“Age only matters while one is ageing”, said Picasso, at the age of eighty. “Now that I have arrived at a great age, I might as well be twenty.” Well, bully for him. From where I sit, far more people at eighty feel they might as well be seventy-eight. Or ninety-eight. Carl Honoré’s Bolder: Making the most of our longer lives tells us that Michelangelo finished the Pauline chapel at the age of seventy-four, Frank Lloyd Wright finished the Guggenheim Museum in New York at the age of ninety-one, and Benjamin Franklin invented bifocals at the age of seventy-four. Well, bully for them, too.
Anyone can continue creating great things all their lives if they are Michelangelo, Lloyd Wright, or Franklin. Besides, their creative work began decades earlier, probably around the age of eight.
A review of books on ageing is inevitably filtered through the age, health and optimism quotient of the reviewer. Thirty years ago I wrote an essay for the New York Times, cheerfully titled “Old Age Is Not What It Used To Be”, full of encouraging news from the newly burgeoning field of gerontology. In those days, “old age” usually referred to people in their sixties and seventies, with some outliers in their eighties and even a few in their nineties. (Bernice Neugarten and other gerontologists had recently begun to speak of the “young old”, who are healthy and mentally competent, and the “old old”, who aren’t.)
Intellectually engaged
My essay was populated with thriving old people who were as witty, active, happy, sexually active and intellectually engaged as they had ever been, and by researchers assuring us that we won’t “lose it” so long as we remain witty, active, happy, sexually active and intellectually engaged. All very nice, cynics muttered, but how are we supposed to retain those satisfactions when every joint aches, we have lost a life partner and too many close friends, mental sharpness blurs, hearing declines, the grown-up children have decamped to foreign lands, the identities that provided meaning are gone, and we start to feel like a bump on the log of life?
As the population surges into young old age and old old age, the number of books wrestling with that question has grown from a trickle to a tsunami. Today the field of gerontology is, dare I say, older and wiser and I am older and warier. “Old age” has crept up a decade or two, reflecting the steady rise of people living into their nineties and, the fastest-growing category, into their hundreds. Many are living well, without mental or physical incapacitation, but anywhere between a quarter and a half of the population will show signs of Alzheimer’s disease and other forms of dementia by the age of eighty-five.
The cost of care – emotionally and financially – is already immense. Understanding the social, physiological and economic consequences of this massive demographic change has thus become more pressing. So has the need to help people cope psychologically, now that old age can arrive almost without warning. People may go along feeling youthful and vigorous, but pain or infirmity caused by injury, bone deterioration, illness, arthritis, stenosis, or any other condition, can alter that overnight. A seventy-four-year-old friend who has spent a decade hiking in exotic places abruptly developed excruciating back pain, forcing her to curtail her adventures. “I suddenly feel old”, she said.
Empirical research
Apart from the science journals and science-fiction novels debating whether is it possible or desirable to prolong the lifespan by fifty or a hundred years, or (might as well go for it) eternally, books designed to help readers navigate the treacheries of ageing fall roughly into three categories: the scientific, the personal and the political.
Books in the first category may provide empirical research on all aspects of the ageing boom, from biology to demographics.
Sue Armstrong, the author of Borrowed Time: The science of how and why we age, is an appealing guide through the evidence and the controversies. She is a woman in her late sixties, “still swimming happily in the mainstream of life”, who watched her mother “lose her sight, her hearing, her beloved life partner and most of her friends, and finally her mind, across her ninth and tenth decades of life”. (This also describes my mother, who lived to be ninety-seven.)
Armstrong goes right to the crucial issue: “what will life be like for us as we reach these venerable ages? No matter how positive and philosophical one’s general disposition, one cannot ignore the evidence that for too many of us old age is nasty, brutish and long”. A five-year-old child in the UK today can expect to live to be about eighty years old, but, for many, around twenty of those years, she observes, “will likely be dogged by ill health” – a fact that has generated immense research and argument.
Is ageing (and its attendant cellular damage and decline in immune function) an inevitable result of normal wear and tear, in which case might it possibly be delayed or repaired, or is it a result of genetic programming, over which we have no control? The controversy is especially pressing today given that, in the words of one gerontologist she quotes, “health care hasn’t slowed the ageing process so much as it has slowed the dying process”.
Fountains of gold
Armstrong usefully details what ageing consists of at a cellular level and why human lifespans vary so widely. Passions in the search for an “elixir of youth” run high because the payoffs are high: psychologically, of course, but also financially, because the fountain of youth will spew fountains of gold. Can we develop a drug that works as an “anti-ageing” compound, as the immune modulator rapamycin is thought to do? Rapamycin, typically used to reduce the rejection of transplanted organs, was found to significantly improve the heart function and overall health of old mice.
Unfortunately, in human beings it can have some serious side effects; its very ability to suppress the immune system and make a transplant successful also makes people more susceptible to infections and inflammation. (Recent research on rapamycin continues, with the aim of solving these problems by manipulating the dose and timing.)
Another popular anti-ageing theory touts the benefits of a super-low-calorie diet, a notion born of a study showing that rodents on a severely restricted diet (low calorie but high nutrient) lived more than twice as long as the controls. Armstrong beautifully tells the story of the CRONies (the acronym stands for Calorie Restriction with Optimum Nutrition) – researchers and true believers who subjected themselves to severe caloric restriction in the name of science (and, it must be said, immortality) in spite of “constant, nagging hunger”, the disruption of social life, and other deprivations. Today, Armstrong reports, most of them have eased up: “You don’t have to do this quite so intensively to get the benefits” on health, said one investigator.
Whether the intervention involves drugs or diet, Armstrong shows, excitement is often followed by dismay when the drug has unacceptable side effects or the method doesn’t work in humans as it does in mice. She concludes with a sobering caution about any new drug that promises to prevent or reverse the ravages of time: “we all respond differently to drugs, depending on our personal biology, our genetic background and our environmental exposure”. For the scope of issues it addresses, this book serves as a fine introduction to the research and controversies about how we age.
- Times Literary Supplement
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