Life and Years
By PROFESSOR R. E. TUNBRIDGE*
IMPROVED sanitation, the development of preventive medicine and the advances in chemotherapy during the past fifty years have so increased the expectancy of life that the proportion of the population reaching a pensionable age is assuming social and medical importance. In England and Wales 13.7 per cent. of the population are of pensionable age today, that is 1:7.5 of the total population, and 1:15 are over the age of 70. In thirty years 1:5 will be of pensionable age and 1: 9 over the age of 70. Similar changes in the age-distribu- tion of the population are apparent in most of the countries of _Western Europe and in the United States of America.
Discussion at the Second International Gerontological Con- gress, recently held at St. Louis, centred round two main themes, the causes of ageing and the sociological effects of an ageing community. Does ageing inevitably mean decay ? Do all cells pass through a cycle of development, maturation, reproduction and decay, as occurs in the sex glands of many species, or are these changes determined by environmental influences so fre- quently referred to today as " stress " ? Carroll, in his experi- mental work, suggested that the duration of the life of a cell was unlimited, provided normal environmental conditions were maintained.
The conference, by bringing together scientists from fifty-two different countries, helped to clarify some of the fundamental problems and to indicate some of the lines of research which offered promise. It was in the medico-social field that the inter- change of ideas appeared most likely to lead to immediate action. The similarity of the problems, medical, economic, social and political, in the different countries was fully realised, and the question of retirement engaged the attention of the conference. No agreed definition of ageing was possible ; controversy even arose as to whether the correct spelling was ageing or aging. There was general agreement, however, that chronological age was not necessarily an indication of biological age. The con- sensus of opinion agreed with Dr. J. H. Sheldon that after 70 a rapid increase in the rate of decline of mental and physical powers is the general trend in man. The cost of retirement pensions, whether provided privately, by insurance schemes or by the State, is rapidly mounting, and the repercussions on national financial policy cannot be neglected. In thirty years approximately two-fifths of the population, 19 per cent. of pensionable, age and 19 per cent. of children under 15, will have to be maintained out of current production. Further, of the remaining 62 per cent. of the population, a considerable percentage will be married women unable to enter industry. Thus rather less than half the population will have to maintain rather more than half. Any policy, therefore, that will retain the elderly in employment will assist the general productivity, and will reduce the burden falling upon the workers as well as maim: * Professor of Medicine, University of Leeds. taming and possibly improving the standard of living of the elderly. A recent survey by Mr. Seebohm Rowntree in the City of York has shown that the major poverty group today is found amongst the elderly.: All medical and social workers and psychiatrists agreed that retirement for the majority means not merely loss of earning power, but a severance of valuable associations and friendships which tends to cause the retired individual to lead a more restricted life and to feel that he or she is no longer wanted. The effect of such reactions upon the physical and mental health of the elderly is bad, and leads to increased demands upon the social services, particularly the hospital services, the most costly of all medico-social services. Sheldon, in his survey of Wolver- hampton, commented upon the longevity of women as compared with men, despite a greater tendency to physical infirmity, and hinted that their continued responsibility for running the house- hold long after the normal retirement age had much to do with it.
In some South American countries a man frequently has two occupations, one heavy, which occupies him for the first part of the day, and the second, usually light, for the latter part of the day. Moreover, it it common for such a man in his early fifties to give up the heavier work but to continue with the lighter work as long as he is able. In many European countries and in the United States retirement at a certain age is becoming the accepted practice, and the inducements offered to remain in employment are having little effect. There is no problem with the highly skilled craftsmen, but they only form a small and rapidly diminishing proportion of the population. It is with the semi-skilled workers, an increasingly large body, that the difficulties are greatest, employment meaning nothing more than a means of livelihood, diversion or contact. In two groups only, miners and dock labourers, retirement at the statutory age is not the inevitable rule. In both occupations group-work is common. Experiments are being carried out in the United Kingdom to discover whether retired workers can be induced to work when organised on a group-basis. War-time experiences have shown that the elderly are not poor employees. Their rate of work may be lower than that of younger men, but they are more reliable, and their absence-rate due to minor illnesses is lower than that of younger employees.
The elderly are more prone to develop certain disorders, mental disorders, degenerative changes in the cardiovascular system, deformities and incontinence. The changing incidence of disease, therefore, that will arise from an altered composition of the population will affect very materially medical training and research and planning for the hospital and social services. The idea that because an elderly person is sick he or she must be a chronic case has to be dispelled, and the fact that restoration to full function may not be possible does not absolye the medical profession from the moral responsibility to assist Nature to attain the greatest degree of restoration of function as rapidly as possible. Continuation ofwork has been indicated as a possible preventive measure. Old people's clubs, visiting, meals on wheels, libraries on wheels, are all important means of keeping the elderly interested, and by creating a feeling that life is worth while, and that they are wanted members of the community, indirectly lower the sickness rate. In many big cities between the wars 90 per cent. of new muni- cipal houses were of the three-bedroom variety, suitable for small families but not ideal for the elderly and not economically con- vertible into flats. During the same period only• approximately 1 per cent. of new building was specially designed for the elderly. Bungalows are preferred by the old people in Great Britain today, but in time no doubt flats will be equally popular. Despite much planning, and the conversion of existing property for use by the elderly, local authorities still have not realised the magnitude of this problem. The schemes submitted by local authorities for fulfilment by March 31st, 1954, only provide hostel accommoda- tion for 52,000 old people, less than 1 per cent. of the pensionable population, although recent social surveys indicate that 5 per cent. of pensioners require hostel accommodation and 10 per cent. special housing. The changing age-distribution has even wider implications. The elderly normally require less in the way of clothing, furniture, household necessities than the younger members of the com- munity, and they are less influenced by new ideas and by adver- tising, all features likely to affect the variety and quantity of goods needed for the home market ; further, since they are more reluctant to travel, their demands upon public transport and some of the public services will be less.
The pensionable population will form an important minority group, and their possible influence upon political thought and outlook is difficult to assess. Finally, if the younger age-groups are compelled to work longer hours in order to maintain output and the present-day standard of living, they will have less time for voluntary service such as serving on local councils, voluntary societies, hospital boards and management committees. Should this occur, we shall be faced with the alternative of leaving such work to officials or to the elderly as the only people with free time. Neither would seem to afford the ideal solution for the British concept of public life and service.
Throughout the conference the constantly recurring theme was that the aim of everyone interested in the problem of the elderly should be to add life to years rather than years to life.
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