You’re Looking Very Well

by Lewis Wolpert

  In developing countries there is no systematic collection of statistics about abuse, but crime records, journalistic reports, social welfare records and small-scale studies contain evidence that abuse, neglect, and financial exploitation of elders are much more common than these societies admit. A hospital manager in Kenya was quoted as saying: ‘Older people are a big headache and a waste of resources. The biggest favour you could do as an older people’s organisation is to get them out of my hospital.’

  In healthcare, ageism presents serious problems as the National Service Framework for Mental Health applies only to people below the age of 65. This seems to be a clear case of age discrimination, particularly as dementia affects large numbers of people over 65. Those over that age receive lower-cost and inferior services to younger people, even if they have the same condition. Patients older than 65 are being denied treatments offered to younger people, either because they are too expensive or because they were not referred on by their family doctor.

  There is considerable evidence of discrimination against the elderly in healthcare, with staff disbelieving older people’s accounts of their medical or clinical symptoms, or with these being disregarded as a natural condition of their age. Older hospital patients can be seen as financial risks: they are viewed less as human beings with health needs than as costly and inanimate ‘bed-blockers’. Physicians themselves and other healthcare providers may hold attitudes, beliefs and behaviours that are associated with ageism against older patients. Studies have found that physicians often do not seem to show concern in treating the medical problems of older people. There is evidence that more than a third of physicians erroneously consider high blood pressure to be a normal part of ageing, and do not treat the condition in their older patients.

  The average size of care home for older people in England is 34, compared to nine places in homes for younger adults. Many of the old themselves believe that doctors view them less favourably than younger patients. Fewer than 10 per cent of older people with clinical depression are referred to specialist mental health services compared with about 50 per cent of younger adults with mental and emotional problems. Elderly stroke patients treated in the NHS do not get the same level of care as younger patients, who are scanned more quickly and more often. Mental health wards for older patients are less clean, more noisy and more violent than average.

  Rabbi Julia Neuberger and many others have argued for legislation against such age discrimination. Older patients are less likely to have their symptoms fully investigated. A study by the Patients Association reported that some NHS nurses had been shockingly cruel to the elderly; some had been left without food or drink while others had been made to sleep in soiled bedclothes. It was estimated that there had been up to a million such incidents in recent years. Though there may be surgeries or operations with high survival rates that might cure their condition, older patients are less likely than younger patients to receive all the necessary treatments. It has been suggested that this is because doctors fear their older patients are not physically strong enough to tolerate the curative treatments and are more likely to have complications during surgery that may end in mortality. The approach to the treatment of older people is often concentrated on managing the disease, rather than preventing or curing it. Thousands are discharged from hospital too early.

  Some sources suggest that ageism in the healthcare system starts in the medical schools where young people—who, of course, will never themselves be old—begin their education. Only 10 per cent of medical schools in the United States require courses in geriatrics and less than 3 per cent of physicians ever take any courses in this area. In the UK there are some medical schools that do not teach geriatric medicine. When actually interacting with older patients on the job, doctors sometimes view them with disgust and describe them in negative ways, such as ‘depressing’ or ‘crazy’. For screening procedures, elderly people are a bit less likely than younger people to be screened for cancers and so less likely to be diagnosed at early stages of their conditions.

  Outside the healthcare system, Help the Aged reported that older people routinely tell them that they feel ignored and undervalued by their local communities. There needs to be much more energy and determination to reach those who are seldom heard‚ for example isolated older people and those living in poverty. By contrast, fortunately, many very old people are sustained by love and care of family and friends.

  * * *

  Some forms of ageism are described as ‘benevolent prejudice’ because the tendency to pity is linked to seeing older people as ‘friendly’ but ‘incompetent’. This is similar to the prejudice most often directed against women and disabled people. Age Concern’s survey revealed strong evidence of ‘benevolent prejudice’. The warmth felt towards older people means there is often public acceptance that they are deserving of preferential treatment—for example, concessionary travel. But the perception of incompetence means older people can also be seen as ‘not up to the job’ or ‘a menace on the roads’ when there is no evidence to support this. Benevolent prejudice also leads to assumptions that it is ‘natural’ for older people to have lower expectations, reduced choice and control, and less account taken of their views.

  When older people forget someone’s name, they are viewed as senile, but when a younger person fails to recall a name, we usually call that a faulty memory. A newspaper recently reported that the actress Keira Knightley was having something akin to a ‘senior moment’ as she came off a plane from London, due to the seven-hour flight and a five-hour time difference. She had just forgotten something, but this phrase is a mild example of ageism. Use of the term implies that she was suffering from one of the problems that afflict the elderly. I am all too well aware of them. But the young also forget things.

  When an older person complains about life or a particular incident, they are called cranky and difficult, while a younger person may just be seen as being critical. It is quite widely assumed that older people might not want the sorts of life chances that younger people have and so it is ‘natural’ for older people to have lower expectations, and less account is taken of their views. Fortunately, as we have also seen, older people are further stereotyped as moral and admirable, and an overwhelming majority of people agree that they should be valued and cherished. But although most people think older people should definitely have equal access to health and care, this is often not the reality.

  One way that implicit or explicit ageism may manifest itself is through the use of patronising language with older people. There are many ageist articles in the media, often presenting the elderly as a burden on younger people in families and society at large. Critical analyses have suggested that both negative and positive newspaper portrayals of old people may be ageist.

  Negative stereotypes of older people range from the hostile image of a ‘cantankerous old codger’ to less explicit images. Not uncommon ageist terms inlude ‘old fogey’, ‘old fart’, ‘geezer’, and ‘old goat’; even the word ‘old’ itself is often used as an insult. Elderspeak refers to a way of communicating with the elderly—it is simplified language with exaggerated pitch and intonation. This can be based on beliefs about the elderly and personal experience.

  The term ‘patronising language’ specifically describes two negative methods of communication: the person being unnecessarily courteous and speaking simple and short sentences loudly and slowly to an older person, with an exaggerated tone and high pitch; and baby talk, which involves the exaggerated pitch and tone that one uses when talking to a baby. Both these ways of talking have negative effects on the elderly. Anti-ageism activists in the US have strongly argued against the use by journalists of terms such as ‘elderly’, ‘fogey’ or ‘codger’—and even ‘senior’. They recommend the avoidance of phrases such as ‘of a certain age’, and ‘old ladies’ of both the ‘little’ and ‘sweet’ variety. The advice is included in a media guide on reporting issued by the International Longevity Center and Aging Serv
ices of California.

  In this guide, the campaign attempts to help journalists and advertisers represent ‘older people’—its preferred term—in a ‘fair contemporary and unbiased’ manner. The authors state that 80 per cent of older Americans have been subjected to ageist stereotypes. While names and characterisations may vary, the message is the same: older men and women are incompetent and lack sufficiency. Journalists are advised: ‘If you need to identify individuals over the age of 50, “older adults” is preferred over “senior” and “elderly”, which can be discriminatory in nature as we do not refer to people under 50 as “junior citizens”. If relevant to the story, state the age.’ Out goes ‘golden years’ as a description of an individual’s period of life after being deemed to be an older adult.

  Images as well as words may be ageist. Campaigns have been mounted in Denmark and some other countries to counter images of old people shown as overweight or sickly. In Australia money was given to promote the contribution of the old to social life: ‘Look past the wrinkles’ was on a billboard in Melbourne.

  The stereotypes and infantilisation of older people by patronising language affects older people’s self-esteem and behaviour. Ageism, as distinct from discrimination, has significant effects. Exposure to ageist stereotypes has negative affects on physiology and mental abilities. After repeatedly hearing that older people are useless, older people may start to perceive themselves in the same way that others do, as dependent, non-contributing members of society. Studies have specifically shown that when older people hear about their supposed incompetence and uselessness, they perform worse on measures of competence and memory. These negative stereotypes thus become self-fulfilling prophecies. Then this behaviour in turn reinforces the present stereotypes and treatment of the elderly. Negative attitudes towards older adults and stereotypes about older people emerge early in a child’s life, even in such a simple ways as, for example, selecting a younger adult to partner them in a game rather than an older adult.

  Ageism operates in high-profile professions no less than in others. In a recent interview, actor Pierce Brosnan, aged 57, cited ageism as one of the contributing factors as to why he was not asked to continue his role as James Bond in the Bond film Casino Royale, released in 2006. Successful singer and actress Madonna spoke out in her 50s about ageism and her fight to defy the norms of society. The actress Geena Davis, at 52, complained that she could not get a decent role because of her decrepitude. Joan Bakewell, who was appointed by the government as the ‘voice of older people’, has criticised the BBC for banishing female news presenters once they reach 50, and for the general lack of older female faces. Arlene Phillips was dropped from Strictly Come Dancing when she was 66. The journalist John Simpson has also complained about ageism in the BBC. Yet just how impressive older women can be was shown when the 89-year-old novelist Baroness P. D. James interviewed the director of the BBC on the Today programme about his executives’ pay packages and, according to press reports, reduced him to a stuttering wreck. But a very recent tribunal ruled against the BBC for dismissing a 53-year-old female presenter.

  In the US version of The Weakest Link, contestants’ voting decisions were, on average, biased against older panellists. At the stage of the game where it is in participants’ interests to vote for poor performers, older people were likely to be chosen even when younger adults had performed worse. But when contestants would benefit by choosing top-performing rivals to eliminate them from the competition, they tended to choose lower-performing, older contestants. Subconsciously, the panellists simply did not want to be around older people.

  In spite of its negative effect on the daily lives of older people, ageism is often unrecognised, ignored or even compounded in health and social care settings. And social exclusion has only recently been officially acknowledged as affecting older people as well as children and families.

  Older consumers have grown into a market force to be reckoned with, says Age UK, as new figures reveal the amount of money spent annually by people over the age of 65 in the UK is set to hit the £100 billion mark. Yet despite seeing their weight in the consumer market grow as a group, older people are still at risk of being frozen out of a marketplace which is slow to adjust to the evolution of an ageing society. Research by the charities found that many older people think businesses and retailers have little interest in the consumer needs of older age groups, and many still face obstacles in accessing financial services which are tailored to the needs of younger customers.

  There are other, more robust views. The actress Joanna Lumley proclaimed, ‘I am not being unkind but I am just saying millions of crones like me shouldn’t suddenly be given the lead in things just because we are damn old.’ But this laudable refusal to claim special privileges for the old should not blind us to the rights of the old to be treated fairly, or to the fact that ageism can lead to social exclusion, diminish the quality of life which older people may enjoy, and threaten their mental health.

  12. Caring

  ‘Old age ain’t no place for sissies’

  — H. L. Mencken

  Joan Bakewell put the problem of care very simply:

  It is what we all hope for. To enjoy our final years living in our own homes, among familiar things, not only the worldly goods but also the memories that cling to the place we know. We hope that when our time comes, some system will be in place that brings sympathetic and well-trained people to our homes, visiting at agreed times, bringing care and comfort, and whatever medical attention we will need. We probably don’t mind too much who provides that care as long as it is friendly and professional. Not much to ask?

  Alas, it seems too much to get. A rather negative view came from Michelle Mitchell, when a director for Age Concern:

  Loneliness, depression, poverty and neglect blight the lives of millions of older people and for many, evidence shows the situation is getting worse, not better. Attitudes to older people are stuck in the past, the care and support system for older people is on the brink of collapse and older people’s experiences of isolation and exclusion have largely been ignored by successive governments.

  Research conducted by the Joseph Rowntree Foundation investigated what today’s older people consider to be necessary for ‘comfortable, healthy ageing’. The major conclusion is that courage is required to cope with the ageing process, either in fighting it or adapting to the limitations it brings.

  There is no common way in which societies care for their old today, and attitudes have changed with time, but it used to be common for children to look after their ageing parents. In Ancient Greece, though there were negative attitudes towards the old, it was the sacred duty of the children to look after their parents or grandparents, and Greek law laid down severe penalties for those who failed to discharge their obligations. In Ancient Rome, the old had great privileges within the family; both a father’s and a grandfather’s consent were necessary for a son to marry.

  Shakespeare’s King Lear gives a moving account of the lack of care for an old parent. Lear had visualised a world in which old men would continue to be respected even after giving away their money and their power. His two elder daughters, instead of looking after him, do all they can to alienate him and send him out, homeless, to the heath. ‘Thou shouldst not have been old till thou hadst been wise,’ Lear’s Fool tells him. Should sons and daughters be responsible for their mothers, fathers and grandparents? This play’s special understanding of old age partly accounts for it being among the most moving of Shakespeare’s tragedies.

  A short tale by Tolstoy is relevant to the predicament of Lear:

  A raven was carrying his chicks, one at a time, from an island to the mainland. In mid-flight he asked the first, ‘Who will carry me when I am old and can no longer fly?’ ‘I will,’ answered the young raven, but the father did not believe him, and dropped him into the sea. The same question was put to the second chick. He too replied, ‘I will carry you when you are old,’ and the father also let him fall int
o the sea. The last chick received the same question, but he answered, ‘Father, you will have to fend for yourself when you are old, because by then I will have my own family to care for.’ ‘You speak the truth,’ said the father raven, and carried the chick to safety.

  People of 75 have had a fair share of life, and many do very well looking after themselves with pleasure until much older. Nearly three quarters of those over 65 in the UK are home-owners. Many are well cared for in their own homes and care homes, and well looked after by the NHS, but by no means all of them. Some 40 per cent of those in care homes have been reported to be depressed. About two thirds of hospital beds in the UK are occupied by the over-65s in all the different wards, and dementia and depression are the most common ailments. Falls and incontinence are also serious problems. Clearly this is very costly, and 40 per cent of the NHS budget is spent on age-related illnesses.

  Ageing makes self-support increasingly difficult. About one in four of the elderly in developed counties will need long-term care of some kind. How much do those who do need help deserve? The Japanese ex-prime minister Taro Aso lost a lot of support when he questioned whether it was right to put large sums of money into healthcare for the elderly. He is reported to have said: ‘Why should I pay tax for people who just sit around and do nothing but eat and lounge about drinking?’ In the UK more than one million older people get some local-authority-supported community-based care.

  The concept of care and comfort for the old who need help has a long history: ‘And he shall be unto thee a restorer of thy life, and a nourisher of thine old age: for thy daughter in law, which loveth thee, which is better to thee than seven sons, hath born him’ (Ruth 4:15). There is also a plea for shelter for the aged in the Talmud, and by the eleventh century, these exhortations had led to the development of Jewish Homes in France and Germany to house the aged. Even before this, during the Byzantine Empire (AD 324–1453) the care of older persons had been undertaken in welfare institutions.