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We dread growing old in the West because we idealise youth, whereas other cultures actually celebrate aging, says Frances Palmer

I was in the pharmacy recently, scrutinising anti-wrinkle creams and considering the expenditure of vast quantities of cash on minute dollops of water, butylene glycerol and potassium hydroxide. Although I know it makes little difference, I still embrace any possibility of fighting the inevitable wrinkles with blind faith. I am not alone: in 1986 the expenditure by British women on skincare products was £113.2m.

Aging is about the body, but it is important not to loose sight of the "lived in" body; the person who has a name, an identity, a profession, in short, someone who plays a multifaceted role in society. Gerontology is not simply about the decline of the physical body, it is also about the changes that occur to the person.

We are born dying is a well known phrase. That the body gets older is a universal truth, and like birth and death, it is one of the few certainties in life. The body weakens with age, works less well and finally stops working all together. Yet in our society we spend a lot of time, effort, and money fighting this inevitable process, or at least trying to deny it. However, in a culture where youth is idealised and associated with power while images of the elderly as infantile, weak, and dependent prevail, it is not surprising that we dread growing old.

Diana Payne-Myers: still dancing at 69. Performing with the dance theatre company DV8

The elderly are segregated from the rest of the population--retirement marks the transition to old age and renders the person redundant in a society where great value is placed on participating in the labour force. Old people's homes further separate the weakest and most dependent, and so hide some of the the harsh realities of growing old.

We infantilise those in old age, childhood being a metaphor for dependency and innocence. Yet these are the people who have the wisdom and strength of a lifetime of acquired knowledge and experience. Although Peggy, who is 95, sometimes feels frustrated that her body no longer allows her to run and climb the trees in her garden, she considers the last 30 years of her life to have been the best. It was only when she reached 65 that she felt she no longer needed to prove anything, or "be" something.

The cellular and organic decline that occurs as we get older is common to all human beings. However, the way different cultures make sense of this event and invest it with meaning varies greatly.

In Botswana the discovery of the first grey hair is met with excitement and is considered lucky. The elderly are considered wise and greetings towards those who are older are more respectful. The Venda speaking people of southern Africa also welcome the bodily indications of old age as these signify the approaching contact with the real world of the spirits. Among the Sherbro people of Sierra Leone, incoherent speech signifies close communication between the old person and the ancestors (the ultimate source of social blessings and good fortune). Old people are: ". . . cared for reverently as they grow into sacredness, a physical care which endorses, rather than diminishes, their status as an elderly person."

In Japan and China the elderly also enjoy more respect, old age being recognised as a source of prestige and honour. In Japanese philosophy one is not a master of any art until at least middle age. The Confucian tradition inherited by the Japanese stresses progress at each stage of the life course.

The Analects of Confucius offers the following advice1: "At 40 I was free from doubts. At 50 I understood the laws of Heaven. At 60 my ear was docile. At 70 I could follow the desire of my heart without transgressing the right."

These examples give a taste of the cultural differences in attitudes towards the elderly and the process of aging. Furthermore, both positive and negative images of the elderly can be found in all cultures--no culture is 100% "wrinkly friendly."

The General Medical Council's 1993 recommendations on undergraduate medical education state that students should demonstrate attitudes essential to the practice of medicine. This includes: "respect for patients and colleagues that encompasses, without prejudice, diversity of background and opportunity, language, culture and way of life."

The focus in medicine is on the physical body, although increasingly we are encouraged to see the patient as a whole person. The foundations of our training are in science; indeed it is from this that we have enjoyed much success in combating poor health and disease. When our primary role is to sort out problems with the body, it is easy to loose sight of the person that lives in that body. The attitudes towards aging and the elderly that we inherit from our culture are strongly embedded in us as children, before we even enter the culture of medicine. These are our "truths" that we do not even begin to question: "Old people are a burden, at best out of touch with the real world, and at worst demented."

Developing positive images of the elderly and questioning our perceptions of them, and ourselves as we grow older, would not only improve our care of the elderly, benefiting those who are in old age, but also benefit society as a whole. We are ignoring a large sector of the population who have an under-used reservoir of knowledge, skill, and wisdom.

In light of all this it is encouraging to see strong images of older people emerging in our society. Diana Payne-Myers (see picture) performs with the dance theatre company DV8. She is 69 years old.

References

1 Soothill's WE. The Analects of Confucius. Oxford University Press, 1910:149-50.

2 General Medical Council. Tomorrow's doctors­Recommendation on undergraduate medical education. London: GMC, 1993.