GET OFF THE COUCH GRAMPS

In 1900, human life expectancy in Australia was 38 years. Now, a mere hundred and twenty years later, our expected lifespan has more than doubled. It’s “one giant leap for mankind”.

Men can now expect 80.5 years. Women do better and can anticipate 84.6 years on earth. Mind you, life expectancy for indigenous Australians is trailing at eight years behind the general population. 

Standing in the supermarket queue recently, I overheard an elderly customer at the checkout ahead, telling the young cashier, that ‘old age is an opportunity’. Not everyone has such a positive outlook. Some folk find this time of life to be more of a prison sentence. Many inhabit their elderly bodies in pain and unhappiness. Does it have to be like this? 

When does old age begin? 

Becoming older is something shared by everybody, one birthday after another. In my young living memory, old age was clearly defined by job retirement. ‘Over the hill’ men stepped into a time of no purpose. No longer functional on the treadmill, rapid senescence on the rubbish heap was the expected outcome. 

Chronological age (birthdays added up) and biological age (state of health in body and mind) is an observable divide. It’s less about the illusion of anti-ageing than seeing that some people in their 80’s and even 90’s are energetic in mind and body. When I see these people, it gives me hope. And there seem to be plenty of them. 

“Over the hill?” Not Moi!

‘Over the hill’ does not have to be the beginning of the end. We have to expect watershed events with getting older and learn to deal with them in constructive ways. Here is my own story of a confronting shock. 

It was a beautiful crisp day, me in my mid-60’s (about ten years ago) walking on the beach. Feeling so good I broke into an unaccustomed sprint. My joyful run was brought to a sudden halt when I felt a whack in the calf of one leg. I turned to face my assailant, but I was the only one there. The next few steps left me in little doubt that I had a torn Achilles tendon. My body refused the brain’s order to lift my heel from the sand. 

The next six weeks in a moonboot gave me pause for review. My body had been faithfully looking after my whims all my years. I realised that it was time to nurture, rather than use and abuse the body. I had to recognise running was no longer safe. My ageing process needed a new skillset. 

Finding a balance

So what to do? The answer is also in what not to do. The safety of the couch is not the full answer because something obvious is emerging from research. To sustain good health, older people need to find a balance between activity and rest. 

Activity and movement

‘Try feeling depressed when you’re waving your arms about over your head’ a Qi-Gong master named Rod demonstrated to his class. Try it. This small demonstration affirms current research, that body movement sends signals to the brain, vital for producing healthy neural cells. 

Walking is a natural human activity, learned in childhood and so ingrained by now that we take this unique gift for granted. Master Rod remarked, ‘We die from the feet up. The slower the walk, the closer to death’. Mindful legwork may benefit brain health more than a crossword. That’s hardly a discovery. ‘Solvitur Ambulando’ is an ancient saying that translates, ‘It is solved by walking’. If there’s a choice, a walk is healthier than sitting in the car, climbing steps more useful than the lift. 

One-third of Aussie adults are inactive. A very elderly patient told me, ‘If I had known I would get this old, I would have taken better care of myself.’

The arthritis association recommends Tai-Chi, a tradition related to Qi-gong, which I find comes more easily. A Master said, ‘there is no good practice or bad practice. There is just practice- or no practice’. 

How do we keep up an interest? A paediatrician said, ‘Watch children at play. They are always doing something different. Adults choose repetitive exercise, which can be very boring.’ 

Letting Go

Why do we spend our lives building up a bank of skills, just to let them go? A friend passionate about SCUBA diving told me she had given it up because all the equipment became burdensome and climbing back into the boat too exhausting. Her 60-year-old body was telling her something. Due to her ability to review and let this part of her life go, she might have avoided the perils that come with ignoring the inner voice. Swimming and snorkelling were much more manageable, and she was able to modify her lifestyle enjoyably.

Everybody has different needs and abilities. If an 80-year old is used to running, sailing, skiing or riding a horse, why stop? That time might come with the likelihood of falling off whatever it happens to be. There may be no second chance. How can you dance between safety and independence?

Falling over

I can speak with some feeling about this. As a young doctor working in the hospital emergency, I recall the steady stream of older people turning up at the casualty due to falling accidents, many of them at home. A frequent presentation, ‘a fall onto the outstretched hand’ was commonly the defining event, resulting in injuries ranging from a lacerated palm, frequently a fractured wrist, elbow, even shoulder or hip injuries. I learned how fragile bones (osteoporosis) could make a trivial incident into significant damage. In an instant, that person’s life may be changed or shortened into a painful demise. 

Forty years later, I can face up to my professional detachment as a junior doctor as heartless. We had a collective description of weak elderly patients- ‘crumble’. It was a pejorative term, but embedding a reality, that these people were inevitably falling apart with no way back. Young doctors felt above the calamity that can accompany old age. Now I have more skin in the game and know that positive change may be within reach. 

Old habits die hard 

A surprising number of Boomers drink alcohol every day, just like in the old days, that daily relaxer after work. Many don’t consider it a problem because the bottles pop only after sundown and better drink is more affordable. When the liver descends into rack and ruin and a problem has to be acknowledged, comes a moment of great opportunity to gently break the habit, like making one alcohol-free day every week. For instance, if Tuesday is a training or sports day, make it a healthy day, maybe substitute beer with a healthy Kombucha. A cold glass in the hand that looks and feels like a drink can fill the emptiness of habit, and the over-worked liver will appreciate the opportunity for a breather. This sort of direction can produce encouraging results in feeling better. 

Nutrition

Concerning food, a new concept, introduced by Dr Michael Mosley, is called intermittent fasting – 2 days a week of hardly eating. In essence, this makes good metabolic sense. But the recommendations are unsustainable for most older people. They do though present a different way to consider hunger – as a normal sensation. We fear what resides in our genetic memory. Some of our ancestors came here as refugees from the Great Hunger, the potato blight in Ireland circa 1850. The world wars and the great depression of the 20th century made starving times for our recent ancestors. In today’s world, taking on hunger is novel and voluntary. 

An adaptation of intermittent fasting, deliberately not eating between meals, highlights snacking as an unconscious habit. I have to work on my pattern of chocolate biscuits after dinner. Learning to curb an impulse is hard, but a craving resisted soon passes. The health dividends are huge because not-eating makes the time between dinner and breakfast a meaningful twelve hours. An extra benefit derived from not eating and drinking late in the evening is improved sleep. Restful sleep is vital. 

Conclusion

Health in later years is a big topic. For sure, illness and injury get in the way. Some of these things are bad luck, but preventative medicine can nip things early. Tune in with your doctor. By the way, Dr Atul Gawande, in his excellent book ‘Being Mortal’, praises podiatry as a most valuable service for seniors. Healthy feet enable activity for as long as possible. 

I don’t know yet about extreme old age. The best news I have heard is that it doesn’t last very long.

Dr David Miller

(Retired GP)

Brunswick Heads

Dr David Miller is a retired GP who writes on Health and Travel

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