Incapacity, Indignity, and Incontinence: Hoping That Help is On the Way?
The goddess of Dawn fell in love with a Trojan prince called Tithonus.
By Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal
"It is not how old you are, but how you are old." - Jules Renard
This issue of HELEN examines the phenomenon of aging with disabilities. This is a relatively new topic as we know that the lifespan of individuals with disabilities, specifically those with intellectual and developmental disabilities, is two decades less than people without disabilities.
The Greeks and Romans laid down the original concepts of the “paradox” of aging. Wisdom coupled with fragility.
Geras was the Greek god of Aging. Geras was known to the Romans as Senectus. As with the Greeks, his shrunken, frail body symbolized not only old age, but the human fear of painful ageing and death. The Romans also painted Geras as a frail old man leaning on a staff. Geras is surely what the Sphynx had in mind when it asked: What goes on four legs in the morning, two legs in the afternoon, and three legs at night? (The answer: Man. He crawls on four legs as a baby, walks on two legs as an adult, and walks on three legs, with a cane or staff, in the evening.)
Geras is seen most often in paintings on Greek vases alongside the famous hero Hercules. He is typically depicted in Greek artwork as an old man wearing a toga and leaning on a cane. He holds out a hand and looks up at Hercules as if asking for help.
The term “geras” also meant a kind of wisdom in ancient Greece. It was virtue and something men gained. The more “geras” or age a man had, the more courage and fame he had. The modern word “geriatric” is thought to have its root in Geras.
“Over ten years ago, Mary Beard from the BBC, penned this thoughtful view of the paradox of growing old. It is a sad commentary that, over a decade later, we are still struggling to promote, celebrate, and embrace those who care for those who continue to wear togas and lean on canes. ”
One cannot approach the subject of aging without thinking about the need to care for, support and dignify those who are the modern day reflection of Geras.
Over ten years ago, Mary Beard from the BBC, penned this thoughtful view of the paradox of growing old. It is a sad commentary that, over a decade later, we are still struggling to promote, celebrate, and embrace those who care for those who continue to wear togas and lean on canes.
Surely, we can do better!
A Point of View: The Paradox of Growing Old
May 9, 2014
Mary Beard reflects on the way the elderly - and their carers - are treated in society.
Once upon a time, according to ancient Greek mythology, the goddess of Dawn fell in love with a Trojan prince called Tithonus. She was so besotted with him that she went to Zeus, the king of the gods, to ask that Tithonus be made immortal. Zeus agreed, but Dawn had been foolish - she had asked for (and received) eternal life for her lover, but she had forgotten to ask for eternal youth. The result was that Tithonus just got older and older and older, though he never died.
Dawn at first looked after him at home, "nourishing him with the food of the gods and dressing him in rich clothing”, as one Greek poet put it in the 7th Century BC. But eventually, when he became absolutely incapacitated, Dawn locked the poor man away. Or, as the same poet goes on, "when awful old age pressed down upon him, she put him away in an inner room of the house and shut the shining doors.” You could hear his "ghastly babbling" ever after, but he could not move a limb.
When I first came across this story, I took it as a cautionary tale about how difficult it was to deal with the almighty power of Zeus. If you ask a favor from the king of the gods, you had better take care to ask for exactly what you want, or it will be sure to rebound. Now, at 59 and a bit, it's perhaps no surprise that I see the tale of Tithonus also as a parable about old age and the various forms it can take. It reminds us that there is the world of difference between being a sprightly, albeit senior citizen, and the degrading state of total dependence.
For most of us, the worry about getting older is not really about the passing years and their minor symptoms (the thickening toenails, the creaking knees or, as I discovered recently, the uncomfortable truth that it is no longer very wise to try to leap down four feet off a wall). In fact, some of these clouds actually have their silver linings. I am very happy to walk unnoticed past a building site, entirely un-whistled at (there were a few years when I fondly imagined that the behavior of the average builder was improving - but the truth is that it was only me they weren't interested in), and, for every woman who is laid low by the menopause, there is one like me who feels liberated by the idea of never having to deal with cramps or a tampon again. What is worrying is the thought of what might happen to us if we cross to the dark side, to the Tithonus side, of old age. Past the senior railcard, to a world of incapacity, indignity, and incontinence.
To put it another way, there are two faces to "seniority" in the West. One is that it is still enjoyed by the relatively healthy and the relatively affluent (and affluence bolstered by decent pensions is, of course, crucial). The other is that long decline into death, which is suffered by ever more of us - a long and "awful old age" as my ancient Greek poet put it.
I can't help thinking here that some of the modern medical professions have made much the same mistake as the goddess Dawn. Why on earth, when so many doctors themselves wish for a quick death from a massive heart attack, do they expend such efforts (and money) in preventing their patients from having exactly that, consigning us to the expensive and nightmare world of the very old and the very decrepit?
These two faces were vividly captured in the news last week. On the one hand, we learned of a big, sell-out discussion in central London, on "How to look hot at 100". This was a kind of "90 is the new 70" event. It featured a man who runs a blog-site, which captures, I quote, "the sartorial savvy of the senior set" and a 76-year-old grandmother keen (as I am) on Doc Martens (to be honest, the whole event brought out the counter-suggestible in me. If, unlikely as it is, I ever get to be 100, I hope I've got something better to do - I thought - than wonder how to be "hot").
On the other hand, there was a series of television programs and newspaper articles about some of the terrible things - and some of the totally unacceptable regimes of care - going on in Britain's "care homes" for the elderly. I don't think anyone could have watched these programs without feeling ashamed - seeing old people crying because no one will take them to the lavatory, to see them being ridiculed, abused, and hit, was deplorable. As an historian, my guess is that in a few hundred years’ time, the treatment of the frail old in 21st Century Britain will be seen as much of a blot on our culture as Bedlam and the madhouses were on the culture of the 18th Century. There will be many books and PhD theses written on how, and why, we got it so wrong.
But the spotlight will not just be on the carers (some brilliant, some inadequate, some - frankly - cruel). It will also be on us, on the readers and the television audience, who looked at these programs and deplored.
Of course, from the safety of our own living rooms, we like to think that, if we were the carers, we would be more or less consistently kind to the frail elderly - we would not abuse or hit. But can we be quite so sure? Dementia is a case in point. The popular, sanitized view of this has made it a rather gentle condition - sufferers are "confused", a bit dopey, living in the past, with the fairies or on another planet. Some indeed are like that, and I hope that that has how come to me, if and when it does. But this disease has a cruel side. Others, we know, become truculent, aggressive, and more difficult to care for than the euphemistic adjective "challenging" can possibly capture.
Most parents know the experience of "losing it" with their own young children. Love them as you do, cute as they are, there are occasions when they wind you up so much that you shout at them too angrily or give them a slap (even though you know you shouldn't). It's wishful thinking, I suspect, for most mothers and fathers to claim anything else. Of course, we shouldn't compare the care of the elderly with that of the very young. Despite Shakespeare's "seven ages of man", which precisely squares that circle, it's misleading (and insulting) in all kinds of ways to conflate the two. But I still wonder how many of us who don't always remain calm with our own beloved offspring could work in a care home and not occasionally say, or do, something we regret to the sometimes very difficult residents.
It is extremely instructive to look at the reports on relatively decent care homes produced by the Care Quality Commission and available online. Here you start to see below the lurid headlines of the day-to-day reality, and conflicts, of the care home world. One old lady, I read, had not had a bath or a shower for over three weeks - or so one partly critical report noted. Why hadn't she? Well, it took three people to get the lady to the shower, and she didn't want to have one anyway. Maybe they had got the care plan wrong, maybe they were too busy to coax her in the right way. Or maybe when you're over 90 you should just be allowed not to bother.
Try too looking at the job descriptions for care home assistants. We are seeking, they say, someone with a couple of NVQ's who will "enable service users", another coy euphemism, "to achieve independence as far as possible in all areas of their life", "help [them] to identify and choose their support needs", someone who will "understand how to treat the patient/client with respect and dignity", and "understand the rights of the individual to have their wishes respected". And so on.
So, is there a better future in sight? When all those books and theses are written in a few hundred years’ time, will the solution seem obvious, the problem solved? We can only hope so. It would be nice to think that when the so-called "elderly" make up a third of the population, sheer people power might make a difference. The fact is, though, that when most of us get to the frail stage, we're past speaking out, as that long non-death of Tithonus reminds us.
His should be a warning tale for all of us in the savvy senior set, still striding out in our Doc Martens.
(A Point of View is broadcast on Friday on Radio 4 at 20:50 BST and repeated on Sunday at 08:50 BST. Catch up on BBC iPlayer.)
Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal