Growing Older Without Feeling Old by Rudi Westendorp

Author:Rudi Westendorp
Language: eng
Format: epub
Tags: SCI086000, HEA049000, MED032000, FAM005000
Publisher: Scribe Publications Pty Ltd
Published: 2015-07-28T16:00:00+00:00

FRAILTY

Equating ageing with ‘collecting’ partial causes of disease helps us to understand the difference between chronological and biological age. When people have accumulated a lot of lasting damage, and so have ‘collected’ many partial causes of disease, they become frail. They are biologically old, and that is usually also reflected in their appearance. ‘He looks old for his age,’ people will say. Physical appearance is also the first thing doctors look at when a new patient comes into their surgery: how old do I judge him to be? Only then do they check the patient’s date of birth to see whether their estimate was right. Sometimes patients turn out to be older than thought — this usually has something to do with the reason they are visiting the doctor — but other people sometimes look amazingly good for their age. Perhaps they have been able to avoid damage during their lifetimes, or they may be blessed with a better capacity for repair.

This initial estimation of biological age helps a doctor get a feeling for whether a patient is generally ‘alright’ or ‘not alright’. If someone is biologically young, their chance of falling sick, becoming infirm, or dying in the near future is considerably reduced, because they have collected fewer partial causes. But judging whether someone is ‘alright’ or ‘not alright’ is difficult on the basis of appearance alone.

I recently met one of my neighbours on the street. He is in his late eighties, and has been married for more than sixty years. He and his wife live down the street, in the house they used to live in with his wife’s grandmother. When the grandmother died, the couple inherited the house. They are of the pre-war generation, amiable and doughty. When you meet this couple, you might almost think such mild manners and resolve are the secret to reaching old age. When my neighbour and I saw each other, and he beckoned me over for a word, I looked at him in surprise.

‘Are you using a walking stick?’ I asked him. I had never seen him with a stick before.

‘Yes, I get such a pain in my shoulders from using the rolling walker. So I put it to one side and started using a walking stick.’ He stabbed the air triumphantly with his walking aid. ‘That’s a colourful tie you’ve got on,’ he said, pointing to my bowtie.

‘Thank you,’ I replied. ‘Anyway, you’re looking well!’ Which really was the case. We exchanged a few more words, and went our separate ways.

As I walked towards my house, I glanced back at my neighbour. I thought about the fact that he had given up cycling a few months before. He just wasn’t up to it anymore. The doctor in me concluded that he had become frail. He had been living for a time with a heart condition that was difficult to treat: a leaky heart valve. There was a possibility he could die suddenly of cardiac arrest at night.

Frailty is a key concept in geriatric care.

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