Ageing is increased vulnerability to infirmity and disease. In a study of over a thousand over 85 year olds in Newcastle, none were without disease. The average number of diseases in those studied was 4 for men and 5 for women. Around 50% reported significant pain lasting for more than a day in the last month. Over a third had fallen in the last year. A quarter of women had profound urinary incontinence. Over half of both men and women had hearing impairment, and between 30 and 40% had some form of visual impairment.
One would expect, given these statistics, that the level of disability in this group would be correspondingly high. 20% of the cohort, however, reported no difficulties in the performance of 17 daily activities such as washing, dressing, eating, getting out of a chair and so on. On average, men had some difficulty with 2 of the activities and women, 4. In other words, the level of disability was low even though the prevalence of disease was high.
78% of those studied reported that they were in good, very good or excellent health given their age. This combination of a positive outlook as regards health and a low level of disability provides a real challenge to our standard account of what it is to be healthy. In this light it cannot be right to think that the absence of disease is the necessary mark of health, though it may be sufficient for it. The World Health Organisation defines health in these terms:
“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity”
If old age brings with it disease and infirmity, then according to the WHO old age is necessarily unhealthy. This is clearly an unsatisfactory account of ageing. It fails to take account of the ability to manage multi-morbidity while suffering low levels of disability and while maintaining a real sense of mental and social well-being. What it is to be healthy simply does not remain the same throughout the life course.
We should not seek to romanticise or wish away the horrors of infirmity in old age, but neither should we prejudge what it is like to live with multi-morbidity.
Last month Cumberland Lodge ran a conference entitled: Our Changing Expectations of Life: What Do We Really Want? (26 – 28 November 2010). For a further summary of the discussions that took place, click here to download the report>>
Dr Owen Gower
Senior Fellow
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