When the
Chapter 13. The Downhill Slope
I guess I don’t so much mind being old, as I mind being fat and old.
Time moves forward, we age. It’s inevitable. And as we get older, our bodies change. Once we’re past our mid-thirties most of us would agree that it gets harder and harder to sustain the same level of physical performance. It doesn’t matter if it’s how fast we can run, how far we can cycle before needing to stop for a break, or how quickly we recover from a big night out. The older we get, the harder everything seems to become. We develop new aches and pains, and succumb more easily to annoying little infections.
Ageing is something we are good at recognising in the people around us. Even quite small children can tell the difference between the young and the very old, even if they are a bit hazy on everyone in the middle. Adults can easily tell the difference between a 20-year-old and a 40-something individual, or between two people who are 40 and 65.
We can categorise individuals instinctively into approximate age groups not because they give off an intrinsic radio signal about the number of years they have been on earth, but because of the physical signs of ageing. These include the loss of fat beneath the skin, making our features more drawn and less ‘fresh-faced’. There are the wrinkles, the fall in muscle tone, that slight curvature to the spine.
The growth of the cosmetic surgery industry appears to be relentless and shows how desperate we can be to fight the symptoms of ageing. Figures released in 2010 showed that in the top 25 countries covered in a survey by the International Society of Aesthetic Plastic Surgery, there were over eight and a half million surgical procedures carried out in 2009, and about the same number of non-surgical procedures, such as Botox and dermo-abrasion. The United States topped the list, with Brazil and China fighting for second place[234]
.As a society, we don’t seem to mind really about the number of years we’ve been alive, but we dislike intensely the physical decline that accompanies them. It’s not just the trivial stuff either. One of the greatest risk factors for developing cancer is simply being old. The same is true for conditions such as Alzheimer’s disease and stroke.
Most breakthroughs in human healthcare up until now have improved both longevity and quality of life. That’s partly because many major advances targeted early childhood deaths. Vaccination against serious diseases such as polio, for example, has hugely improved both childhood mortality figures (fewer children dying) and morbidity in terms of quality of life for survivors (fewer children permanently disabled as a result of polio).
There is a growing debate around the issue sometimes known as human life extension, which deals with extending the far end of life, old age. Human life extension refers to the concept that we can use interventions so that individuals will live to a greater age. But this takes us into difficult territory, both socially and scientifically. To understand why, it’s important to establish what ageing really is, and why it is so much more than just being alive for a long time.
One useful definition of ageing is ‘the progressive functional decline of tissue function that eventually results in mortality’[235]
. It’s this functional decline that is the most depressing aspect of ageing for most people, rather than the final destination.Generally speaking, most of us recognise the importance of this quality of life issue. For example, in a survey of 605 Australian adults in 2010, about half said they would not take an anti-ageing pill if one were developed. The rationale behind their choice was based around quality of life. These respondents didn’t believe such a pill would prolong healthy life. Simply living for longer wasn’t attractive, if this was associated with increasing ill-health and disability. These respondents did not wish to prolong their own lives, unless this was associated with improved health in later years[236]
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