You’re Looking Very Well

by Lewis Wolpert

  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:

  An Old Man, planting a tree, was met

  By three joyous youths of the village near,

  Who cried, ‘It is dotage a tree to set

  At your years, sir, for it will not bear,

  Unless you reach Methuselah’s age:

  To build a tomb were much more sage;’

  But all three youths die from accidents.

  The Old Sage, then,

  Weeping for the three Young Men,

  Upon their tomb wrote what I tell.

  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.

  3. Forgetting

  ‘First you forget names, then you forget faces, then you forget to pull your zipper up, then you forget to pull your zipper down’

  — Leo Rosenberg

  Almost all of us who are ageing must admit that our minds deteriorate in some ways as we age. Memory is the most obvious example: it is all too common for simple things, particularly names, to be forgotten, and then often they come back unexpectedly a little while later. In fact speed of thought and spatial visualisation begin to decline in our twenties and our mental abilities peak at about 22 years old, before beginning to deteriorate just five years later. Memory has been shown to decline from an average age of around 40. But abilities based on accumulated knowledge, as shown in performance on tests of vocabulary or general information, increase until the age of 60. George Burns pointed out: ‘By the time you’re eighty years old you’ve learned everything. You only have to remember it.’ And though our mental processes do become less efficient, we can become more efficient in solving complex moral and social problems.

  The Ancient Greek dramatist Sophocles was hardly positive about old age: ‘When a man is old the light of his reason goes out, action becomes useless and he has unmeaning cares.’ His sons appeared to agree: because of his absorption in literary work, Sophocles was thought to be neglecting his business affairs, and his sons hauled him into court in order to secure a verdict removing him from the control of his property on the ground of imbecility. Then the old man read to the jury his play Oedipus at Colonus, which he ha
d written at the age of over 80, and inquired: ‘Does that poem seem to you to be the work of an imbecile?’ When he had finished, he was acquitted by the verdict of the jury.

  The Roman orator Cicero wrote: ‘Old men retain their mental faculties, provided their interest and application continue; and this is true, not only of men in exalted public station, but likewise of those in the quiet of private life.’ It is impressive to see how similar his views about how to age best are to current ones—keep mentally and physically active. To the objection that memory begins to fail in old age, he replies: ‘No doubt it does, if you don’t keep it in trim, or if you happen to have been born a trifle dull. I have never heard of any old man forgetting where he had buried his treasure: the old remember what is of real concern to them: their days in court, their debts, and their debtors.’

  Those reaching 70 with some 14 years ahead will, on average, spend nearly two years in moderate or severe cognitive impairment. There is thus great concern, even fear, about the increase in dementia with age, especially Alzheimer’s disease. The Disconnected Mind team is conducting an extensive analysis on the contribution of lifelong demographic factors to the rate of brain ageing. Brain function at age 11 is the biggest indicator of brain function in later life; clever children make clever and mentally competent old adults.

  There is not a significant loss of nerve cells with age, though several populations of nerve cells are lost in the old. As people age, peripheral nerves may conduct impulses more slowly, resulting in decreased sensation, slower reflexes, and often some clumsiness. Nerve conduction slows because myelin sheaths, the layers of cells around nerves that speed conduction of impulses, degenerate. Shrinkage of the brain is due to fluid loss as well as reduced branching of extensions from nerves. There is also a reduction in the size of the cell bodies and the accumulation of granular pigment and filament tangles and abnormal small structures. In about one third of old brains, there are abnormal deposits of amyloid, which are proteins that form insoluble fibrous protein aggregates and are common in the brains of those with Alzheimer’s disease, and this leads to damage of nerve cells. Late onset schizophrenia is rare.