Inside Story

The right to be old

Ageing needs to be treated as a state of living rather than failing, argues Melanie Joosten in this extract from her new book

Melanie Joosten 17 June 2016 4086 words

“By limiting our empathy for older people because they’ve had a ‘fair innings,’ we are denying them the worth of their present.” mbbirdy/iStockphoto

A few times a month I volunteer for a crisis telephone line, taking calls from people who are feeling hopeless and despairing. Rather than proposing straight-up solutions, the service offers someone to talk to. In this digital age – when people are constantly putting opinions out into the world through status updates and tweets – it is sometimes difficult to feel heard.

The helpline volunteers meet regularly for group supervision, where we discuss the calls we’ve had: how we responded, how we felt about it, what we could do better next time. While every call I’ve taken stays with me in some way, it was a call I didn’t take that made me reflect the most.

There we were one weekday evening, sitting in a circle of chairs in an old church hall as rush hour swept through the city; a motley group composed of different ages, colours, accents. One of the volunteers offered to discuss a call he had found difficult.

“She was an eighty-six-year-old woman,” he said. “She called because she was moving into a nursing home later that morning and didn’t want to go.”

He confessed that it took him a long time to understand her distress. After all, weren’t nursing homes nice places – warm pockets of bingo and crochet blankets over frail knees? Why would she not want to go? Did she really prefer rattling around in her house by herself?

“It was her kids who had organised the move. They didn’t think she was safe living alone.”

I could almost hear her voice then, talking about her “kids.” They must be in their fifties, perhaps even sixties.

“I tried to find out if she had any resources, anyone else she could talk to. But she said her kids didn’t understand and she didn’t want to worry them anyway. Her husband had passed away twenty years before. And her friends – all her friends have died.”

What would this look like for me? No partner at home to talk to each evening; no brunch dates with my siblings on the weekends; no text-message pings from my phone; no point in logging on to Facebook, all of the pages frozen with inaction.

“That’s when I realised that, for her, moving really was a crisis,” said the volunteer. “She had absolutely no one. I wanted to give her a referral to some kind of service; I wanted to let her know that it would be okay, that she had options. But she really had no one left. And I couldn’t think of anywhere to refer her to. Was there something else I could have done for her?”

“Couldn’t she see her kids were worried about her?” a woman in her fifties asked. “It sounds like she was just being difficult.”

“They would only be doing it because they care about her. They don’t want her to be lonely.” One of the other volunteers, a man in his early twenties, offered this, shrugging his shoulders beneath his hoodie and rocking back a little on his chair. As far as I could tell, it didn’t seem like a crisis to him.

“Unless they just want to get their hands on the family home,” countered another woman, her palms wrapped around a styrofoam cup of tea, her comment prompting laughter.

“She spoke about being tired of this world,” said the man who had taken the call. “And that the only thing she had to look forward to was one day meeting her late husband again. I asked her if she had thoughts of suicide.” This is something we are obliged to cover with every caller who gives any indication of such thoughts. “She said she had – that she often thought about walking into the sea, but she didn’t want to chance being punished by God and ending up in limbo, unable to be reunited with her husband in heaven.”

“That’s sweet,” said the woman with the tea. It was the first time I had heard a caller’s thoughts of suicide described as sweet.

“But why would she bother doing away with herself? She’s only got a couple of years to go anyway,” said the hoodie-wearing volunteer. The circle broke into awkward laughter, taken aback that he should say such a thing.

But was it simply what some of us had been thinking?

The just-born crowd are below, spreading along the base. The old teeter at the top, a single antenna reaching for the skies. If you graph by age Australia’s population at most points throughout the twentieth century, it looks like a pyramid: the largest age groups are the young, and there are very few elderly people perched at the top.

Postwar prosperity and increased longevity have changed the shape of our population. The pyramid has become wider as the overall population has increased, and the arrival of the baby boomers can be seen in all their onomatopoeic glory: a sonic boom sending shockwaves across the chart so that there is a noticeable bulge around middle age. There are still fewer elderly people at the top than young propping it up from below, but the whole thing is stouter, like the trunk of a boab tree.

It is only when we graph the projected population of the twenty-first century that the advances in healthcare, living standards, and technology, which have contributed to increased life expectancy and lower fertility rates, are most apparent. The pyramid becomes a tower, straight up and down, slightly narrower at the top and bottom. In some projections it resembles a coffin or a sarcophagus: narrow at the feet, where the children are located, and broad across the shoulders of the retirees, before tapering to the elderly.

All projections by the Australian Bureau of Statistics make one thing clear: Australia’s population is ageing. At present, 14 per cent of us are aged over sixty-five. By 2060, this is likely to have increased to approximately 25 per cent, or a quarter of the population.

These graphs represent unprecedented success. Our life expectancy has so increased that a non-Indigenous girl born in 2012 can expect to live ninety-four years, her twin brother almost ninety-two. (There is still, of course, a gap in life expectancy between Indigenous and non-Indigenous populations.) This success should be celebrated, since most of us want to reach old age rather than die young.

Yet all around is evidence of hypocrisy in our youth-loving culture. There is an invisible turning point where we stop respecting the old and begin punishing them for existing.

When Treasury released its Intergenerational Report in 2010, it named our ageing population, along with climate change, as one of the most difficult economic challenges facing Australia in the next forty years. The recently updated report of 2015 is similarly steeped in apprehension for the slowing of growth in a post–mining boom economy, just as an ageing population increases the need for aged care, healthcare, and the age pension. The 2015 report, however, hardly mentions climate change, choosing to focus on older generations and their very existence as a “threat” to the budget.

This anxiety about the ageing population is neatly summed up by the oft-cited concept of dependency ratios, which considers part of the population (those aged between fifteen and sixty-five) as productive working providers, and the rest as freeloading dependants. The 2015 report takes as a given that Australia should aim to achieve the same unsustainable rate of growth in living standards that we have done over the last few decades, even if it comes at the expense of the environment and social cohesion.

In alarmist documents such as this, older people are often seen as a burden. In the eye of governments looking to make savings, older people require too much in the way of pensions and healthcare, and they provide too little to be counted as productive citizens. This assumption is incorrect – apart from a lifetime of tax-paying contribution, older people are the backbone of the volunteer industry and provide care for a quarter of children. Nonetheless, this negativity filters down into day-to-day interactions, feeding the kind of stereotypes that label old people as frail, dotty and unnecessary.

We all want the opportunity to grow old, yet we penalise those who already have.

Anne, seventy-nine

The only time I think about my age is when I wake up in the morning and my legs are a bit slow to get going. Thomas, my cat, and I stagger around, especially when it’s cold. But I don’t think about my age much. If people ask me I tell them, but the response I usually get is, “I didn’t think you were that old.”

I’ve got a neighbour who’s younger than I am, but she’s not young. She’d be well into her sixties, I reckon. She’s still working; she’s a very senior person in an aged-care centre. She was their acting manager a while ago, which she hated because she wanted to spend more time with the patients. She went white-haired fairly early and she got tired of being invisible so she paints a splodge of colour – it’s either pink or purple – in her hair. And she said, “The first day I went out with it, people noticed me.” It was like she existed in the world again.

I’ve got several other friends who do the same thing, actually, though I’ve never bothered. I mean, it’s very irritating being invisible, but I’m very confident about making myself visible by using my voice, and I enjoy working with other people to make that happen.

I was in a knitting shop once and I bought some wool for a yarn-bombing project. I spent quite a lot of money in there, actually. And this new, young woman – very young, early twenties I would think – talked to me as if I were a three-year-old. She handed me my change or my receipt or whatever and she said, “Bye, sweet pea!” And I walked out of the shop and I was just stunned! I thought, Why didn’t I do something? It really irritates me when people accept being treated differently.

I’m better now. “I don’t like to be called darling,” I told one woman. “But I call everyone darling,” she replied.

“Not me, you don’t! I’m not your darling.”

Active ageing, productive ageing, positive ageing. These are buzz phrases that encourage people to remain healthy and active as long as possible. The intended payoff is twofold: older people remain in better health and can enjoy their retirement and increased longevity, and governments don’t have to watch the ageing population tip their budgets into the red. It is reasonable to expect individuals to make a concerted effort to take responsibility for their health and attempt to age well, but are the intended outcomes actually achievable in the face of our increasingly sedentary lifestyle and the realities of getting old?

The World Health Organization promotes active ageing as a holistic concept, encouraging older people’s participation in social, economic, cultural, spiritual and civic affairs. But the term has primarily been co-opted by those who seek to medicalise ageing, and is most often used to refer to physical, and perhaps social, activity. Under the banner of ageing well, all levels of government encourage older people to join exercise classes and eat a healthy diet in order to maintain their independence and delay age-related illnesses as long as possible. In short, to postpone becoming old.

Part of the positive-ageing agenda relies on health-promotion material and superannuation ads that show happily active and untroubled older people who are not frail or in need of constant support. Almost 95 per cent of older Australians live at home, a quarter of them alone, so this may be a true representation. But can this relentless positivity do harm as well as good?

Aged-care advocate Linda Sparrow is concerned that positive-ageing campaigns carry “the risk of developing a new and equally misleading myth about older people – that all old people are, or should be, fit and healthy, productive and engaged with life.” She points out that this focus on successful ageing puts the blame for failing to age well on the shoulders of the individual, ignoring wider systemic causes and refusing to accept that some things – such as the inevitability of death – cannot be treated or cured.

This positive-ageing view, according to Sparrow, “undermines those who find themselves burdened with the diseases and conditions that can and do affect old people, such as Parkinson’s disease, arthritis, dementia, and impaired vision. Rather than enhancing the dignity and self-esteem of those who are old and frail and in need of care, it adds a sense of failure to the difficulties they already face.”

This sense of failure can translate to feelings of burden – on family, partners and society – and can lead to older people feeling as if they have no right to continue. As Karen Hitchcock points out in her wonderful essay Dear Life, to the outsider an older person’s life can look meaningless: “Unable to walk to the shops. Taking ten pills a day. Isolated. Housebound. Sitting for two years in a nursing home, waiting to die.” Yet to the older person themselves, each day may still be a medley of achievements and joys among the frustrations: a walk to the park, a visit from a family member, a favourite show on television.

In his book Being Mortal, doctor Atul Gawande documented how the slow demise of his father, whose health failed as he aged, led Gawande to closely consider people’s experience of old age and how society can better manage it. As a son and a doctor, Gawande attempted to seek treatments and cures for the things that ailed his father. But he also noted the way that over time his father adjusted his desires for his remaining years in line with the limitations of his body. Gawande points out that as people age, they seek to continue to have agency: “to make choices and sustain connections to others according to their own priorities. In modern society, we have come to assume that debility and dependence rule out such autonomy.”

While well-meaning, the positive-ageing agenda is partly born of this terror of debility and dependence. It posits that a person’s best self is their young self – before the onset of any age-related concerns – and sees old age as a corruption of the natural way of things rather than a continuation. In the essay “The Seductiveness of Agelessness,” academic Molly Andrews writes: “The unspecified but clearly preferred method of successful ageing is, by most accounts, not to age at all, or at least to minimise the extent to which it is apparent that one is ageing, both internally and externally.” She argues that we are all products of an ageist society, and upon reaching old age most of us still try to distance ourselves from the old. Andrews calls this a desperate plea for exceptionalism. It doesn’t challenge the ageist stereotype, only the application of it to ourselves.

While people of all ages should be encouraged to strive for good physical and mental health, trying in and of itself will not ensure one succeeds. In many ways, positive ageing is an endeavour not to age at all – to achieve the fantasy of agelessness. But it’s a goal we will all fail to some degree. If living longer is really about staying young, do we risk turning a blind eye to issues facing the elderly?

For many, old age is not a kind place to be. The body’s natural ageing process can be difficult to experience. But ageing can also be expedited and exaggerated by other factors – such as poverty and insecure housing, loneliness and mental illness. Our society sees these issues as problems when they affect younger and working-age people, but too often overlooks them as just an ordinary part of old age.

The international survey Global AgeWatch found that one-third of older Australians live in poverty, meaning they live on an income that is less than half of the country’s median income. This is partly due to the fact that while 80 per cent of older people receive a pension, it is a very small amount, coming in at approximately $1850 a month (less if you’re part of a couple), or less than 28 per cent of the average income.

While making for a miserable day-to-day existence, poverty and disadvantage are also risk factors for chronic physical and mental illness, as well as hospitalisation, social isolation and early death. This is particularly apparent in Indigenous populations, where a history of discrimination and racism has resulted in high rates of psychological harm and chronic illnesses. Many aspects of positive ageing, such as remaining physically and socially active, do not require a high income, but it would be disingenuous to ignore the fact that ageing well is more achievable by those who have had a lifetime’s access to good, preventative healthcare, and the education to make beneficial lifestyle choices.

The difficulties of eking out an existence on a small income in a time when the cost of living is increasing should not be underestimated. While isolation in old age will strike people from all walks of life, it is exceptionally hard to ameliorate the effects when you are worried you won’t have enough money to pay rent. If you’re having trouble hearing, your sight is failing, or your knees won’t allow you to walk as easily as you once did, you might find it difficult to participate in a harried, fast-paced world. If your partner has died, and so have many of your friends, and your children visit just twice a year, you may spend days without speaking to another person.

Occasionally the media will report on an older person who has died at home and not been discovered for months, or perhaps years. The loneliness of such an existence is candidly rendered in the journal of one unnamed woman who passed away in her kitchen in Sydney in 2014, her death undiscovered for six months: “When we moved into our present house in 1966, the atmosphere of the streets was more or less one of a village formed by different nationalities. Today the friendly atmosphere of the neighbourhood is extinct. Except for a few privately owned houses, the whole neighbourhood has been transformed into apartment blocks of strangers. A smile and a good day or a helping hand have become as rare and as exceptional as a white whale.”

If you have ever experienced loneliness, you understand how ruinous a feeling it can be, and there is much evidence to suggest that loneliness is a major public-health issue: it’s related to depression and other forms of mental illness, as well as to physical impairment and reduced quality of life. It is also associated with a greater risk of chronic illness, with lonely people more likely to undergo early admission to residential aged care.

Older people with depression and anxiety have a much higher risk of suicide than the general population, and this is particularly apparent among older men, who tend to have lower levels of social support than older women. In 2013 the highest age-specific suicide rate for men was in the group aged eighty-five and above. For every 100,000 men in this group, close to thirty-eight ended their own life. Compare this to the fourteen out of every 100,000 men aged fifteen to nineteen, or almost twenty-four for every 100,000 men aged forty-five to forty-nine. The real numbers in all age groups could be much higher, as suicide is notoriously under-reported.

Just as depression does not always result in suicide, suicide is not always a result of clinical depression. As psychiatrist Michael Baigent says, “I think in the elderly we’ve got circumstances that don’t arise as often in younger people. One of them is that they generally have a lot of medical problems that people don’t experience when they’re younger. And there’s no doubt that the presence of chronic medical conditions, particularly if they cause pain, is a factor in people ending their lives. So you could put that together with the horrible kind of isolation that happens when your friends move away or pass away; you do become very isolated – it is a very lonely thing.” His comments are backed up by research that shows stress and social disconnectedness account for a larger proportion of cases of suicidal ideation among older people than the presence of mood disorders.

Our increased social awareness of the high suicide rate of younger men may have been one of the reasons the rate has halved since a peak in 1997. This suggests that if we applied the same awareness to the situation of older men, we might have a similar result.

Yet it seems too difficult to move away from the belief that a loss of a young life is worth more than an old one. We lament a young person’s death because we can see the future he or she has foregone. But by limiting our empathy for older people because they’ve had a “fair innings,” we are denying them the worth of their present.

Bob, eighty-one

What’s changed with age? I’ve become accustomed to people standing up on the tram for me, and instead of saying no I’ve started to say thank you. Occasionally I realise that I’m being bypassed in the conversation and I don’t know what’s going on.

Retirement’s good as long as you keep yourself interested in something. And as you get older, your circle of friends drops. Family is important, but on the other hand my wife and I have still got a good circle of friends.

We want to stay here in this house and for it to be comfortable for us for as long as possible. So we’ve just started taking steps to remodel the bathroom. We’ve got most of the approvals and now we’re waiting for government approval, which will take twelve months. So we hope we’ll be around to see it! We wish to be as independent as possible, not to be a burden, and to be helpful, as much as we can be.

I’ve always struggled with depression at critical times in my work life and sometimes I regret some of the things that have happened there, and reflecting on that brings it up today. But generally speaking I endeavour to look at the good things that I can remember, rather than the less so. The family know, they have a saying – “Come winter, Dad’s down.” So I’ve just come back from ten days up north, getting away from the cold.

And I work at it, but I’m aware I sometimes become morose. Each of us experiences our own sense of depression – you droop, you’re less lively – but how you come out of it is from your own experience. With help.

The current inclination to treat ageing as a medical problem to be solved or arrested rather than to see it as a natural part of the life course robs older people of the right to be themselves. The positive-ageing agenda says: it’s okay for you to keep on living, so long as you don’t become old. And in too many circumstances we seem to give up on older people when they do face problems, framing these difficulties as an inevitable part of ageing.

Yet they don’t have to be. We need to stop pushing people to the margins of society as they age, or deeming their needs inordinate and their contributions insufficient. We need to recognise that old people are not lesser than young people, and that true intergenerational cooperation is both desirable and necessary.

Realising the right to be old and putting it into practice in our cities, communities and personal lives asks us to rethink the concepts of productivity and participation, and to consider what kind of society we wish to live in, both now and in the future. Because we will all age, and we all have a right to be old. •

This is an extract from Melanie Joosten’s latest book, A Long Time Coming: Essays on Old Age, published by Scribe.