Old Age Is Not an Illness
The points of reference of normality and health have been placed firmly in young adulthood. Old age has lost the value it once had. When life was more stable than it is now and technology did not change the way people lived each new generation, older people acted as the community’s reservoirs of wisdom.
Patriarchal and matriarchal societies in the relatively recent past listened to the opinion of their elders in times of crisis. Whether this social prestige would have been enough to compensate for the losses often experienced in old age is a different argument, of course.
We still have sporadic examples of gerontocracy, like the pope, or the American president, but they are exceptions.
From a cultural point of view, old age is not so much rejected as it is denied. Old people are rarely seen in cinema and TV dramas, and when they are shown, they tend to be portrayed in negative roles.
Alternatively, they may be depicted in benign but infantilizing roles, often pretending to be young and portrayed as frisky, disinhibited, and generally comic. Given that most films belong either to the romance or to the action genres, one can forgive scriptwriters for not including many old people in their stories.
To put it brutally, the loss of sexual attractiveness and physical vigor that comes with age has erased old people from popular culture. Old has become abnormal and therefore, in a sense, pathological.
Growing old well
We, health professionals, know better, of course. We know that there is a dignity in growing old well and that it shouldn’t be necessary to pretend to be young to be valuable. And yet, we also unwittingly contribute to the marginalization of old age by pathologizing one of its inherent attributes. We accept oldness, but not forgetfulness.
The British Medical Journal has been arguing for some time that our profession over-medicalizes life in general, but in old age we seem to over-medicalize cognitive issues in particular. No doctor would regard a diminution of physical strength, or wrinkly skin, as pathological processes in old people, and yet the relative loss of mental agility that tends to be associated with old age is often given a name—mild cognitive impairment—and a diagnostic code.
This is despite the fact that MCI has no useful value in predicting dementia. MCI is a risk factor for dementia, but most people with MCI do not go on to develop the disorder. And there is no evidence that it is frequently associated with the essential characteristics of a medical disorder, such as suffering or distress, other than that resulting from the worry of receiving a pre-dementia diagnosis, ironically.
Loss of mental agility is not pathological
Any loss of mental acuity is arguably a bad thing, but so is any loss of physical strength, skin suppleness, fertility, or sexual attractiveness. So why do we single out cognition as the one area of decline that deserves a diagnostic code?
We reside in our brains, so any mental decline, however mild or natural, may threaten our sense of identity. Devoid of the positive social attributes that she once held, and unable to manage new technologies, the slightly forgetful old person is now marginalized and labeled as pathological.
Celebrating old age
Celebrating old age may be a challenging task, but we should at least accept it for what it is, warts and all. Denying old age by pretending to be young is undignified and futile. Denying the attributes of old age by declaring them abnormal is also futile.
Old age is natural and potentially beautiful. An early death is the only way to avoid it, so it is also desirable, even if it brings with it wrinkly skin and a little forgetfulness.