Age doesn’t tell you anything

Frisky older people on a beach

From here to eternity?

One of the many lessons ageing populations are starting to teach us is that age is a rubbish way of categorising people. Advertisers have been obsessed for years with selling to an 18-49 or 25-54 demographic and, partly as a result, we are stuck with the idea that people over the age of 50 or 55 are somehow of a piece with people over the age of 90: none of them of much interest, at least if you’re an advertiser, or, consequently, a media outlet.

The truth is that one person aged 50 isn’t even like a lot of other people aged 50, let alone with most 90 year-olds. But age goes on being used as a proxy for other characteristics – principally, as far as older people are concerned, two identities, which we might call frisky retirement and frailty.

We see the friskily retired bouncing along in ads for insurance and cruises, usually outdoors, often on a beach, evidently still having masses of great sex. This is the opportunity, so often talked about, that is offered by the ageing population – to sell things, of course; but also (to be less cynical, momentarily) to evolve new ways of life, because they are living longer with much higher levels of education, better health and more money than any generation before.

The frail include the lost tribe of the lonely, as well as the demented and the residents of care homes. They are the fourth agers, approaching death whether from near or far, and we turn away from them in fear. They explain the other reason that the 50-plus population is seen as a homogeneous lump. This is a period that none of us wants to contemplate, and if we concentrate on the idea of a long, sex-filled third age hiking through woods to the beach, we don’t have to.

Sometimes, when it suits, there’s an effort to subdivide the ageing population: the third age and the fourth, the young-old versus the old-old. But this too, uses age as a proxy for other, more germane characteristics; it’s not really very helpful, because it’s perfectly possible to be old-old at 65, as well as one of the youngest-seeming young-old.

The research company Nielsen recently pointed out that the Baby Boomer generation was neglected by brand marketers, who have never taken much interest in the over-50s, but who now face a population skewed towards the old in terms both of numbers and disposable income. This was greeted in some quarters as a statement of the obvious, but there have been rather fewer ideas about how to change it.

Some efforts, it is true, are being made to segment and reach the older consumer. Generation Jones, the creation of Jonathan Pontell, has gained some traction by sectioning off the group born between 1954 and 1965. In an American context, Jonesers are slightly younger than the Baby Boomers, and they are of huge interest to marketers, given that they include Barack Obama and any number of people who currently run things.

(The Jones reference is said to come from the Counting Crows song Mr Jones, though I’ve listened to it and I’m not sure why. I assumed at first it was something to do with Bridget, although she already has quite enough cultural baggage. Wikipedia seems to think it’s got something to do with the slang term Jonesing – new to me – meaning yearning or craving.)

Jonesers are a start, but they are an age-led start, subject to the same reductive stereotypes as so much discussion about ageing. Which is not to say that age is irrelevant; but it doesn’t explain the totality of people’s interests and anxieties, let alone their identities. We have allowed ourselves to become so focused on age that we are incapable of seeing the diversity that the part of life after 50 – half of many lives – entails.

A few marketing experts have urged an age-neutral approach, noting, for example, (who woulda thought!) that 41% of iPads in the US have been bought by the over-50s. But even this falls prey to the lump of ageing fallacy: the idea that the over 50s are a distinct group, or at best two distinct groups, and they need managing and including (poor loves).

In fact, they’re a group that needs to be unpicked, unbound, seen as a bundle of niche enthusiasms and diverse people making intricately personal choices. Just like young people, in fact. Our antipathy to ageing, combined with deeply-rooted marketing and advertising prejudice, has allowed older people to be treated as a lump, in a way that no one would any longer think of imagining the young. Which is daft really, when you think that the older people get, the greater the extremes of capacity they display.

Ageing is both an opportunity and a tragedy. Sometimes, because things are complicated, both at the same time. Much like the rest of life, then.

The Big Society is alive and well…in Kerala

Charles LeadbeaterDavid Cameron’s idea of the Big Society seems destined for a life as troubled as its long-lost older sibling the Third Way.

At its worst, the Big Society could be a flimsy fig leaf designed to cover up some of the worst consequences of deep cuts in public services. Charity, local volunteering, philanthropy, at least in affluent areas, may make up for some of the cuts that are bound to come in social care, welfare, arts and libraries.

It would be a pity, however, if the Big Society idea suffered that fate and was no more than a political device. Ageing is just one area where we need different solutions to social need, ones that build relationships and participation rather than simply delivering sub-standard public services to people. Increasingly we need to look at what people may want to do by themselves and with one another. We need solutions that cost less, but deliver better outcomes by doing things differently, as a recent report from the Innovation Unit and Nesta argues.

At its most ambitious, then, the Big Society programme could open the way for the creation of these solutions, which are often more distributed, less institutionalized, and rely less on professionals and more on able volunteers. It could mobilise resources from within the community as well as using public funds; it could build on people’s capabilities, rather than starting from the assumption that they are dependent.

To put it simply: rather than relying on institutional, professional systems, we need to rely more, for at least some of what we need, on social and voluntary systems. These must, however, provide far more than a patchwork of charities. They need to be national in coverage and provide a degree of reliability.

Already in the UK, Southwark Circle and the Circles movement started by Participle is just one example of this approach. However there are far more impressive international examples, especially in the field of ageing, which should set the standard for what the Big Society could achieve, and provide some lessons about how to do it.

One is Japan’s staggering campaign to create 1m “dementia supporters”: community volunteers capable of recognising the symptoms of dementia and helping families cope with the disease. The number of people with dementia in Japan is projected to reach 3.76m in 2035, up from about 1.7 in 2005. The Ministry of Health, Labour and Welfare launched a 10-year programme to promote better understanding of dementia, build community support networks, and provide more person-centred care. By 2008, a nationwide caravan had recruited and trained about 600,000 dementia supporters to be the frontline and first port of call for anyone with dementia. Japan has a highly cost effective health care system with universal coverage. Yet it threatens to be overwhelmed by the costs and complexity of advanced ageing and dementia. Thus the Japanese government has deliberately set out to create a stronger social system to deal with dementia, to reduce the burden on the formal, public health system.

Another comes from Canada where the non-profit Victorian Order of Nurses has launched a programme in which neighbours can train one another to provide respite care. Respite care is one of the most contentious and difficult issues for any family providing care. Often public sector respite facilities are difficult to get into and not what everyone wants. The idea of being able to provide respite by having someone cared for at home by neighbours makes a lot of sense. The VON programme provides a simple toolkit to create a community group in which people can train one another to provide mutual support and respite. When one family needs respite others are ready to step in to share the burden, distributing the tasks and making them more manageable.

The most impressive example of this approach, however, is the remarkable Neighbourhood Network for Palliative Care in Kerala. India’s recent economic growth has meant that many middle class Indians can now afford hospital care, including at the end of life.  It remains the case, though, that the vast majority of Indians still cannot; and those close to the end of life, often elderly, with chronic conditions and quite possibly illiterate, are the most likely to suffer.

A remarkable doctor, Suresh Kumar, founded the Institute of Palliative Medicine in the medical college in Calicut in Kerala in 1993 as a fairly traditional clinic with a community outreach programme. Initially, community involvement in the programme was limited, as were resources, which constrained the initiative’s reach.

The Neighbourhood Network Palliative Care emerged from the inadequacies of this traditional, medically-driven approach to end-of-life care. It is a sustainable, community-owned service offering comprehensive long term and palliative care to the bedridden, mainly based on linked cells of volunteer-led, autonomous initiatives, which now mobilise close on 10,000 trained volunteers.

People who can spare at least two hours a week to care for sick in their area are enrolled in a structured training programme of 16 hours interactive theory and four days of training under clinical supervision. Volunteers work in teams of 10-15 to identify need in their locality and to call in medical expertise when it is needed. Most of the funding for the programme comes from local donations, 90% of which are less than 15 cents. In other words, the NNPC network is funded almost entirely by voluntary donations from the very poor to create a mutual self help network to cope with long term conditions and death.

By late 2007, about five years after the NNPC was launched, it had 4,000 volunteers, 36 doctors and 60 nurses looking after about 5,000 patients. All the doctors and nurses are employed by the community organisations, which focus on providing care at home in a holistic way that combines the medical with the social and emotional.

In a little over a decade the NNPC has grown to cover almost all of the 12m people in Kerala, providing a highly flexible social network for long term and palliative care rather than relying entirely on costly hospitals and doctors. The backbone is a social system which calls in the doctors and nurses as they are needed. In the developed world, meanwhile, we generally try to do it the other way around: we try to socialise and personalise medical and institutional systems that are often impervious to change.

If the Big Society is more than a piece of political marketing, a sop to distract us from the prospects of reduced public services, then it will have to offer the kind of transformation the NNPC has brought about. If you want to see the Big Society, go to Kerala.

Where are the clothes for older women?

older fashionI have a feeling that this may seem rather frivolous when compared to the problems that many older people experience. I celebrated my eightieth birthday last year and it seems that clothing stores are not in the least interested in the growing number of women who, although elderly, don’t wish to look dowdy.

I am a size eight and it seems to me that clothing manufacturers think I must be seventeen. My friends all talk about the same thing: we don’t wish to expose acres of flesh. Why can we not find simple, smart summer dresses with a sleeve that covers the upper arm and doesn’t have a neckline which plunges almost to the waist? A little more elegance is what we long for.

We don’t have lifestyles that demand haute-couture and we couldn’t afford it anyway, but we don’t wish to buy garments that are designed to make us look as if we are on the way to a day on the beach. The easiest option is trousers and top, which is fine but becomes tedious if there is no alternative.

As I mentioned, this seems trivial compared with some of the problems facing people as they grow old, but if we are still active and interested in life why shouldn’t we be able to find suitable clothes?

It seems that manufacturers and retailers have written us off. But there are plenty of us, and we still care about style and smartness and looking as good as we can, just as we always have.

I do understand loneliness and the difficulties that living alone can bring, and I know that anything that can boost confidence is very valuable.

The exciting and previously unknown ageing brain

The Secret Life of the Grown-Up BrainThe Secret Life of the Grown-Up Brain, by Barbara Strauch, Viking, US $26.95

Some of us  (I am speaking personally here) have been afflicted for our entire lives with the habit of running eagerly upstairs to get something, arriving in the bedroom and completely forgetting why we’re there. Some of us (me again) arrive at parties with our anticipation at a delightful evening tempered by alarm that we’ll end up having to introduce someone we know really well but whose name we cannot, for some reason, dredge up out of the slimy morass of our brains.

Even those who haven’t carried this burden throughout their lives are likely to start suffering from it in middle age. Those for whom parties have always been something of a trial are likely to find the struggle to retrieve information even harder. Partly because of this noticeable change, the assumption until recently has been that the middle aged brain is in decline. Your brain cells start dying off after the age of 19, your teenage children will tell you, while your friends speak ruefully of ‘senior moments’. Common sense suggests that brains age in parallel with bodies, sagging and greying and generally becoming less useful.

Yet in the last 10 years, developments in neuroscience have shed a whole new light on what happens to the brain as it ages, and previously commonsensical notions are looking like less than the complete picture. In this new book, Barbara Strauch, the health and medical science editor at the New York Times, canters through much of the recent academic research to produce a rather more complex picture of the resilience and plasticity of the ageing brain.

Broadly, Strauch’s conclusion is that aspects of memory do indeed decline with age, not least the ability to remember names. Yet it turns out that the Greeks were on to something when they decreed that citizens could become jury members only when they reached the age of 50. MRI scanning, genetic analysis and sophisticated long-term studies are beginning to show that the ability to make accurate judgements, to build patterns of connection and interweave layers of knowledge actually grow with age. We could yet establish a biological basis for wisdom.

brain graphicBrain science remains in its infancy, and Strauch is unable to paint a complete picture, but she does offer lots of tantalising glimpses. At UCLA, MRI scanning has shown that the fatty white coating of neurons called myelin continues to grow into late middle age; George Bartzokis, a neuroscientist involved in this work, believes this is ‘the brain biology behind becoming a wise middle-aged adult.’ The Seattle Longitudinal Study, which has tracked the mental powers of more than 6,000 people since 1956, shows better functioning in middle age than at any other time on four out of six cognitive tests.

The trend of research across different disciplines seems to point to a midlife loss of processing speed – the ability to swerve to avoid a squirrel in the road – as well as of the ability to mug up and retrieve dates in history. But it also suggests a growing mastery of vocabulary, spatial orientation and inductive reasoning. Emotions remain strong, and yet the ability to regulate them increases. Most impressive, and most convincingly researched, is the ability to recognize patterns and see connections, which persists strongly and offers hope for continued creativity, intuitiveness and social and emotional responsiveness.

Strauch’s book is in two parts, the first an overview of the current state of knowledge, and the second an attempt at a how-to-keep-your-brain-fit guide. Neuroscience has shown the brain to be nothing if not mutable. Experiments on rats and monkeys have found that those that are allowed to live in enriched and stimulating environments end up with bigger brains, making more connections. On all tests they are smarter than those living lonely, mundane lives.

Taking her cue from this, Strauch looks at how you might keep your brain working. Here she’s on less comfortable ground, because the science is so nascent and tentative that any prescription based on it looks rash. Certain general principles seem to be valid: education is good, social relationships are vital, exercise is excellent, nutrition is important. Beyond this, there are few certainties. What kind of education? The brain training industry has gone from being worth $2million in 2002 to $80 million in 2007, yet, as she points out, there is no proof that brain training games work outside the laboratory.

We can be pretty sure obesity is bad for the brain and oxidative stress and inflammation are unhelpful, yet there’s no proof that eating foods high in antioxidants or anti-inflammatory agents will make a difference. You can buy what are advertised as resveratrol pills on the internet. Resveratrol, an ingredient in red wine, has been shown to extend the life of yeast, and, at very high doses, rodents. These pills are part of a vast market in anti ageing preparations and potions. They are at best, and putting it as politely as possible, a hunch.

Strauch is too good a journalist to get drawn into too much cheerleading ‘you can save your brain’ business. But the book is sold in part as a guide to discovering that, to quote the blurb, ‘your smartest years are still ahead.’ In fact, what The Secret Life of The Grown-Up Brain leaves you with is a conviction that it will be a long time before we have definitive answers to most of our questions about the brain, because each individual brain’s development is such a complex mixture of genetics and environment. As an overview of where we are now, though, it is excellent. And, in a cautious, hopeful frame of mind, as befits the state of the science, quietly but definitely encouraging.Barbara Strauch

If you can breathe, you can sing

Headphones and heart graphicOne resident no longer speaks, but he still sings. Another’s memory loss and condition mean that he can no longer read. But he has been singing since he was a child and knows how to harmonise and sustain a note; he is one of the finest singers in the choir.

Both men are members of the Emmy Monash Community Choir, based at a care home for the elderly in Melbourne. Pamela Bruder, who started the choir and conducts it, is convinced that ‘singing can achieve quite miraculous things. Husbands and wives come in to visit their spouses and sing in the choir and it creates a sense of joy. There aren’t many other instances where you feel a sense of joy coming into a high-care unit.’

The Emmy Monash aged care home  (named after its founder, a community activist) is designed to allow people to ‘age in place’ as the Australians say: no matter what happens, you can stay. It offers its 90 residents (most of whom arrived in Australia after the war as concentration camp survivors from Eastern Europe) independent living apartments, a low-care area, high-care and a dementia wing. The choir draws members from all the areas of the home, as well as from local school students, friends and relatives.

There is increasing interest in the value of music therapy to people with dementia and Pamela Bruder, who is herself working on an anthropology PhD on the choir, is convinced of it. ‘Singing seems to be the last thing to go,’ she says. ‘The transformative power of music is physiological. A group of people in tune with music is in tune with each other. There are members of the choir who may not be able to put sentences together any more and who certainly wouldn’t initiate a conversation, but they can sing. And if they can still read, they can learn new songs, including in other languages. We sing in six languages.’

Pamela has been running the choir for a couple of years, having been brought in to Emmy Monash, rejoicing in the title of Life Enrichment Coordinator, to find ways to make living there a more nourishing and culturally rewarding experience while building links to the wider community. From the start, she was determined the choir would include the residents of the dementia wing and high-care area. ‘A lot of the low-care residents don’t want to confront high care, even though there may be people there who were their friends. They won’t go upstairs. So we bring people in wheelchairs down to the low care area, plus quite a few in what we call Princess Chairs – fully reclining bed-chairs. Some people, especially with dementia, need encouragement to come, and I make written invitations for them, which I deliver in the mornings. They like to be invited.’

About 30 people attend the choir each week, of whom 15 will be from the high care or dementia wings. They rehearse 10 to 15 songs and work towards concerts and festivals to which they invite friends and relatives, when the size of the choir doubles. In between the weekly sessions with a pianist, Pamela works on a one-to-one basis with individuals, accompanying on the guitar.

singing faceStudents from local schools also come in on a regular basis. ‘The choir is an icebreaker. Often kids will come in to a high care facility and they don’t know where to look: there’s someone with a paralysed limb, or repeating the same thing over and over. But singing is a neutraliser. You can’t tell what people are capable of by looking at them. We sit the students two between residents, and we often run out of songbooks, so people have to share. You can find a person from the high care area who’s had a stroke but is cognitively unimpaired helping someone from the low care area. It’s hugely important never to make assumptions about what people are capable of because they carry a label – “high care” or “short-term memory loss.”’

I heard about Pamela Bruder from Kevin Johnson of Cisco, who has become interested in how technology might extend the capacity and reach of the choir. Together, they have hatched a plan for a TelePresence singalong with a group of older people from Almere in the Netherlands, where Cisco is pioneering the use of video technology to allow older people to participate in a wide range of activities designed to promote wellbeing. They haven’t confirmed the date yet, but the cross-continent choir will sing together some time in October.

Emmy Monash Choir with visiting school students

Emmy Monash Choir with visiting school students

‘Entry to the Emmy Monash choir is not based on how well you sing,’ Pamela says; ‘it’s a question of whether you can breathe. But we achieve a really good sound quality, because people are so enthusiastic.’

‘Mad professor’ tackles social care

Heinz Wolff

Heinz Wolff

When I get out my camera to take his photograph, Heinz Wolff says: ‘I have three faces,’ and demonstrates: ‘Mad professor [glasses on forehead], slightly less mad professor [glasses on nose] and normal [no glasses].’ We decide to go for mad professor. Continue reading

Shocking photographs of beautiful women

Una Stubbs by Jill Kennington

Una Stubbs by Jill Kennington

Some are famous beauties. Their faces are characterful, fascinating, vivid. Yet the effect of these pictures is shocking, because the women are old.

Infinite Variety is an exhibition of photographs of older women – some famous, some not – put together by the actor Harriet Walter and currently showing at the National Theatre. The idea dates back to 2002, when Walter was playing Cleopatra at Stratford and began collecting and commissioning pictures, and the show takes its title from the play: ‘Age cannot wither her, not custom stale her infinite variety’ – a line that celebrates of the complexity and resilience of an older woman, her powerful appeal.

It’s a sentiment not all that often expressed today, when our ideal images of womanhood are blank-faced girls, Botoxed and airbrushed, onto whom we can project our fantasies. The photographs in Infinite Variety, by contrast, are of women who insist on being themselves. Continue reading