By Patrick Graham
Let’s talk about your death (shocking idea that it is)…and how to live well before it.
There are some people who seem to live relatively contentedly into old age then suddenly die, as in the proverbial, ‘party till you drop’. You (and I), on the other hand, are much more likely – almost inevitably, in fact – going to experience a decline in our health and physical abilities as we enter the final 10 years of our lives.
According to Newcastle University’s Institute for Ageing, the research is very strong. No matter at what age this decline starts, it will last approximately 10 years, (this is a loose guide that varies relative to the age that an individual first joins the curve, see graph below) in the absence of fatal accidents such as those caused by cars, cliffs, cardiology or cancer.
The non-news is: you are going to die. Even though all our daily actions and thoughts tend to work on the basis of avoiding this reality, it is a fact that requires you to think about what it means in order to live well now, and right up until your demise.
The best possible life
So, how to plan for the best possible life before its inevitable end?
First let us destroy some glib assumptions:
- “I will end it all if I start to get too ill, no need for all that planning for me.” This is not how anyone who has a terminal illness, who I have ever met, thinks. Few people seriously want to eliminate their tomorrows due to the uncertainty of having many more.
- “Our care services, hospitals, ambulance, police and firemen will keep me safe.” They can only fix things after they have broken. Emergencies are not a dominant reality of how we age and decline in our abilities. No statutory servant can prevent this decline happening but advice and support early on may help you to prevent it, or at least “party” much longer than would otherwise have been the case.
- “As long as I still have all my marbles, I’ll be fine.” While dementia is a growing problem for many as we all succeed in living longer, it is still not the main cause of misery and breakdown of personal health in the 65-80 age group. Isolation and the gradual slide towards becoming a “prisoner in your own home” are part of a pattern that begins with being unable to walk to the corner shop and back. These are the overlooked issues that start 90% of the population on a path that leads to greater dependency on things you really don’t want to depend on, and less control = less life.
- “Dementia is my nightmare I shall just end it all as soon as I find out that is happening.”
Dementia is not what people who say this think it is. Seeing the decline in memory in others is just the main observed characteristic. From reports of people on the inside of the disease, and among those who spend time caring for a loved one with dementia, it is clear that the way this affects people is entirely influenced by their individual natures and the progress of the disease over time. It is also clear many people lead satisfying and fulfilling lives for a surprising number of years after developing dementia.
- “I will choose a nice care home as I don’t want to be a burden on my family.”
Do you have £200,000 in the bank? Any less and you are unlikely to be able to choose your own final care home, and will only be supported by the state to live in a not so nice one if you are assessed as having night-time care needs, such as skin breakdown and double incontinence, that cannot be successfully managed at home. The people who believe this will not happen to them are acting on the same thought pattern as smokers who cite the person they heard about who smoked 20 a day and lived to 95. The realities of both extreme old age and regular smoking typically involve painful degenerative aspects that no one wants to even think about yet alone try and positively avoid by their actions. Maybe it’s time to take action to cover this likelihood rather than gambling on winning the lottery?
- “What will happen, will happen… there’s nothing I can do about it.”
If people really believed this we would all still be in caves. The things we can do to improve the quality of our lives do not suddenly cease to be possible upon retirement. The main things we can all do are set out below.
The bulk of care for older people in the UK is provided by the people themselves, their families and in the best communities, others who know and care for them. The oft-derided notion of ‘the nanny state’ was never what Beveridge envisaged when he set out his plans for a welfare state. His vision was that we would be helped by the state to quickly regain our maximum level of independence when the state was the last and only effective safety net.
The need to avoid falling into frayed safety nets is becoming more apparent as we walk a longer high wire of life expectancy and see that these nets are filled with people with a mixed level of needs and wants, most of which may have been prevented by their own informed actions.
Research is increasingly pointing to feeling lonely and isolated as the prime indicator of, and ultimately causative factor for, decline and illness in the older population. You may be that rare person who enjoys just your own company and a good book, but if you are not connecting with other people the odds are that you will not notice vital indicators of failing health that could be triggers for you losing control of your lifestyle.
Unless you are a successful hermit, the odds are you enjoyed company once, and need to again.
Keep a sense of purpose
So statistics can show you that retirement is one of the leading causes of death; losing a sense of purpose is a savage way of declining into an unhappy old age.
Help someone else
Being able to give of yourself to others has proven to be one of the more successful routes to happiness. Even if you do not need to work to earn money, working is what gives most adults their sense of purpose. Being free to work when and where you want, as a volunteer, is a magnificent way of gaining the happiness of giving, whilst retaining that sense of purpose normally reserved for paid workers.
Knock on that neighbour’s door
It’s all very well talking about “communities of interest”, but your neighbours represent the community of first resort if you’ve fallen in the garden and are shouting for help. Contrary to much that is said about nosey, noisy, or nuisance neighbours, most people long for an opportunity to develop friendship and trust with their neighbours. If you do not have a good relationship with them perhaps retirement is the time to reverse the situation and call round with a cake?
Use those local facilities
People have fought long and hard to retain libraries in our local towns, many are now run largely by volunteers and offer much more than a silent warehouse for book exchange and storage; book clubs and social groups are run from the premises.
Clubs and pubs are just some places where we do not see enough older members of our community. Some pubs, like society at large, appear to target “professionals” they believe are the only big spenders in our society. But clubs and pubs that do promote pensioner get-togethers, bargain lunch deals, trips and games, know that the over-65 demographic is bigger, wealthier and better behaved than the 18-40 age group.
Act on the GP’s advice
All very well looking for a pill for every ill, but doctors often report that no one appears to take their advice on exercise and social contact seriously. They are basing this advice on hard facts that represent the paths we choose that lead towards the mire or away from it.
Of course, there are more options to keep happy in retirement and old age, the trick is to work out what suits you.
The last 10 years
Research from University of Newcastle is illustrated in the diagram below.
Graph: ADL SmartCare
Those who rely solely on the help of the statutory sector to prevent a slow decline in abilities and happiness tend to follow the lowest sub-optimal curve in the graph, which belies choice, and ends with up to four years of virtual total dependency often in a residential care home.
Those pursuing their passions into their pension spending lives, and maintaining a physically and emotionally active life, (often with a bit of help and support, but of their own choosing), can expect to follow the much happier optimal curve.
The critical ways that others can help:
Reablement can be a matter of regaining confidence and rediscovering old networks of friends, and/or recovery from a broken hip, for example.
Compensation can be using any kind of equipment that maximises your ability to stay in control and engaged in living, despite an irreversible loss of some physical or mental ability.
Care should really be only acceptable to us when our physical and mental abilities have deprived us of the ability to look after ourselves. The nature of care should be to facilitate engagement with every individual’s differing ideas of what will stimulate them and give an essential quality of life. I would suggest that sitting in wingback chairs in a large lounge with a TV on, over which none of the group has any control, does not meet this definition of care.
Patrick Graham is community manager in adult social care at Gloucestershire Council