The Book About Getting Older and Ageless: Two takes on ageing

The Book About Getting Older by Dr Lucy Pollock (Michael Joseph, £16.99)
Ageless by Andrew Steele (Bloomsbury, £20)

“In 2018, the age at which British women most commonly died was 89; for men the favourite age of departure was 86.” Dr Lucy Pollock doesn’t give information on the situation in the Republic of Ireland, although she refers frequently to Northern Ireland when discussing health services and legal issues, but the Central Statistics Office gives similar figures for Ireland. According to Andrew Steele, author of the second book under review , “the maximum life expectancy has increased by three months every year since 1840”.

Both books deal with “getting older”; both offer advice on how to remain healthy for as long as possible, and both are interesting and engaging. In one major way, however, they differ radically. Pollock accepts ageing as an inevitable part of life, to be handled as sympathetically, comfortably and sensibly as possible. Andrew Steele sees it as a condition not unlike an illness, which can be “cured” – and quite possibly will be.

Nobody wants to talk about what will happen if they become incapacitated, if they are no longer able to think clearly or make decisions themselves

A geriatrician who loves her job, Pollock, aka Dr Lucy, has experience dealing with old patients. An advocate for the rights of the ageing, she vehemently criticises common ageist prejudice, promulgated by the media, government and people in general: terms such as “a demographic time bomb” and the “economically inactive” are bandied about, promoting a sense that the old are a burden society would be better off without. Why should we accept these slurs?

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Treatment of old people

In eminently readable prose, the book discusses common physical illnesses which plague the elderly – from falls to cancer to dementia. Dr Lucy is critical of ways in which old people can be treated in hospital. They can be victims of hasty, incorrect diagnoses; over-specialisation by consultants; polypharmacy – the all too familiar practice by which patients are prescribed vast quantities of medicines by different specialists who don’t communicate with one another, medicines which may interact badly, rendering some useless or even harmful. Due to lack of time, a holistic approach to treatment and medication is often lacking.

Possibly the most important chapters in this useful book are those about the end of life and how to prepare for it. Pollock discusses advance care plans, the question of resuscitation, power of attorney. Nobody wants to talk about what will happen if they become incapacitated, if they are no longer able to think clearly or make decisions themselves. Above all, nobody wants to talk about actual dying.

She is adamant that the old and ill should be helped in every way possible to make their own decisions about such delicate matters as whether they should be resuscitated or not, and down-to-earth matters relating to the management of their finances. She points out that sometimes it can be decided that an old person lacks mental capacity, when what he needs is a new battery in his hearing aid.

Although Pollock does not take a stance on assisted suicide, she strongly believes that very ill old people who have “no quality of life” should be allowed to die peacefully, without medical intervention, if they so wish, and points out that there is nothing in the Hippocratic oath which prevents such a course of action.

The tone throughout is warm and friendly, even as serious and dark subjects are under discussion

It is next to impossible for humans to imagine being dead. But we can readily imagine, and thus anticipate, being ill, being in hospital, losing our memory, not being able to function physically. What do we want to happen in the event that we are totally incapacitated? “The debate about assisted dying . . . has distracted us from a more pressing need,” Pollock writes. “We need to talk more openly and kindly about the benefits of treatment in those coming towards the natural end of a long life.”

Death

Her most wonderful chapter is on death itself – that most mysterious, ordinary and taboo subject. She quotes a comforting description of death by Dr Kathryn Mannix: “Dying, like giving birth, is just a process. With time people become more tired, more weary. At some point . . . when we go to wake the person who is dying, they are more than asleep. They are unconscious and can’t be woken.”

In the manner of self-help books, The Book About Getting Older is populated by a large cast of invented characters, mostly distinguished by their clothes: “Cathy, who is wearing a fluffy pink sweater and has a gentle face”; “Mrs Everton is wearing a cream polo neck and brown trousers”.

These fictional people bring the abstract topic to life. The tone throughout is warm and friendly, even as serious and dark subjects are under discussion. It is an important book.

The author seems to take if for granted that everyone wants to live for as long as possible

There are no characters in fluffy pink cardigans in Andrew Steele’s Ageless. Rather one encounters tortoises from the Galapagos Islands who live for 200 years, or the 400-year-old Greenland shark, as well as a lot of mice. (En passant, and of interest right now as we vaccinate the oldest in society against Covid-19, both Steele and Pollock point out that clinical trials are seldom conducted on anyone above the age of 65. Even the laboratory mice tend to be young.)

Ageless employs a scientific vocabulary – autophagy, amyloids, adducts and countless other specialised terms abound. But the book is nevertheless accessible, its style chatty and engaging. As a computational scientist, Steele explores the history of ageing and views it as a medical problem rather an inevitable destiny. A relatively new science, biogerontology, researches the physical process of ageing and seeks cures for it.

This is an enthralling book, the essential message of which is that advances in science and medicine mean that increased longevity in humans is on the horizon. The author seems to take if for granted that everyone wants to live for as long as possible. Given that he means they want to combine longevity with health and fitness, I think he is probably right.

Most of Ageless is concerned with recent advances in scientific understanding of the ageing process, the prospects of a cure for ageing, and a plea for more funding for the underappreciated science of biogerontology. And although he writes that the longer we manage to hang on the more likely we are to be around for new cures, like Pollock he includes a chapter giving tips which may help in the meantime.

Dr Lucy claims that exercise is the single thing proven to promote health in old age. Steele has several recommendations for those who want a long life: don’t smoke. Don’t eat a lot. Get exercise. Get eight hours’ sleep. Take care of your teeth . . . And be a woman.

There is not much new on that list, but the rest of his book is packed with new and fascinating insights and ideas. I am in no position to judge the scientific validity of the information or his conclusions, and since it is a “popular” book there are no footnotes. But Steele includes more than 50 pages of endnotes that provide evidence for his claims, as well as suggestions for further reading.

In the meantime, Ageless is a rich and exciting exploration of that surprisingly intriguing topic we'd rather not talk about: old age.

Éilís Ní Dhuibhne's latest books are Twelve Thousand Days: A Memoir of Love and Loss (Blackstaff, 2018) and Little Red and Other Stories (Blackstaff, 2020)