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I hated old people when I was young. Having been dragged around to see barmy aunts and elderly lunatics as a boy, my every sense was offended by what I saw, heard, felt, and smelt. In the old people's home I was consigned for what seemed like an eternity to the day room - to a view of tatty armchairs, leering smiles, clawing fingers, and spittly remarks I could not understand. Me and my more resilient sisters were often abandoned for tea with a mad old lady whose flat was plastered with cuttings about the Queen. (Princess Diana has not yet been born). The blended aroma of disinfectant and strawberry jelly is one of the few smells I can still recall from my childhood, together with instant nausea.

It was not much better when I went to medical school. One of the teachers there ignored any old person who was not able to cough up some titbit to stimulate and add to his endless anecdotes. If nothing was forthcoming, the ward round sailed past that particular bed thereafter as if the person in it did not exist. But if an old person had stories to tell about the "auld days" (that is, before the 1930s), he would be permitted to waste hours of our precious clinical time droning on about things of no interest to anyone who was still alive. I emerged from medical training with my revulsion of old people intact.

As a houseman in medicine I was appalled by the waste of time and money spent admitting people in their 70s with strokes or dementia. I was even more appalled by the fact that I had to go to the trouble of trying to make some sense out of their story. (Fortunately, I could pronounce them as poor historians so I could safely ignore most of what they said, and no one seemed to mind.)

Suprised by love in later life.

After a time I started training in psychiatry. My only contact with older patients was while on call in the psychiatric hospital, when I would be summoned to a back ward to clerk in a demented patient for respite care. These wards were like hell. They smelt, were overcrowded, and the staff seemed to be either dashing to and from the toilet with wheelchairs or sitting in the office smoking and reading the paper. I did my bit and got out fast.

I did not look forward to my first psycho-geriatric senior house officer's job. I have to admit though that it wasn't bad. One of my prejudices took a bit of a bashing. Some of the patients seemed to get better. I also met staff who actually liked working with older patients, and they were reasonable people. Old people were still smelly, repulsive, and mad, but I now accepted that some of them got better.

I finished training and moved on to research work in a team studying older people. The people in it were very clever, far smarter than me, and - to my amazement - they liked older people. Many of the older people I interviewed lived at home and were not in any psychiatric, social or medical crisis. My contact with them was quite different from anything I had experienced before. All of a sudden I was with old people who were as intelligent, warm and enjoyable, to talk to as anyone else. They did not smell or dribble. I came across the term "ageism" for the first time, and identified myself as a chronic victim of this condition. The next encounter with older people (attending their general practitioners) exposed me to many normal, intelligent people leading active and fruitful lives, and for the first time I found myself envying some of them for their happiness and history.

I moved on to teaching and find that many of the medical students have the same negative attitudes that I had. I try and help them with piercing epidemiological questions, such as: what proportion of over 65s have dementia? (Answer: 6%). In my professional world I meet old sick people who are anxious, depressed, paranoid, demented, physically ill, or frail. Exposure to this, especially for a very limited period of time where you do not have the opportunity to see improvements, does not alter attitudes. It may even reinforce them. It doesn't help that the media bombard us with negative messages of old people. For instance, a poster advertising an ugly Toyota car depicts an old man in a ludicrous shirt with his equally ludicrous trousers pulled up his over chest. The advertisement says that you must buy this car before you find yourself dressed like that - an offensive allusion to the inevitability of folly with old age. Other cases involve newspaper reporters who come across an 80 year old person who enjoys learning a new skill, like computing, and report it as if it were an wondrous exception (to the implicit rule).

Perhaps we must make sure that students have some experience of contact with healthy older people in their training. There is some evidence from the United States that this works.1 We could also sponsor "spot the ageist" competitions, and involve campaigners like Jack Jones, a former trade union leader who fought for improvements in pensions. We might arrange our increasingly fragmented curricula so that students follow up carefully chosen older patients over a long period. Fortunately, the aging population and delay in childbirth mean that students have more contact with normal older people in their families than I did.

Ageism is unique amongst the "isms." Few people change sex, and even fewer change "race." It's likely that most of us will eventually become old. In the third stage of life we become the object and victim of our own prejudice - so finally, there is some justice.

References

1 .Adelman RD, Fields SD, Jutagir R. Geriatric education. Part II: The effect of a well elderly program on medical student attitudes toward geriatric patients. Journal of the American Geriatrics Society 1992;40(9):970-3.