While there were scientific studies on child development, ageing was still largely ignored in the early twentieth century. The psychologist G. Stanley Hall was a founding father of psychology as a science. His major work was on child development, but, concerned about his own ageing, he wrote a book about ageing, Senescence, in 1922. He interviewed some elderly adults and found that their attitudes towards death changed as they aged. This was the first analysis of the changing attitudes and thinking linked to ageing:
How different we find old age from what we had expected or observed it to be; how little there is in common between what we feel toward it and the way we find it regarded by our juniors; and how hard it is to conform to their expectations of us! They think we have glided into a peaceful harbor and have only to cast anchor and be at rest.
It was Peter Medawar in 1952 who pointed out that environmental factors progressively reduce an individual’s lifespan, and natural selection would ensure that the good genes that support reproduction act early, and the bad ones that prevent reproduction much later. This was a major advance and it later became the basis for Tom Kirkwood’s disposable soma theory, which recognised that just a small amount of energy was devoted to repair of ageing processes as compared to reproduction, growth and defence. The theory also claims that ageing is due to the accumulation of damage to the body, and that long-living organisms devote more to repair.
Perhaps the greatest impetus for the modern ‘merchants of immortality’ came from Leonard Hayflick’s finding that there were just a finite number of times a fibroblast cell could divide when placed in culture. This eventually became known as the ‘Hayflick Limit’. The original article by Hayflick was rejected by the Journal of Experimental Medicine with a scathing letter from the editor that stated, in part, ‘The largest fact to have come from tissue culture research in the last fifty years is that cells inherently capable of multiplying, will do so indefinitely if supplied with the right milieu in vitro.’ It was eventually published in Experimental Cell Research in 1961.
If Nascher was the father of geriatrics, Marjory Warren was its mother—particularly in relation to care of the aged. She worked at the Isleworth Infirmary, which in 1935 took over responsibility for an adjacent workhouse to form the West Middlesex County Hospital. During 1936 Dr Warren systematically reviewed the several hundred inmates of the old workhouse wards. Many of the patients were old and infirm, and she matched care to their needs. She initiated an upgrading of the wards, thereby improving the morale of both patients and staff. She advocated creating a medical speciality of geriatrics, providing special geriatric units in general hospitals, and teaching medical students about the care of elderly people. Among her innovations was to enhance the environment and emphasise increased motivation on the part of the patient.
Before the Second World War there had been little interest in old peoples’ mental or physical health. Joseph Sheldon, while working at the Royal Hospital in Wolverhampton, undertook a survey of 583 old people sponsored by the Nuffield foundation, which he published in his book The Social Medicine of Ageing in 1948. He found that over 90 per cent were living at home and many had severe problems with respect to care. He introduced home physiotherapy and promoted environmental modifications to prevent falls, which were all too common. Old-age psychiatry was only recognised as a speciality by the Department of Health in 1989. Now, of the 1700 patients each GP typically has, about 6 per cent are over 75 and 2 per cent over 80. There will be around six consultations a year for the over-65s, so old age is quite a burden for GPs.
The first chair for geriatrics in the world was the Cargill Chair at Glasgow University, awarded to Dr Ferguson Anderson in 1965. Alex Comfort, more famous perhaps as a novelist and for writing The Joy of Sex, was a great propagandist for research on ageing. His early research was on ageing in the fruit fly Drosophila and thoroughbred horses. He then attempted to determine biomeasures of physiological ageing.
In the US the first head of the Unit on Aging within the Division of Chemotherapy at the National Institutes of Health, Nathan Wetherwell Shock, was appointed in 1940. In 1948, the gerontology branch was moved to be under the National Heart Institute. An attempt was made to have an Institute of Ageing established with Heart as a subsidiary, but this failed, as a physician to the Senate stated, ‘We don’t need research on Ageing. All we need to do is go into the library and read what has been published.’ This contrasts with Nathan Wetherwell Shock’s own viewpoint, enunciated just before his death in 1989: ‘I would remind you that we were formed and nurtured in the firm belief that the biological phenomenon we call “ageing” was worthy of scientific pursuit. We have achieved some degree of success. I would caution, however, that our future will be determined only, and only, by the quality of our scientific research on understanding the basic mechanisms of ageing processes.’ In 1974, Congress granted authority to form the National Institute of Aging to provide leadership in ageing research and training.
Research on ageing expanded significantly as it was realised that life expectancy was increasing, and thus the number of elderly. The Gerontological Society of America was founded in 1946 and the field has grown very fast. There are now many scientific journals devoted to the topic, such as Gerontology and Age and Ageing. But compared with certain fields of medical research, this topic is still relatively neglected. In the words of Professor Tom Kirkwood:
I think doctors struggle with ageing as their training is to diagnose and treat diseases—they want to cure someone. For them ageing is a medical failure. There is a little progress with age-related diseases. It may be possible to cure Alzheimer’s but this is very difficult and prevention is more promising. There has not been enough research on very old people, which is what we are doing in Newcastle. Not a single person in our study over 85 has zero age-related disease, most have four or five.
6. Evolving
‘Getting older is no problem. You just have to live long enough’
Research into the nature of ageing has helped us to understand its mechanisms first in terms of evolution, and then cell behaviour. We are essentially a society of cells and all our functions are determined by the activities of our cells. Evolution plays a key role, since it has selected cells to behave in a way that gives organisms reproductive success—a fundamental feature of Darwinian evolution. Evolution is not interested in health but only in reproductive success. Almost all the features of an organism, including of course humans, have been selected on this basis. The fertilised egg gives rise by division to all the cells that make up our body, as well as those of all other animals. Genes are turned on and off during the development of the embryo and this determines when and where particular proteins are made in cells and so also their behaviour. The details of this process have been selected for during evolution to give rise to adults that will reproduce.