The Ageing World: Make Room ! Make Room !

elderly crowd

Once upon a time all the world was young because most of us left the party early. Now we hang on so much longer that there are more old people alive than at any time during recorded history. Soon there will be many more. These numbers sketch the story:

Observed and Forecast Percentages of the Elderly (65+ years) in Selected Areas, Regions, and Countries of the World: 1950, 2000 and 2050.1

 

Major Area, region and country 1950 2000 2050
World 5.2% 6.9% 19.3%
Africa 3.2% 3.3% 6.9%
Latin America and the Caribbean 3.7% 5.4% 16.9%
China 4.5% 6.9% 22.7%
India 3.3% 5.0% 14.8%
Japan 4.9% 17.2% 36.4%
Europe 8.2% 14.7% 29.2%
Italy 8.3% 18.1% 35.9%
Germany 9.7% 16.4% 31.0%
Sweden 10.3% 17.4% 30.4%
U.S.A. 8.3% 12.3% 21.1%

centenarian

The growth of the New Aged is scary: Over the first half of this century the number of people in the world who are  60 or over will treble to nearly 2 billion. In 2050 more than one in five persons  in Europe and over  in three in Japan and Italy will be over 65. On the most optimistic forecasts world fertility rates will decline by up to 40% of their 1966 levels by 2050 2 . Until, and for a while after this happens we will have to somehow find ways in which the dwindling proportion of adults of working age can support these billions of lingering guests and provide the demanding care they will need. These hard questions are best tackled by economists, agriculturists and health professionals. Cognitive gerontologists and psychologists may ask a simpler question: Apart from the growing inconvenience and so resentment of their demand on global resources how well do  young people like the old?

My only try at this was to ask 76 Manchester undergraduates what most irritated them about older family members. Some included bizarre responses that they insisted were not jokes, such as “boiling squirrels” (!?!). More common were “deliberate loud gasping”, “explosive sneezing” “pretending to be deaf”, “food on the cardigan” and “smells”.  It was hard to find a single main theme but a strong thread was embarrassment at those who try to pre-empt notice of their disabilities by exaggerating them. As by bellowing “Oooffff” or “One, two, three Lift-off” when staggering out of deep chairs, or by exhibitionist demonstrations of loud knee creaking. It is not just that the jokes are weak and grow more tedious with endless repetition but that the disabilities of old age are uncomfortable to notice and that by deliberately stressing them we provoke unease rather than pity and empathy. Is there any good way to applaud a knee-creaking demonstration?

knee cracking

I am old and well understand a futile compulsion to acknowledge that one is aware of the stigmata of old age and of one’s own growing frailties and problems before others can pick up on them. Perhaps some of us also hope that we may win points for jolly stoicism and brave humour.  I have learned that this ploy rarely works.  Undergraduates’ anecdotes of the behaviour of their elders do not give profound insights into possible relationships between young and old during the next half-century so I went to the academic literature confident that my colleagues must have done much better. Of course they had but, as usual, they asked different questions from those that puzzle me.

Most nursery age children find elderly adults strange, and so also disconcerting. Old people are puzzling simply because they  usually meet few of them.

quizzical infant

Even very young children can have uncomfortable feelings about elderly people based on “negative physical and behavioural stereotypes” 3. As they meet more old people strangeness wears off and their attitudes improve, at least to neutrality. Rare  contact with the elderly may also explain why college students, especially men, also express negative attitudes towards the old 4. The old really are different from young adults. Not just because of obvious physical changes but also because of their behaviour, the conversational topics they choose, or fail to follow up, the responses that they make and so uncertainties about the quality of interactions with them. Again there is evidence that the more elderly people college students meet the more comfortable they feel in their company and the more they find to like about them, though this strongly depends on the quality, rather than simply the number of interactions they have had6   We cannot assume that just because the elderly become more numerous they will increasingly be understood, accepted and, hopefully, appreciated.

The question as to whether increased immersion in elderly groups can change attitudes is an important issue in health care 5.  Medical training recognises this but evidence from junior doctors, trainee nurses and health carers who must adjust to placement on geriatric wards is not entirely reassuring. One small study (36 Cases) found evidence that medical students working on geriatric wards have slightly more positive attitudes towards elderly people than those without this experience . There is some evidence that more active training may achieve more. Training can be made surprisingly onerous, especially during the  bizarre “Age Game” in which young doctors and health professionals undergo simulated visual and hearing losses, joint stiffness, mobility restriction and ingenious imitations of the tiresome physical problems of old age. There is some evidence that playing the Age Game brings about slightly greater empathy, and so perhaps greater tolerance of the difficulties of elderly patients. Documented trials seem to be too rare, and too small and to suffer from a common problem that they only evaluate changes from pre- to immediately post-study evaluations 7. Perhaps  being forced to totter about, physically constrained and inconvenienced and half – blind and deaf, while being lectured on the problems of hypothermia and incontinence makes even  dim or callous participants guess that they are supposed to show some change of heart. It has not yet been shown how long sudden new empathy lasts. Another difficulty is that these and similar attempts to educate junior nurses and doctors towards better attitudes may enhance recognition of the difficulties patients face, but  may do less to increase liking or affection for them. It is sad that for many of us, in spite of clinical experience, sympathy for disabilities and physical problems is tinged with revulsion.

Perhaps the attitudes of the young are unsurprising because even the elderly have negative attitudes towards each other. It is very common for old people  facing  the prospect of admission to a care – home to bitterly complain “I don’t want to be locked up with all of those awful old people”. One study attributes some of the unease that older people sometimes express about each other to discomfort at being reminded of the nearness of death 8.  Personally I do not find that meeting other elderly people is a sad memento mori. Rather, it  sometimes confronts me with aspects of what I have become, or am becoming, that I would prefer to ignore. So I am not surprised if younger people who meet me may wince at an illustration of things in store for them. This is regrettable but there is little I can do about it and pre-emptive acknowledgements of disabilities will hardly help. My generation find that sympathy and pity are too readily available, but we are uncomfortable with these generous emotions because they are alienating for both givers and receivers. Like all the human race, of all ages and conditions, we just want to be loved. Or at least liked ? Just a little bit?  Or, failing that, tolerated and benignly ignored ? This remains just as hard to achieve as at any time during our long lives.

The obligation to find ways to like one another is not one-sided. We elderly have the obligation not only to express but to feel liking for the young and to learn to be better company, more sensitive and responsive to their problems, which are often as acute as any we experience. We must try to re-learn social skills we should have discovered earlier in life and to take genuine interest in others- even if this means giving up tedious self-preoccupations with which we waste our time. If the billions of us who are about to crowd the world are to gain tolerance, let alone respect and affection from the young it is not enough to lecture them on our problems,  immerse them  in experiences of geriatric wards, or in simulations of our infirmities by the Age Game.  We should also take courses or classes or, failing that, take really serious thought as to how to become more likeable human beings. Giving up boiling squirrels or shouting “One! Two! Three!  LIFT OFF” , or endlessly offering the same anecdotes and opinions or stopping public exhibitions of noisy joints is  start, but not enough. We do not need or want pity from the young.  If the young pity us we should just pity them back. More than anything we need to be amused and if we can just manage this we may begin to hope to be amusing

1. Gavrilov L. A and Heuveline, F. (2003) The Encyclopaedia of Population, Macmillan Reference, U.S.A.

2. Jantz, R. K. (1977). Children’s Attitudes toward the Elderly. Social Education,41(6), 518-23.

  1. Seefeldt, C., Jantz, R. K., Galper, A., & Serock, K. (1977). Using pictures to explore children’s attitudes toward the elderly.The Gerontologist,17(6), 506-512.

4 Hawkins, M. J. (1996). College students attitudes towards elderly persons. Educational Gerontology: An International Quarterly,22(3), 271-279.

  1. Lovell, M. (2006). Caring for the elderly: changing perceptions and attitudes.Journal of vascular nursing,24(1), 22-26.
  2. K. Schwartz, Joseph P. Simmons, L. (2001). Contact quality and attitudes toward the elderly.Educational Gerontology,27(2), 127-137.

7. Varkey, P., Chutka, D. S., & Lesnick, T. G. (2006). The aging game: improving medical students’ attitudes toward caring for the elderly. Journal of the American Medical Directors Association7(4), 224-229.

About Gray Rabbitt

Grumpy gerontologist
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