A girl born today is likely to live to more than 100, with boys not far behind. Yet rather than focusing on the productive, rich, varied lives older people lead, we dwell on the burden of ageing. Patricia Edgar challenges our preconceptions about ageing, arguing that 50 is now the start of the second half of life … not the beginning of the end.
A revolution is underway. Life expectancy has increased by 30 years in the twentieth century. By 2050, we can expect to live beyond 90: 14% of our population of 23 million are now over 65. By the end of the twenty-first century, 25% of Australians will be older than 65. They will demand respect and opportunities to work and participate in society, with appropriate care at the end of life. But right now our political leaders are making the wrong decisions.
We should treat old age as a natural stage of life which has its particular needs, as do the stages of childhood, adolescence, adulthood and our working years.
We talk a lot about ageing, but our definitions are all over the place. You can’t develop policy and programs for people when we don’t know who they are and what they are really like. Medically, old age sets in before 50. When my husband, Don, was taken to hospital by ambulance after smashing his foot in an accident, he overheard a nurse comment, ‘We’ve got an old one out there.’ Don was 44 at the time. Newspaper reports commonly refer to 60-year-olds as elderly, when they might have 30 odd years ahead of them.
So when is someone old today? Is 50 the magic number? Is 70 the new 60? Are we old when we qualify for a Seniors’ Card? When we retire from the workforce? When we qualify for the pension? When we have grandchildren? When we access our superannuation? The answers have very different policy implications.
We have no agreement about when a person is old, but the word is used loosely and pejoratively very early on. Once we are so defined, we are often patronised, ignored, even shouted at. You silly old bugger was Bob Hawke’s riposte to a 74-year-old who challenged him on the campaign trail in Whyalla in 1989.
Measuring the wrong things
We should treat old age as a natural stage of life which has its particular needs, as do the stages of childhood, adolescence, adulthood and our working years. At each stage the state provides essential services and does not scapegoat the recipients. Another day in the life of an elder is as worthwhile as a day in the life of a young adult. Yet current policies and attitudes do not start from this premise.
Treasury, successive governments and the Productivity Commission carry on about the ageing population and the dependency ratio insisting the old are going to squeeze the life out of younger workers. But they are measuring the wrong things.
Treasury uses an arbitrary definition of the ‘dependency ratio’: that is the number of non-working dependants as a proportion of the number of productive workers. It’s a flawed formula of infinite flexibility, depending on the assumptions you build into it. For example, a lower birth rate means fewer dependent children and youth, lower costs for maternity hospitals, child-care benefits and schools. An increase in productivity of a mere 0.5 per cent, through advanced technology or improved management systems, would cover the costs of aged-care and aged-health expansion.
And what is dependency anyway, when we know the flows of both financial assistance and moral support run from old to young more than from young to old? What, even, is productivity when the GDP fails to measure the significant dollar-value of caring work, voluntary work, community work and creative work, without which our economy could not function, and none of which is a monopoly of the young?
Old age is not a disease.
Staying in work longer
There are more people in the workforce who are over 55 than there are under 25. Those over 55 contribute the staggering sum of $74.5 billion a year: through caring for spouses and grandchildren and other unpaid voluntary work. In 2011, 937,000 children received childcare on a regular basis from a grandparent.
The trend is already for people to stay in work longer. People want to work — and not just for economic reasons. Work gives them purpose and social involvement.
‘Old age is not a disease’
So if the assumptions about productivity are wrong, what about the assumption we are going to crash the health system?
Old age is not a disease. The evidence for an impending disaster is spurious; the health system – those who run it — and the pharmaceutical companies have much to answer for in propounding this myth. Misdiagnosis and over-diagnosis is rife in our medical system. It is important not to allow medical treatment to get in the way of good health.
There are many ways the system can become more cost-effective.
We are not very good at talking about death. ‘I’m not afraid of dying,’ Woody Allen joked, ‘but I don’t want to be around when it happens.’ In the absence of talk, millions of dollars are wasted on ‘futile’ aggressive medical interventions for patients unable to speak for themselves, whose death is inevitable. Advanced care planning would save $250 million annually.
The Grattan Institute has argued that the government could save $1.3 billion each year by reforming the Pharmaceutical Benefits Scheme (PBS).
Applying the new science (of pharmaco-genomics) of prescribing drugs based on an individual’s biomarkers, which can be examined through a simple blood test, would save the health system $12 billion over five years.
Improved anaesthetics and improved cataract surgery have already helped reduce the duration of hospital stays. Doctors are calling for new surgical techniques to be subjected to the same level of scrutiny as new drugs.
In commercial media, people are generally depicted according to their relative importance in the market.
Expert panels with disclosed financial relationships to drug companies are widening the boundaries for diseases like blood pressure, osteoporosis, attention deficit disorder, asthma and high cholesterol. The growing diagnosis of so-called depression is another case in point. As a result of these expert panels doctors are over-diagnosing and treating more and more people with low risk of these diseases, adding significantly to the costs in the medical system. The medical industry must put its house in order.
Brain exercise stalls dementia
Then there is the disease we fear more than death — Alzheimer’s — which is not a consequence of normal ageing. Pharmaceutical solutions have so far been unsuccessful. Social isolation is believed to exacerbate all forms of dementia and researchers now believe the single most important thing anyone can do to stall dementia is to exercise the brain and develop cognitive reserves.
How?
Brain exercise. Not just doing the daily crossword, but continuing meaningful education, enjoyable work, pleasurable leisure activities, physical exercise, social interaction, learning new skills like a new language or computer skills, playing video games and interacting on social networks — and doing all this across our lifetime.
The brain needs to be active and stimulated in ways that are always new. The brain is inquisitive by design; it is constantly and productively self-exploratory. What confounds the brain enlivens the brain.
So if we implemented what we already know, there would be massive savings to the health system. The budget deficit we hear so much about could be reduced by billions.
As the old are the fastest growing demographic in our society, what needs to be done?
Ageing and the media
The media has an important role to play in changing perceptions of the ageing. In commercial media, people are generally depicted according to their relative importance in the market. The young (who spend most) fill our screens in news, entertainment and fiction. Just as black people were absent from television before the civil rights movement in America and Australian children were absent before program regulation, the group with least exposure in the media today are the aged.
In a society that glorifies youth as ours does, we do all we can to deny the ageing process. The market trades on our vulnerability with the promotion of body industries worth billions to the economy. But no matter how much we invest in treatments, it is 100 per cent certain (if we dodge the traffic) that old age will take hold of us, and when it does it comes as a surprise. We catch an unexpected view of ourselves in a window and think, ‘That can’t be me.’ We react because we know we don’t fit the image society imposes. So the dominant images must change. It can happen. When I first started teaching media courses in the 70s, we regularly had bare-breasted girls on page three of the tabloid press. Feminists brought change. Elders will do the same.
Attitude is important
Distinguished political economist Robert Reich sees ageing as ‘a far bigger threat to the world economy than the Eurozone debt crisis, US unemployment and the Chinese slowdown combined; a problem unfolding’, he says, ‘like a slow-motion train wreck’. If this happened, it would be because there is a collective failure to understand ageing and to implement policies that could transform us. We ageing Australians are not going to take this neglect without action.
My book In Praise of Ageing is a challenge to the negative propaganda and short-sighted thinking we experience. We are a resilient bunch, but our lives could easily be very much improved.
While about 30 per cent of one’s likelihood of living to 100 is determined by genes, and longevity does run in families, attitude is just as important in determining whether we will live a long life.
My argument assumes we accept the responsibility for looking after ourselves to the best of our ability physically and mentally; that we make an effort to reinvent ourselves, our work and purpose as circumstances change over a long life. Most centenarians alive today live independently, not in aged-care homes.
In turn, as individuals, we have a right to be given respect, given access to work opportunities (both paid and unpaid) and good medical support. Cultural attitudes, media reporting, and the language used to talk about ageing Australians should not be allowed to create and amplify social problems for those living the second half of their lives. Portrayals of the aged as a burden just do not help.
The elders I have written about in In Praise of Ageing are striking examples of living well and successfully in their advancing years. They demonstrate how it is done. It’s time to praise ageing, not to bemoan a natural stage of our lives — an achievement that should be celebrated.