Age alone does not cause sleep problems. Disturbed sleep, waking up tired every day, and other symptoms of insomnia are not a normal part of ageing, but pain and health issues are often obstacles to sleep for old people. A frequent need to go to the bathroom, arthritis, asthma, diabetes, osteoporosis, night time heartburn, menopause, and Alzheimer’s can cause frequent awakenings.
Are there any mental gains that come with ageing? Wisdom can be one, along with the advantages of accumulated experience. Older adults are better at comprehension of questions, and detection of absurdities. They are able to give attention to quite complex tasks, including events requiring focused attention, and also when a task requires divided attention. But if things become very complex, they may do less well than the young. There is some evidence that discourse skills improve with age, and the elderly are capable of complex narratives. In spite of the declines mentioned earlier, older adults do very well performing their jobs. Knowledge about the job increases with age and is maintained. Many tasks become almost automatic. Computer skills are significantly less than those of the young, but brain scans have shown that using the internet boosts brain activity of the elderly more than reading, and this could help prevent dementia.
I talked recently with Dr Martin Blanchard, a geriatric psychiatrist, and asked how he got involved in old age psychiatry:
I became interested in geriatric medicine when I was a student as it involved many disciplines, and I had a very good experience working in old-age psychiatry, the patients were so grateful. One of our problems in medicine is that we do not think enough about the quality of life, we prolong it. The main problem with our patients is not dementia but depression. There is no real treatment for dementia but rather there is management of the patients lives.
Did many of his patients actually want to die?
That is in fact quite rare unless they have a severe depression. Even when frail and with problems they want to go on living. Few of our patients actually remain in hospital for more than several weeks. The number of patients we have to deal with has not increased over recent years, but the number of referrals we get from different GPs varies a great deal as they handle their patients in different ways.
Given the many problems, physical and mental, linked to old age, we need to look at how the old actually live.
4. Living
‘Old age has its pleasures, which, though different, are not less than the pleasures of youth’
The Greek poet Anacreon (c. 572–488 BC) wrote one of the earliest poems about old age, and it strikes a cheerful note:
A happy old age is what many people spend their lives preparing for, particularly with regard to financial security and good health. But what is our lifestyle? How varied is it and is there much pleasure still to be had as one ages? Can one enjoy old age? This is an important question. There are at present 10 million in the UK over 65 and there will be double that in ten years’ time. There are one million over 85.
Nobody wants to be old, but old age doesn’t have to be a time of despair. Joan Bakewell offers a positive view: ‘In their leisure time, the old aren’t just boozing and cruising: the hardier spirits are climbing mountains, visiting the pole, meeting sponsored challenges. I have a friend in his late seventies who has recently taken up tap-dancing.’ I interviewed Joan after she had been asked to become ‘the voice of older people’:
When I was 70 I wanted to reinvent myself, it was time to start something new. So I managed to start a column in the Guardian called ‘Just Seventy’. It was up to me to have the idea—no one was going to come to me with it. My column was about being 70 and all the things you have to adjust to. For example, for women I wrote about them having to give up high heels, and children, and other changes. Also old women become socially invisible when they have lost their high heels. Sheila Hancock says she always asks for a corner table and then others around her will have been served before anyone has even brought her the menu. My columns were eventually put into a book which is still in print. And then the government in 2008 came to me—Harriet Harman phoned and said parliament was trying to outlaw ageism and would I be the voice of the older people. I only agreed to do it part-time as I wanted to continue to do my own work. I said I would pass on to her everything they tell me. I no longer do it.
There are important differences between men and women as they get old. Their patterns diverge as men remain fertile, have children, have second wives, have a renewing life. Women know that they are no longer biologically needed and so they are in a psychological sense ready to grow old. I am rather against that. They can start to wear clothes designed for older people, sensible, rather neutral clothes that do not have any style to them, like your mother and grandmother did, but many are becoming more fashion conscious. I colour my hair as that keeps you looking a bit younger.
A lot of people worry about money, it’s almost biological. They worry if they will have enough and where it is going to come from. The state pension is tiny and many have to live a lifestyle on a tiny amount of money. There is a sense of loss, things are not what they were—your children have flown the nest and your grandchildren have grown up. Living on your own as I do can present problems unless you have an attitude towards it. Many worry about how they will be right at the end of their lives and not being able to look after themselves—that is what I am making a TV programme about. Will they have to sell their house to pay for a carer, which is very expensive? Will they have to go into care? And that spoils their pleasure in being quite comfortable, having time on their hands, going out, playing golf. The absence of a competitive compulsion in life to do and achieve can make one much more relaxed. I do not get bored—too many books to read and films to see.
One feature of getting old is that your contemporaries die, and I have begun to make friends with younger people. New friendships are a blessing in old age. I am set on continuing to my mid-nineties—will keep working, travel—but I have signed the documents for non-resuscitation should I get very ill and go, for example into a coma. I am for euthanasia and support dignity in dying.
An important book that gives accounts of a diverse number of individuals’ views of ageing is About Time: Growing Old Disgracefully by Irma Kurtz. She herself wrote: ‘Talking to men and women of my generation, I am struck again and again about how we shed freight from that heavy goods vehicle, memory, as we age and gently drift back to early events that were the making of us. Growing old, as it separates us from the world, returns us to our original selves.’