The right to be old

As each generation lives longer than the last, there is a tendency to see ageing as a medical problem to be solved rather than a natural part of the life course. But if living longer is really about staying young, do we risk turning a blind eye to issues facing the elderly? And, in the process, are we denying ourselves the right to be old?

The helpline volunteers regularly meet for group supervision where we discuss the calls we’ve had: how we responded, how we felt about it, what we could do better next time. While every call I’ve taken stays with me in some way, it was a call I didn’t take that made me reflect the most. There we were one weekday evening, sitting in a circle of chairs in an old church hall as rush hour swept through the city. A motley group comprised of different ages, colours, accents. One of the volunteers offered to discuss a call he had difficulty with.

“She was an 86-year-old woman,” he said. “She called because she was moving into a nursing home later that morning and she didn’t want to go.”

He confessed that it took him a long time to understand her distress. After all, aren’t nursing homes nice places? Warm pockets of bingo and crochet blankets over frail knees? Why would she not want to go? Did she really prefer rattling around in her house by herself?

“It was her kids who had organised the move. They didn’t think she was safe living alone.”

I could almost hear her voice then, talking about her “kids”. They must be in their 50s, perhaps even 60s.

“I tried to find out if she had any resources, anyone she could talk to. But she said her kids didn’t understand and she didn’t want to worry them anyway. Her husband had passed away 20 years before. And her friends, all her friends have died.”

What would this look like for me? No partner at home to talk to each evening; no brunch dates with my siblings on the weekends; no text message pings from my phone; no point in logging on to Facebook, all of the pages frozen with inaction.

“That’s when I realised that, for her, moving really was a crisis,” said the volunteer. “She had absolutely no one. I wanted to give her a referral to some kind of service, I wanted to let her know that it would be okay, that she had options. But she really had no one left. Was there something else I could have done for her?”

“Couldn’t she see her kids were worried about her?” A woman in her 50s asked. “It sounds like she was just being difficult.”

“They would only be doing it because they care about her. They don’t want her to be lonely.” One of the other volunteers offered this, shrugging his shoulders beneath his hoodie and rocking back a little on his chair. It didn’t seem like a crisis to him.

“Unless they just want to get their hands on the family home” countered another woman, her hands wrapped around a styrofoam cup of tea, her comment prompting laughter.

“She spoke about being tired of this world,” said the man who had taken the call. “And that the only thing she had to look forward to was one day meeting her late husband again. I asked her if she had thought about suicide.” This is something we are obliged to cover with every caller that gives any indication of such thoughts. “She said she had – that she often thought about walking into the sea, but that she didn’t want to chance being punished and ending up in limbo, unable to be reunited with her husband in heaven.”

“That’s sweet,” said the woman with the tea. It was the first time I had heard a caller’s thoughts of suicide be described as sweet.

“But why would she bother doing away with herself? She’s only got a couple of years to go anyway,” said the hoodie-wearing volunteer. The circle broke into awkward laughter, that he should say such a thing.

But was it simply what some of us had been thinking?

***

The just-born hunker below, spreading along the base. The old teeter at the top, a single antenna reaching for the skies. If you graph Australia’s population by age throughout most of the 20th century, it looks like a pyramid: the largest age groups are the young and there are very few elderly people perched at the top.

In more recent years post-war prosperity and increased longevity changed the shape of our population. The pyramid became wider as the overall population increased, and the arrival of the baby boomers can be seen in all their onomatopoeic glory: a sonic boom sending shockwaves across the chart so that there is a noticeable bulge around middle-age. There are still less elderly people at the top than the young propping it up from below, but the whole thing is stouter, like the trunk of a boab tree.

It is only when we graph the projected population of the 21st century that the advances in health care, living standards and technology, which have contributed to increased life expectancy and lower fertility rates, are most apparent. The pyramid becomes a tower, straight up and down, slightly narrower at the top and bottom. In some projections it resembles a coffin or sarcophagus, narrow at the feet where the children are located and broad across the shoulders of the retirees, before tapering to the elderly.

All projections by the Australian Bureau of Statistics make one thing clear: Australia’s population is ageing. At present, 14 per cent of us are aged over 65 years. By 2060, this will have increased to 25 per cent, or a quarter of the population.

These graphs represent unprecedented success. Our life expectancy has so increased that a non-Indigenous girl born in 2012 can expect to live 94 years, her twin brother almost 92 (the distinction is important: Indigenous Australians currently have life expectancies 17 years lower than the overall population). This success should be celebrated since most of us want to reach old age rather than die young.

Yet all around is evidence of hypocrisy in our youth-loving culture; an invisible turning point where we begin to punish the old rather than respect them.

***

When the Australian Treasury released its Intergenerational Report in 2010 it named our ageing population, along with climate change, as one of the most difficult economic challenges facing Australia in the next 40 years. The recently updated Intergenerational Report of 2015 is similarly steeped in apprehension for the slowing of growth in a post-mining boom economy, just as an ageing population increases the need for aged care, health care and the age pension.

The 2015 report, however, hardly mentions climate change, choosing to focus only on the older generations and their very existence as a “threat” to the budget.

This anxiety about the ageing population is neatly summed up by the oft-cited concept of dependency ratios, which views part of the population as productive working providers (those aged between 15 and 65) and the rest as freeloading dependents. The 2015 report takes as a given that Australia should aim to achieve the same unsustainable amount of growth in living standards that we have done over the last few decades, even if it comes at the expense of the environment and social cohesion.

In alarmist documents such as this, older people are often seen as a burden. In the eye of governments looking to make savings, older people require too much in the way of pensions and health care, and they provide too little to be counted as productive citizens. This assumption is incorrect – apart from a lifetime of tax-paying contribution, older people are recognised as the backbone of the volunteer industry and provide care for a quarter of children. Nonetheless this negativity filters down into day-to-day interactions, feeding the kind of stereotypes that label old people as frail, dotty and unnecessary.

We all want the opportunity to grow old, yet we penalise those who already have.

***

ANNE, 79

The only time I think about my age is when I wake up in the morning and my legs are a bit slow to get going. Thomas, my cat, and I stagger around, especially when it’s cold. But I don’t think about my age much. If people ask me I say, but the response I usually get is “I didn’t think you were that old.”

I’ve got a neighbour who’s younger than I am, but she’s not young. She’d be well into her 60s I reckon. She’s still working; she’s a very senior person in an aged care centre. She was their acting manager a while ago, which she hated because she wanted to spend more time with the patients. She went white-haired fairly early and she got tired of being invisible so she paints a splodge of colour – it’s either pink or purple – in her hair. And she said, “The first day I went out with it, people noticed me.” It was like she existed in the world again.

I’ve got several other friends who do the same thing actually, though I’ve never bothered. I use my voice, I think, to be visible. I’ve always been an activist in lots of ways and some people have found that confronting. But now it’s really good to be able to do it. I mean it’s very irritating being invisible, but I’m very confident about making myself visible and I enjoy working with other people to make that happen.

I was in a knitting shop once and I bought some wool for a yarn-bombing project. I spent quite a lot of money in there actually. And this new, young woman ­– very young, early 20s I would think – talked to me as if I was a three-year-old. She handed me my change or my receipt or whatever and she said, “Bye Sweetpea!” And I walked out of the shop and I was just stunned! I thought why didn’t I do something? It really irritates me when people accept that it’s right to be treated differently. I’m better now. “I don’t like to be called Darling,” I told one woman. “But I call everyone Darling,” she replied. “Not me you don’t! I’m not your darling.”

I don’t think ageing has affected my identity as such, but women – women like me, anyway, I don’t know that all women do it – become more truly themselves as they get older. Even the ones who don’t think very deeply about it. I think there’s a liberating thing about getting old.

***

These are buzz phrases that encourage people to remain healthy and active as long as possible. The intended pay-off is two-fold: older people remain in better health and can enjoy their retirement and increased longevity, and governments don’t have to watch the ageing population tip their budgets into the red. The World Health Organization promotes active ageing as a holistic concept encouraging older people’s participation in social, economic, cultural, spiritual and civic affairs. But the term has primarily been co-opted by the medicalisation of ageing, and is most often used to refer to physical, and perhaps social, activity.

Under the banner of ageing well, all levels of government encourage older people to join exercise classes and eat a healthy diet in order to maintain their independence and to delay age-related illnesses as long as possible. In short, to postpone becoming old.

Part of the positive ageing agenda relies on health promotion material and superannuation ads that show happily active and untroubled older people who are not frail or in need of constant support. Over 95 per cent of older Australians live at home, a quarter of them alone, so this may be a true representation. But can this relentless positivity also do harm as well as good?

Aged care advocate Linda Sparrow is concerned that positive ageing campaigns carry “the risk of developing a new and equally misleading myth about older people – that all old people are, or should be, fit and healthy, productive and engaged with life.” She points out that this focus on successful ageing puts the blame for failing to age well on the shoulders of the individual, ignoring wider systemic causes and refusing to accept that some things – such as the inevitability of death – cannot be treated or cured.

This positive ageing view, according to Sparrow, “undermines those who find themselves burdened with the diseases and conditions that can and do affect old people, such as Parkinson’s disease, arthritis, dementia and impaired vision. Rather than enhancing the dignity and self-esteem of those who are old and frail and in need of care, it adds a sense of failure to the difficulties they already face.^”

In the essay The Seductiveness of Agelessness, academic Molly Andrews writes: “The unspecified but clearly preferred method of successful ageing is, by most accounts, not to age at all, or at least to minimise the extent to which it is apparent that one is ageing, both internally and externally.” She argues that we are all products of an ageist society, and upon reaching old age we still try to distance ourselves from the old. Andrews calls this a desperate plea for exceptionalism that challenges not the ageist stereotype, but only the application of it to ourselves.

Our health and wellbeing in old age will be governed by a combination of factors – genes, culture, gender, wealth, education and chance – with disparities experienced over the life course amplified in old age. It’s an unfortunate cumulative effect, meaning those who have lived on low incomes or have poor education are likely to struggle even more in later life, while those with good resources and support systems are more able to tackle problems that arise.

While people of all ages should be encouraged to strive for good physical and mental health, trying in and of itself will not ensure you succeed. In many ways, positive ageing is an endeavour not to age at all – to achieve the fantasy of agelessness.

But it’s a goal we will all fail to some degree.

***

If living longer is really about staying young, do we risk turning a blind eye to issues facing the elderly?

For many, old age is not a kind place to be. The body’s natural ageing process can be a difficult experience. But ageing can also be expedited and exaggerated by other factors – things like poverty and insecure housing, and loneliness and mental illness. Our society sees these issues as problems when they affect younger and working-age people, but too often overlooks them as just an ordinary part of old age.

Poverty and housing

The international survey Global AgeWatch found that one-third of older Australians live in poverty, meaning they live on an income that is less than half of the country’s median income. This is partly due to the fact that while 80 per cent of older people receive a pension, it is a very small amount coming in at approximately $1850 a month (less if you’re part of a couple), or less than 28 per cent of the average income.

While making for a miserable day-to-day existence, poverty and disadvantage are risk factors for chronic physical and mental illness, as well as hospitalisation, social isolation and early death. This is particularly apparent in Indigenous populations where a history of discrimination and racism has resulted in high rates of psychological harm and chronic illnesses. Compounded by generations of disadvantage and poverty, the consequence is that only a small percentage of Indigenous Australians live past 65 years of age.

For most Australians their major asset is the family home, making ownership a protection against poverty. Around 80 per cent of older people own their own home outright. This is what lifts so many people above the poverty line, even though many are unable to access the equity in their home to fund their retirement or aged care.

The costs of private rental can be too expensive once someone retires and stops earning. Even for those who can afford it, private rental is notoriously unstable. Landlords are able to increase rent at any time and evict tenants with little notice. This is of increasing concern to older people as the rapid inflation of housing costs means fewer people are paying off their mortgage before retirement age and increasing numbers are priced out of housing ownership altogether, causing them to live in private rentals even though they can be an unsustainable and insecure option in the long term. The only available alternative is public housing, for which there are extensive waiting lists of seven to 10 years in many states.

Some of these problems could be solved for all age groups with legislation that focused on the rights of tenants rather than landlords, the introduction of long-term leases and regulated rent, and an increase of community housing where the rent is set at a percentage of the tenant’s income.

***

VALERIE*, 79

I think other people make you think about your age. It’s the way you’re treated by other people. It makes you aware. But I am aware of my own physical shortcomings. When it comes to doing some things, I find that I just cannot do what I used to do. So then I become really aware that I am ageing, or aged already.

Younger people are sometimes surprised ­– they look at me and say, “You’ve got a sense of humour!” But I’ve always had it, why would it disappear now? Still, I suppose there’s always a chance that it will, but I doubt it. It’s helped me cope over the years with all sorts of things.

I never considered buying a house, mainly because I never had money. I didn’t marry and because equal pay wasn’t in I frequently had a situation where I was sitting at a job for $60 a week and the young man sitting next to me was getting $90, simply because he was a man. Now that was terribly frustrating. But that was before the women’s movement got started again. I was in the Women’s Electoral Lobby for quite a long time. And the Union of Australian Women – they were really bolshie, I liked them!

Women had a long struggle for equal pay and we still haven’t got it. I battled when I was working. In one job I made the shortlist and I was talking to the personnel manager and he said, “You realise, of course, that this job is for men.” But I convinced him to hire me. Though when I started he said, “I’m very sorry but I can’t start you on the same salary as the males.”

Superannuation came in when I was about 40. As a woman, you were eligible but you couldn’t afford it. I went into the public service in NSW on a very, very low salary. And my entitlements were actually more than my salary.

I’ve rented all my life. I’ve heard that if you go into an estate agent and you ask for an application form as a pensioner, you may as well not bother. Conservative governments only think of seniors as self-funded retirees living in their own homes. I don’t think they’re really interested in people on pensions and in public housing. Especially women – women have had a long struggle, and they should never have had to.

***

Loneliness and depression

The prevalence of loneliness is high among elderly people who live alone.

If your partner has died, and so have many of your friends, and your children visit just twice a year, you may spend days without speaking to another person. Occasionally the media will report on the unattended death of an older person who has died in their home and not been discovered for months, or perhaps years.

The loneliness of such an existence is candidly rendered in the journal of one unnamed woman who passed away in her kitchen in Sydney in 2014, her death undiscovered for six months:

“When we moved into our present house in 1966, the atmosphere of the streets was more or less one of a village formed by different nationalities. Today the friendly atmosphere of the neighbourhood is extinct. Except for a few privately owned houses, the whole neighbourhood has been transformed into apartment blocks or strangers. A smile and a good day or a helping hand have become as rare and as exceptional as a white whale.”

If you’re having trouble hearing, your sight is failing, or your knees won’t allow you to walk as easily as you once did, you might find it difficult to participate in a harried, fast-paced world. If you have ever experienced loneliness, you understand how ruinous a feeling it can be and there is much evidence to suggest that loneliness is a major public health issue: it’s related to depression and other forms of mental illness, as well as physical impairment and reduced quality of life. It is also associated with a greater risk of chronic illness, with lonely people more likely to undergo early admission to residential aged care.

Older people with depression and anxiety have a much higher risk of suicide than the general population and this is particularly apparent among older men, who tend to have lower levels of social support than older women. In 2012 the highest age-specific suicide rate for men was in the group aged 85 and above. For every 100,000 men in this group, close to 38 ended their own life. Compare this to the nine out of every 100,000 men aged 15 to 19, or 17 for every 100,000 men aged 20 to 24. The real numbers in all age groups could be much higher, as suicide is notoriously underreported.

Just as depression does not always result in suicide, suicide is not always a result of clinical depression. As psychiatrist Michael Baigent says, “I think in the elderly we’ve got circumstances that don’t arise as often in younger people. One of them is that they generally have a lot of medical problems that people don’t experience when they’re younger. And there’s no doubt that the presence of chronic medical conditions, particularly if they cause pain, is a factor in people ending their lives. So you could put that together with the horrible kind of isolation that happens when your friends move away or pass away; you do become very isolated – it is a very lonely thing.”

His comments are backed up by research that shows stress and social disconnectedness account for a larger proportion of cases of suicidal ideation amongst older people than the presence of mood disorders.

Our increased social awareness of the high suicide rate of younger men may have been one of the reasons the rate has dropped more than 50 per cent since a peak in 1997. This suggests that if we applied this same awareness to the situation of older men, we might have a similar result.

Yet it seems too difficult to move away from the belief that a loss of a young life is worth more than an old one. We lament a young person’s death because we can see the future they have foregone. But by limiting our empathy for an older person because they’ve had a “fair innings”, we are denying them the worth of their present.

***

BOB, 81

What’s changed with age? I’ve become accustomed to people standing up on the tram for me, and instead of saying no I’ve started to say thank you. Occasionally I realise that I’m being bypassed in the conversation and that I don’t know what’s going on.

Retirement’s good as long as you keep yourself interested in something. And as you get older, your circle of friends drops. Family is important, but on the other hand we’ve still got a good circle of friends.

We want to stay here in this house and for it to be comfortable for us for as long as possible. So we’ve just started taking steps to remodel the bathroom. We’ve got all the approvals and now we’re waiting for government approval, which will take 12 months. So we hope we’ll be around to see it! We wish to be as independent as possible, not to be a burden, and to be helpful, as much as we can be.

I’ve always struggled with depression at critical times in my work life and sometimes I regret some of the things that have happened there, and reflecting on that brings it up now. But generally speaking I endeavour to look at the good things that I can remember, rather than the less so.

The family know, they have a saying – “Come winter, Dad’s down.” So I’ve just come back from 10 days up north, getting away from the cold. And I work at it, but I’m aware I sometimes become morose.

Each of us experience our own sense of depression – you droop, you’re less lively – but how you come out of it is from your own experience. With help.

***

The current inclination to treat ageing as a medical problem to be solved or arrested rather than seeing it as a natural part of the life course robs older people of the right to be themselves. The positive ageing agenda says: it’s okay for you to keep on living, so long as you don’t become old. And in too many circumstances we seem to give up on older people when they do face problems, framing these difficulties as an inevitable part of ageing.

Yet they don’t have to be – we just need to recognise that we all have a right to be old. This means we stop pushing people to the margins of society as they age, or deem their needs as inordinate and their contributions insufficient. It means we recognise that old people are not lesser than young people, and that true intergenerational cooperation is both desirable and necessary.

Realising the right to be old and putting it into practice in our cities, communities and personal lives asks us to rethink the concepts of productivity and participation, and to consider what kind of society we wish to live in both now and in the future. Because we will all age, and we all have a right to be old.