FADING eyesight, uncertain memory, scrawny limbs and diminished voice in the sixth age, as described by Jacques in As you like it
, herald the journey towards our inevitable end.
We have increasingly corralled our old folk into small residential units or aged care facilities, away from family life and their children and grandchildren, often a long way from where they formerly lived and where remaining friends still reside. Because families are not available or are too busy to provide consistent support, care for many aged persons has necessarily become professionalised.
At the same time, life expectation has increased, with greater confidence in the ability of medicine to reverse serious pathology. Common diseases of older age, such as cardiac and respiratory insufficiency, renal failure, diabetes and cancer, now have treatments that were unknown in past decades.
Dementia remains a source of frustration, increasing in prevalence as age advances, and continuing to resist effective prevention and treatment.
As medical specialties assume more importance, the generalist family physician fades from the aged care scene, undertaking fewer visits and less supervision in aged care facilities. Patients and families increasingly feel a sense of passive dependence, waiting for the next round of prognostic or therapeutic pronouncements from the next specialist, which are too often couched in the jargon of that particular specialty.
The overall result is a loss of control, augmenting a sense of separation and isolation that is amplified by the rigid routines of an aged care home. The professionalisation of aged care carries a number of consequences that do not, of themselves, promote good health.
Meeting the challenge of aged care in future decades calls for a re-imagining of what it means to be old, and how healthy, active ageing might be recognised, encouraged, facilitated and admired.
In some cultures, there has traditionally been a place for the elderly that is missing from our culture today. The elderly were few in number, but they had a happy place in the scheme of things, knowing the important stories and skills that remained significant to that time, centred within the extended family, surrounded by familiar things and persons.
I saw this in the 1960s in Papua, where it was the village elders who knew the stories of legend and the past that lent significance to the community, placing it in a context of history and wider relationships.
Less value is placed on these memories and skills in our modern urban centres, so how do we make our older citizens relevant and productive in the 21st century? How will they find a meaningful cultural role among the persuasive, rapidly-changing technologies, the new groupings fed by social media?
Our elderly are fitter
than ever before, and many cope remarkably well with their multiple chronic conditions, so should they be better primed to take a larger role in community life in the times ahead?
This will require our elderly to detach themselves from any traditional querulous disappointment with their isolated lot, or any self-satisfied complaining about what value and meaning has been lost in the lives of the young.
They will need safe and available opportunities for continued learning, best accomplished in their own settings, where both physical and intellectual capacities are renewed and enhanced.
We need to imagine and prepare for elderly persons who will look forward with optimistic intent to the decades that stretch ahead in retirement, and who will be ready to engage with their next phase of life.
Care facilities, while remaining centres of residential care for the dependent and needy old, should offer comprehensive education opportunities and physical training. They should have places to build relationships and skills, and to contribute time and knowledge into many areas of community life, offering new volunteer support opportunities not considered in times past.
A re-modelled aged care facility can become a community hub.
It can house a family medical practice, with a team including nurse practitioners and carers skilled in aged, dementia and palliative care, and paramedical staff ready to support care, both in-house and in local homes.
Our elderly can come together in these hubs. They can feel empowered to explore their physical and mental capacities.
These hubs can build some truly effective “grey power” to contribute meaningfully to communities that will not just bring them new respect, but will eventually come to rely on them.
Emeritus Professor Ian Maddocks is an eminent palliative care specialist, recognised internationally for his work in palliative care, tropical and preventive medicine. He was Senior Australian of the Year in 2013.