studying, the development of the embryo. Is ageing part of our developmental programme? We are essentially a society of cells, so what is the cellular basis and what is the cause of both physical and mental decline in old age? Can these be prevented? Is immortality in the future a real possibility? As the proportion of elderly people in society rises, there are more general social and economic problems related to their treatment and care. I needed to know how the old can live well, and whether, when the time comes, we can choose when to die. Also, does understanding ageing help with one’s own ageing?
Yet old age is by no means easy to define. It is a biological phenomenon characterised by certain physical changes that take place with time and also by their psychological consequences. It is the changes in individual appearance that prompt your friends to remark, ‘You’re looking very well.’ Indeed, one can now think of there being four ages, rather than Shakespeare’s seven, in our lives: childhood, active adulthood, maturity and finally ‘You’re looking very well.’ As an 81-year-old, I hear it all the time, and use it again and again when I meet my ageing friends. There is a quite wide belief that old age starts at around 65, which has been a common age for compulsory retirement. But now that there are so many aged over 75 and even 85, we need to look again at when old age really begins. Of course ageing really begins, as we shall see, when we are quite young—there are few 40-year-old football or tennis champions.
Getting old is often more apparent to others than to the actual person who is ageing, and many who are old persist in the belief that they are still young. It is important to realise that everyone ages differently, depending on their circumstances. The big question is how one deals with old age. The author Doris Lessing, for example, finds it acutely irritating. Does one try to find new activities? Should one reflect on one’s life to decide if it has been worthwhile? And how does one deal with both bodily and mental decline?
* * *
For many, ageing is frightening. Only about one in ten of those aged 75 to 79 remains free of physical illnesses such as those of the heart, eye and bones. Those with wealth and a good education do best, as do those who have a positive attitude to ageing. But though all our bodily functions deteriorate with age—for example, muscles lose their strength and the immune system weakens—evidence from those who play sports shows that even when old it is possible to continue to play quite well. There are also many false ideas about the decline of sexual activity in the elderly: in fact there is little evidence for a significant age-related decline.
There is a significant chance of developing a mental disability after the age of 50, dementia, particularly Alzheimer’s disease, being the most common. This costs the UK an estimated £17 billion each year, and is a great problem for carers. Other common age-related mental diseases include Parkinson’s disease and depression. But while our mental abilities undoubtedly decline with age—we become forgetful and slower—our acquired knowledge, fortunately, seems to remain intact. Many of the old hold high positions and remain creative, with their intellectual abilities in good shape.
For some, old age has very positive aspects. It can even be a time of joy. Today the title of the Beatles song would be ‘When I’m Eighty-four’. At the age of 106, a neighbour of mine is very happy and still active with her piano playing. Things that are dear may become dearer, such as ideals, friendships and family. There may be time to do things which we could not do when we were young—and there is the possibility of being adventurous either physically or mentally, even if immobility is creeping on. For me it is very encouraging to see that even when old, scientists can still be very active. A fine example is Professor Dennis Mitchison, a friend of mine who is distinguished for his work on tuberculosis. Mitchison is 90 and is an Emeritus Professor at St George’s Hospital medical school. I asked him about his views on ageing:
I did not begin to notice the effects of age till I was about 85. I got a bit slower and my organs worked less well. I enjoy my current age since the research is very exciting and even if a bit slower I just get on with it. I collaborate and get grants mainly from drug companies. We have seven scientific papers in preparation, one of which has just been rejected but at my age I get less upset when things go wrong. We have a project that will only be finished in about ten years—not sure I wil
l still be here. I do think that euthanasia raises difficult problems but I do think we have the right to choose when to die.
We live longer today than at any time in history. Over a sixth of people living in the UK are expected to celebrate their 100th birthday. Mortality has been considerably postponed, as a result not of revolutionary advances in slowing the process of ageing, but of progress in improving health. Ageing itself has undergone a dramatic change over recent years. In the industrialised world in the twentieth century there was an unexpected and unprecedented growth in the older population—some 30 years were added to life, an increase greater than in the previous 5,000 years. This was due to improved healthcare, food and sanitation. There are now more people aged over 65 than under 16 in the UK. And the number of people aged 85 years or more doubled between 1983 and 2008.
In the UK, there are currently around 10 million people who are over 65 and 1.3 million over the age of 85, of whom 422,000 are men and 914,000 women. Women have outlived men throughout history. We humans generally live longer than our ape-like relatives, and have an extended period of juvenile dependence—this may be related to getting food, which is difficult for the young. The elderly are, in this sense, repositories of knowledge. But while there have been many individual exceptions—such as St Augustine, who lived to 75, and Michelangelo, who died at 88—for most of human history the average lifespan was short. In London in 1800 you could expect to live to just 30, in 1900 to 42, in 1950 to 61, and now to about 80, women for a few more years than men.
The recent increase in the number of the old and very old has major implications for how they live and are cared for. Ageing can thus have major economic impacts, particularly if the number of the aged becomes greater than the number of the young needed to support them. It is thus essential that we understand both the biological basis of ageing and how the old are treated.
* * *
Why do we age? The Ancients mainly thought that it involved the loss of some key factor in the body. The scientific study of ageing began with Francis Bacon in the seventeenth century, but it was only after cells were recognised as determining how bodies functioned that scientific research into ageing could properly progress. Even doctors eventually became interested in ageing, and geriatrics was established. Peter Medawar proposed an evolutionary theory, and there was the surprising discovery that cells aged in culture. Evolution and sex play key roles in understanding why we age: evolution is concerned only with reproduction, so does not care if we age after having successfully reproduced. Ageing is not programmed in our genes like normal growth; on the contrary, there are genes which try to prevent it. Another surprise is where our great progress in understanding has come from: it has been the investigations of ageing in a simple nematode worm and flies, as well as in mice, that have been so productive.
These studies have identified some of the molecular mechanisms responsible for ageing, and even raise the possibilities of extending life still further, but whether this is desirable unless age-related disabilities can be avoided is a key question. How long could we live? How long should we live? There are many myths about humans living to a very old age, but there is no evidence for any of those claims beyond 115 years for men and 122 for women. Genes can account for about one third of lifespan. In spite of much publicity and advertising, there is no known method of extending lifespan other than through exercise, not being overweight, and being healthy and positive. In model organisms like worms and flies, it is possible to increase their age fivefold, but at present there are no validated means for significantly extending human lifespan.
Our ancestors were no less aware of ageing than we are, and were interested as to its cause and how it could be prevented. In the oldest known document about ageing, dating from 2,500 BC, an ancient Egyptian official named by Ptahhotep drew a gloomy picture:
How hard and painful are the last days of an aged man. He grows weaker every day; his eyes become dim, his ears deaf, his strength fades; his heart knows peace no longer; his mouth falls silent and he can speak no word. The power of his mind lessens and today he cannot remember what yesterday was like. All his bones hurt.
It still strikes an all too familiar note.
There are important myths that we should bear in mind when we wish to extend longevity, notably that of Tithonus, who lived long but aged horribly. Efforts to disguise ageing by altering a person’s appearance go back a long time, and Cleopatra certainly tried. There is now a multi-billion pound cosmetic and surgical industry devoted to limiting the physical ravages of getting old. The most common cosmetic surgery treatments are for face, breasts and fat; it is sexual attraction that seems to matter most. But some older people are joining in, even if the many facial creams for getting rid of wrinkles have only a minor effect in spite of all their claims.
Both ancient and current views about ageing are on the whole negative. There are of course significant differences in how different societies treat the old, as for instance in China or the US, but the way the old are viewed in our society is not as positive as we oldies would like. The old tend to be stereotyped as ‘warm but incompetent’; and I do not like to be thought of as an ‘old fogey’. As they age, people may become wiser, but at the same time are thought less competent in their jobs—even though, surprisingly, surveys do not bear this contention out. The old are now less welcome in public arenas such as politics. They are also often mocked in the press. The result is that the positive aspects of ageing are grossly neglected, and there is a failure to recognise that many of the elderly are quite happy with being old. As Mark Twain put it: ‘Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.’
There is, nevertheless, a lot of sympathy for the old and many people try to help them. In 1940 a group of individuals‚ as well as governmental and voluntary organisations, came together to form a committee to help old people and it soon gained national recognition. With the birth of the welfare state in the 1950s‚ government money became available to fund local work with older people and the committee became completely independent of government and took a new name—Age Concern. It became a national agent for schemes run by local groups, and drew attention to the plight of older workers who were unable to return to work because of long-term unemployment or redundancy. In spring 2010 Age Concern England joined together with Help the Aged to form Age UK, a new charity dedicated to improving the lives of older people.
Age UK combats ageism in all its forms, both social and as manifest in the treatment of the health of the old. Some of those responsible for medical care seem to see little point in spending much money and effort in keeping the old with serious illnesses alive. Age discrimination is present in many current societies—the compulsory UK retirement age being an obvious case—and when this occurs in a medical setting the results can be very serious and damaging.
But what really matters is how the old are treated. The worst cases, fortunately rare, are those where the old have been put to death when they were no longer thought to be of value to a society. Many of the old are lonely and poor. Most of the elderly want to stay in their own homes, and this can require support from others as well as money. Many of the old will end up having care at home, or living in a care home or nursing home. The money for this is partly provided by the state but there are complaints that it is inadequate, and many have to sell their homes. There are also problems with respect to professional care; many cases of incompetence and neglect are reported, even in hospitals. Dementia patients do especially badly.
* * *
The economic realities of an ageing society are only just beginning to impact on us. There are those who oppose extending human life partly because it is bad for the young, and because there are negative economic implications. A society in which the old greatly outnumber the young faces many challenges. Who will support all those elderly, and pay all their health costs? Countries like Japan and China face similar problems.
Ageing makes one think of death: how one
should prepare for death, and how one should die. Most people want to die at home—I certainly do—but most people don’t in fact do so. Do we die of old age? There is no good evidence that we can die of old age, and it is rarely put on a death certificate. In the US the use of these words alone is forbidden. Then there is the question of the best way for the old to die. Suicide is not uncommon, but euthanasia would be far preferable and the law preventing it must be changed; the old should have the right to choose how they die, while taking into account the pain loved ones feel for the dying.
A final surprise. Happiness, it seems, peaks at the age of 74—or so Austrian and German scientists have concluded after asking 21,000 people how happy they were on a scale of 1 to 7. Teenagers registered around 5.5; in their 40s people reckoned they had less happiness, and those who were 74 rated themselves 5.9, the highest of the lot. This change in happiness was apparently most pronounced amongst British respondents; German men and women reported relatively stable levels of satisfaction throughout their lives. Dr Carlo Strenger, an Israeli psychologist, commented: ‘If you make fruitful use of what you have discovered about yourself in the first half of your life, the second half can be the most fulfilling.’
So if you are told you are looking well, and are feeling happy, enjoy it for as long as you can.
2. Ageing
‘The minute a man ceases to grow, no matter what his years, that minute he begins to be old’
— William James
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.
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