The elderly old

I have a problem with elderly. I really don’t like the term, it makes me think of dependence, vulnerability, falling-over and needing assistance – it is, to my mind, a misrepresentation of what it is to be old. Whatever old is.

Who are the old? Who are the elderly? Are they those people living in nursing and residential homes across the country? Are they those who have retired? Are they the people you see walking along the street with a stick in one hand, a shopping trolley in the other?

You see, it is so hard to define who is old and what is old.

When I think of old, I think of my grandfather, who would have been 105 last summer, I think of his old ways, his style of dress, slicked-back hair and smile.

As a doctor whose reason for being is caring for older people, you might think it funny that I haven’t got a handle on this yet. I mean, those other specialists in medicine, the cardiologists, gastroenterologists and endocrinologists, etc. all have a fairly good idea of where their remit starts and ends – either with the heart, the gut, the hormones, or some other organ.

I however, am adrift in the complexity of what it is to be old.

You could argue, that my remit is treating those people who have diseases and conditions that are associated with the ageing process; yet, what are those? Certainly, strokes, dementia and Parkinson’s disease are all occur more commonly as people age, yet, I have seen people, all younger than me with these diseases.

Perhaps, it is those who experience diseases that predominantly just affect older people – again, strokes and the others would feature here, but what about the conditions – falls, infections and pain that occur with equal frequency amongst younger people, even children?

And, this comes back to my problem with old & elderly.

I hate the associations these words conjure in my mind; thinking elderly, I see in my minds-eye those road signs outside care homes with a stooped, black and white figure carrying a walking stick.

I hate the notion that people who are old are somehow dependent, when most older people, whatever their age in our society or around the world are happily living independent lives without recourse to health or social care; I sometimes wonder whether some of those work in care imagine that their role is to save the elderly from themselves.

So, I have a problem with the elderly; what do I do when I have James, a 95 year old man, with coal tattoos crisscrossing his knees from years down the pit, as he coughs and lies in bed worrying about his wife who is at home, struggling to cope herself.

Do I swoop down and make everything better, like some sort of therapeutic Cinderella? Or do I move in ways that are more cautious, helping James establish where he is, what has happened, acting as a guide to facilitate his recovery, to assist his return to independence?

All too often, we, the caring people – whether doctors, nurses, therapists or social workers inadvertently harm people by caring too much, by being over-protective and vigilant, believing that despite our fewer years of life and experience, we know better.

We need to let-go, we need to accept our role, accept that patients are in general better off not being patients, are better off, often, without our intervention.

For those times when we are needed, when the services of someone trained in the art, science and craft of medicine are required, we need to provide as little support as will enable the person to recover, all the time, balancing the scales of dependence and autonomy.

So, I prefer older people, they are more fun to be around, and, more interesting, they have better ideas and retain more of themselves than someone who has been diminished to the level of patient, or elderly, at that.