Lucy Pollock - The Book About Getting Older (for people who dont want to talk about it)

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First published by Michael Joseph, 2021

Copyright Lucy Pollock, 2021

The moral right of the author has been asserted

Cover illustration by Christophe Jacques

ISBN: 978-1-405-94444-1

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In memory of Anthony Pollock

In February 2020 I sat at my desk wondering how to indicate a task completed. I had written the last chapter of a book that I had wanted to write for decades, which might help my patients, and those who love them which might perhaps help all of us as we envisage a future that includes years of life far beyond those of previous generations.

I typed the end in a variety of fonts, but none seemed satisfactory. If I had done my job properly, I had reached not the end of a book but the beginning of a conversation.

Less than a year later, it feels as if coronavirus has changed everything. It has changed how we live, and with whom. It has changed where we work, what we wear, who we see, how we greet one another. It has altered futures, has broken and forged relationships. It has taught us a new and unwelcome vocabulary, of social distancing, shielding and self-isolation. It has brought suffering, loneliness and loss.

Yet the things that mattered most about getting older before COVID-19 still matter most now. Has it become easier to talk about them? For many perhaps not. Fear, urgency and misinformation cloud the picture. Has the conversation become more important? Of course. Now, more than ever, the time has come to tread carefully, to treat one another with kindness and respect, and to speak honestly, gently, clearly. We need to work out how to talk about delicate subjects. We need to explore how the shape of our society might be altered, to make the most of the opportunities granted by long lives. We need to consider how we can work together to create a path that allows us to walk into our future, getting older with confidence, sure-footed.

The people in this book older people, their families, friends and carers seem very real to me. I can picture their mannerisms, clothes, expressions. I can see an emerald ring, a stripy tie, a creased handbag, can feel a tremor, hear a phrase or a laugh. And yet none of them are real they are woven together from multiple tiny threads of reality drawn individually from the cloth of others lives. Each person is imagined, with imagined experiences, hopes and worries, but I hope that they will seem solid and truthful, for each has a story to tell. My colleagues, however, are entirely real. I have changed their names to spare their blushes.

It is your birthday. You are about to blow out the candles on your cake, when you realize that for the first time in your life your chance of living until your next birthday is less than fifty-fifty. What age might you be when this happens? At what age do you develop a less than even chance of living another year?

When I ask my medical students this question they start guessing. Seventy? (The students are very young, and I correct them with a raised eyebrow.) Eighty-one, they venture, knowing that this is the average life expectancy in the UK. I push them upwards. The figure is derived from UK census data, averaged across men and women. Lets put the question another way: if we had a party of ninety-year-olds, would we expect half to have died by next year? Frowning, they guess again, but none get the answer.

It is 104.

Late one night in a hospital in London in 1995, I had just seen Mrs Mildmay. I was the medical registrar on call, and she had been admitted earlier that week with a bad cough and worsening confusion. Despite antibiotics and intravenous fluids, her blood pressure was dropping. Her kidneys had stopped working, and her oxygen level was stubbornly refusing to come up. In her late eighties, she had dementia, and she had been living alone since the death of her husband a few years previously.

I sat with her son John. Im so sorry she seems comfortable, and I think shes peaceful, but it doesnt look as if our treatment is working. Its a really bad pneumonia, and I think shes going to slip away.

He looked stricken. I put my hand on his arm. His head was bowed, his shoulders hunched.

Sorry, doctor. Its just well, Dad died of heart failure and diabetes. And now Mums got dementia and pneumonia. I wouldnt mind if it was natural causes, but all these diseases really get me down.

At the time I couldnt help a smile. What, I wondered, did John think old people died of? What would natural causes be, if not pneumonia or heart failure? It has taken me another twenty-five years of looking after very old people and their families, to work out what John was talking about.

We live a long time in the UK vaccinated, well nourished, provided with clean water, and free from war and violence, we are protected from the scourges that carried off our ancestors prematurely in the past. That special age of 104, used to grab the attention of medical students, is real. Even though its a bit of a statistical trick (it doesnt mean half of all people will live to be 104 very few achieve that), it reminds us that we can reasonably expect a very long life. Only four in one hundred people celebrating their eightieth birthday will die before they turn eighty-one. In 2018 the age at which British women most commonly died was eighty-nine; for men the favourite age of departure was eighty-six.

Increases in life expectancy are greeted with enthusiasm by public health experts, because these figures really tell us something about the health of the whole nation; we cannot expect more people to live beyond ninety if we havent made some progress in improving health at sixty, and at keeping eighty-year-olds well. Some years ago the UK government announced a target that south-west England should have the highest life expectancy of any comparably sized region in Europe, and by 2013 we had achieved that.

Yet when I mention these figures to friends, especially to those who are older, they dont look especially happy. Theres a frown, a look of concern. My friend Vivienne, eighty-one and in cheerful good health, asks Why would I want to be a hundred? It sounds grim. There is a frisson of fear that often comes with contemplating extreme old age. The possibilities of pain, loneliness and most of all loss of independence are unwelcome spectres that hover beside us while Vivienne and I talk.