– ‘the survivor’s story was, at heart, a happy one’ – though Moss felt that they did not always seem as happy as they said they had been. On the other hand, he wrote: ‘They exhibited a stoic calm, an unshakeable acceptance of the hand that life had dealt them.’
They also lived for today. Harry Walker was asked what targets he still had in life, and replied:
There aren’t any. You live day by day. I wake up in the morning and make sure that my legs are still working. I don’t think I’m much trouble to the staff. I regularly go for a walk around the grounds. It’s getting a bit harder, but I’m still living.8
These centenarians, on the whole, despite some forgetfulness, some dementia, a stroke, various frailties and ailments, thought of themselves as relatively strong, healthy, and in good spirits – and one was still driving her car. Not a sad tale at all. It was a surprising story because society fears extreme old age, even fears the thought of so many very old people in our society.
We have two ways of looking at ourselves when old that are contradictory, said Mary Riddell in the Observer shortly after these interviews.9 Are we ‘British pensioners with double cataracts and leaking roofs’, or are we the Greek goddesses to whom immortality is indispensable? Again, this contradiction seems to allow the treatment of older people in ways that we would never allow for someone younger. Mary Riddell cited the case of the British actors Francesca Annis and Ralph Fiennes. They had been together for eleven years; she was then 61, he a mere 43. The public was asked by the media to forgive Fiennes’s affair with a singer on the grounds that Annis is ‘so old’– and cheating on a long-term partner is clearly all right if she is old. Yet, if we are to live to 100 or more, 61 is barely middle age.
As for couples who are both elderly, they get treated with the greatest contempt. Like Richard and Beryl Driscoll, both 89 and married for 65 years, who were separated for seven months because Gloucestershire social services refused to pay for Mrs Driscoll to be in a care home alongside her frailer husband, even though she was blind.10
The question that Mary Riddell asked – What is all this extra life for? – is really the question at the heart of this book. Instead of allowing a gradual state of impermanence to take over – short-term marriages and relationships, constant cosmetic surgery, new ideas and yet more change – older people could call a halt to some of this, and ask the public at large to think again. But all this requires a real debate about what old age is for. Until we think about that a little more deeply, we will carry on treating older people as second-class citizens, and none of this will make much sense. And behind that question lies the issue of how we judge when old age is fulfilled and worthwhile, that state of being and aspiration which policy-makers call ‘healthy life expectancy’.
Healthy life expectancy
But here there is a major problem. If life expectancy is rising, there is some evidence that healthy life expectancy – the years we spend well – is falling as a proportion. This is a vitally important discrepancy, if we believe it, because it would imply that more of our extra years will be spent sick and disabled in some way or other. That is the view of the Department of Health and the Office of National Statistics (ONS). But the ONS, at least, concedes that ‘concerns remain about the reliability of subjective assessments … They are known to vary systematically across population sub-groups … [reflecting] differences in ill-health, behaviour, expectations and cultural norms for health.’
When the government responded to the 2005 report on ageing by a House of Lords select committee, they didn’t mention these nuances. ‘Although healthy life expectancy is increasing, it is doing so more slowly than overall life expectancy,’ they wrote.
This irritated the select committee, which responded a year later by saying: ‘this statement is made without any suggestion that it is either a cause of concern or that any remedial action is needed. It flies in the face of the claim by Professor Ian Philp, the National Director for Older People’s Health, in a report published in November 2004, that “health in old age is improving and should continue to improve”.’
So which is right? The National Director for Older People’s Health? The Director of Research and Development for the Department of Health? The Office of National Statistics? How is the ordinary person supposed to make sense of this if three government departments face three different ways? Should we not be saying that we need to know, and that real research needs to be done, with longitudinal studies looking at people’s health from the point of view both of experts and of older people, so that we know a little better what we are letting ourselves in for with all this increased life expectancy? Perhaps then we might make better decisions about it.
The ONS also gave an explanation, of sorts, for the apparent widening of the gap between life expectancy and healthy life expectancy. They say that people are getting more sensitive about their health, or have adopted higher expectations about their health, so that conditions that wouldn’t have seemed like problems a few years ago are now considered to affect daily living. It may be that economic incentives are persuading people to think of themselves as ill more readily. There are theories, too, that improvements in survey methods have led to the discovery of a growing proportion of health problems.
Diseases are also being detected earlier, especially chronic diseases. People with ill-health are living longer. Illnesses and injuries that used to be resolved by dying are now more often managed instead. Short deadly illnesses, such as infectious diseases, have been replaced by diseases which are chronic and take a long time to resolve, if they ever do. Any of these could give the impression that healthy life expectancy was going down.
There is no doubt that feeling they are suffering from ill-health – even if they might be objectively no sicker than previous generations – would be quite enough to undermine people’s quality of life and their sense of well-being. The question is what we can do about it. In their evidence to the House of Lords Committee, the Royal College of Physicians in Edinburgh warned that ‘disability may be postponed but it cannot be eliminated’. That is obviously true. Nor can the adverse effects of disability be eliminated. But the question is whether it is possible to increase disability-free years in the UK, as they have in the United States, and how to reduce the adverse effects of disability on older people’s lives?
At the moment it is hard to imagine how we can take on Professor Sir John Grimley Evans’s advice to the House of Lords Committee on ageing. He said: ‘Live longer, die faster’. That may be a wise piece of advice. But how do we put it into action, short of killing ourselves, something most of us don’t want to do? And that’s the stuff of another story, in another chapter.
If there is really an increase in ill health, nobody has ever explained it or measured it. The questionnaires that ask people to assess themselves on ‘vague’ concepts like health, while they may enable comparisons to be made with replies to the same questions from different groups or different areas, are not reliable enough to give us objective measures of health in old age. Perhaps the real question is whether the researchers are using sensible categories – and who, anyway, is deciding how people feel? Who is defining healthy old age?
Different definitions
This business of who decides if we are having a successful old age is important – and it is no small problem. One of the issues that has come up over and over again when I was researching this book has been the difference of approach between the ‘experts’ and the lay people, particularly those who are in fact old themselves, and have some experience to add to the picture. Behind that is
