You’re Looking Very Well

Lewis Wolpert YOU’RE LOOKING VERY WELL The Surprising Nature of Getting Old

Acknowledgements

As always I have had a lot of much-needed help. I am greatly indebted to Alison Hawkes for her editing and comments throughout my writing of the book. I am also indebted to Julian Loose, my editor, and Kate Murray-Browne at Faber for their comments and encouragement. My thanks also go to my agent, Anne Engel, and to all of those who gave up their time to talk to me.

1. Surprising

‘Old age is the most unexpected of all the things that can happen to a man’

— Leon Trotsky

When we are young we do not think about being old; it is simply not part of our agenda. So when we age we are not prepared for it and it can be quite a surprise. It has come as a shock to me. How can a 17-year-old, like me, suddenly be 81? The only obvious features, if I do not look in the mirror, are that I now walk so slowly that most people dash past me on the pavement, and I have retired from my university job. I find it hard to come to terms with both. But I also forget names, words and faces. I recently forgot several things I had meant to do, and was worried that this was age-related and might indicate the start of dementia. I intended to ask my psychiatrist at my next appointment related to depression. I went to see him and then laughed when I remembered, as I cycled home, that I had forgotten to ask him.

I never thought much about ageing, but Shakespeare’s memorable description in As You Like It doesn’t offer a particularly positive view:

All the world’s a stage
And all the men and women merely players;
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurse’s arms;
Then the whining schoolboy, with his satchel
And shining morning face, creeping like a snail
Unwillingly to school…
The sixth age shifts
Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose, well sav’d, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans every thing.

I decided I wanted to understand ageing, not least because it seems so different a topic from the one I have spent most of my life studying, the development of the embryo. Is ageing part of our developmental programme? We are essentially a society of cells, so what is the cellular basis and what is the cause of both physical and mental decline in old age? Can these be prevented? Is immortality in the future a real possibility? As the proportion of elderly people in society rises, there are more general social and economic problems related to their treatment and care. I needed to know how the old can live well, and whether, when the time comes, we can choose when to die. Also, does understanding ageing help with one’s own ageing?

Yet old age is by no means easy to define. It is a biological phenomenon characterised by certain physical changes that take place with time and also by their psychological consequences. It is the changes in individual appearance that prompt your friends to remark, ‘You’re looking very well.’ Indeed, one can now think of there being four ages, rather than Shakespeare’s seven, in our lives: childhood, active adulthood, maturity and finally ‘You’re looking very well.’ As an 81-year-old, I hear it all the time, and use it again and again when I meet my ageing friends. There is a quite wide belief that old age starts at around 65, which has been a common age for compulsory retirement. But now that there are so many aged over 75 and even 85, we need to look again at when old age really begins. Of course ageing really begins, as we shall see, when we are quite young—there are few 40-year-old football or tennis champions.

Getting old is often more apparent to others than to the actual person who is ageing, and many who are old persist in the belief that they are still young. It is important to realise that everyone ages differently, depending on their circumstances. The big question is how one deals with old age. The author Doris Lessing, for example, finds it acutely irritating. Does one try to find new activities? Should one reflect on one’s life to decide if it has been worthwhile? And how does one deal with both bodily and mental decline?

* * *

For many, ageing is frightening. Only about one in ten of those aged 75 to 79 remains free of physical illnesses such as those of the heart, eye and bones. Those with wealth and a good education do best, as do those who have a positive attitude to ageing. But though all our bodily functions deteriorate with age—for example, muscles lose their strength and the immune system weakens—evidence from those who play sports shows that even when old it is possible to continue to play quite well. There are also many false ideas about the decline of sexual activity in the elderly: in fact there is little evidence for a significant age-related decline.

There is a significant chance of developing a mental disability after the age of 50, dementia, particularly Alzheimer’s disease, being the most common. This costs the UK an estimated £17 billion each year, and is a great problem for carers. Other common age-related mental diseases include Parkinson’s disease and depression. But while our mental abilities undoubtedly decline with age—we become forgetful and slower—our acquired knowledge, fortunately, seems to remain intact. Many of the old hold high positions and remain creative, with their intellectual abilities in good shape.

For some, old age has very positive aspects. It can even be a time of joy. Today the title of the Beatles song would be ‘When I’m Eighty-four’. At the age of 106, a neighbour of mine is very happy and still active with her piano playing. Things that are dear may become dearer, such as ideals, friendships and family. There may be time to do things which we could not do when we were young—and there is the possibility of being adventurous either physically or mentally, even if immobility is creeping on. For me it is very encouraging to see that even when old, scientists can still be very active. A fine example is Professor Dennis Mitchison, a friend of mine who is distinguished for his work on tuberculosis. Mitchison is 90 and is an Emeritus Professor at St George’s Hospital medical school. I asked him about his views on ageing:

I did not begin to notice the effects of age till I was about 85. I got a bit slower and my organs worked less well. I enjoy my current age since the research is very exciting and even if a bit slower I just get on with it. I collaborate and get grants mainly from drug companies. We have seven scientific papers in preparation, one of which has just been rejected but at my age I get less upset when things go wrong. We have a project that will only be finished in about ten years—not sure I will still be here. I do think that euthanasia raises difficult problems but I do think we have the right to choose when to die.

We live longer today than at any time in history. Over a sixth of people living in the UK are expected to celebrate their 100th birthday. Mortality has been considerably postponed, as a result not of revolutionary advances in slowing the process of ageing, but of progress in improving health. Ageing itself has undergone a dramatic change over recent years. In the industrialised world in the twentieth century there was an unexpected and unprecedented growth in the older population—some 30 years were added to life, an increase greater than in the previous 5,000 years. This was due to improved healthcare, food and sanitation. There are now more people aged over 65 than under 16 in the UK. And the number of people aged 85 years or more doubled between 1983 and 2008.