Professor Terry Quinn is the David Cargill Chair and an Honorary Consultant Physician in Geriatric and Stroke Medicine, School of Cardiovascular and Metabolic Health, University of Glasgow, and Senior Editor of Age and Ageing journal. He Tweets at @DrTerryQuinn.
Dr Jodi Watt is a Postdoctoral Research Assistant at the School of Cardiovascular & Metabolic Health at the University of Glasgow.
Amy Brewerton is Publications & Website Editor at the British Geriatrics Society. She tweets at @Amy_Brewerton.
In its simplest form, growing older is an accumulation of life. Each of us travel on this gradual journey every single day, and most of us hope to continue to do so, until such a point as our bodies or minds become unable to sustain the processes essential for living.
Ageing is a universal state of being, and older people are not ‘other’. We all have an age, which is ever-changing, and the longer we exist, the greater that age is. Age is one of the few things that unites us all, independent of all other aspects of our identities, yet it can also affect us physically and mentally, positively or negatively. As healthcare professionals, our own narratives around ageing set the tone for us all, and how we view the ageing of ourselves and others.
It is a personal privilege, and a medical triumph, to live in a body that is sustained in its function as we age. But perhaps the ultimate goal is to live in a body that can continue to exist, in the context of a society that enables that body to achieve all the things that the person inhabiting it wishes to do, for as long as possible and without avoidable suffering. For those at the upper end of the age spectrum, the notion of living well, feeling well, and having your needs met becomes even more important. Nothing lasts forever, as they say, and the human body of course is no exception.
While there are indeed ways to delay, reduce or even avoid the effects of frailty as we age, each person’s genetics, history, needs, wishes and goals are unique, and the interplay between all these things becomes increasingly complex the longer our lives play out.
There is no shame in frailty. A person with frailty has lived a life without frailty. And just as they were supported when they learnt - with wonder and joy - how to achieve things in their first years of life, they deserve be supported to find similar meaning in what they can achieve in their final years of life, too. To quote John F Kennedy, “It is not enough [...] to merely to have added new years to life - our objective must also be to add new life to those years.”
It is not enough [...] to merely to have added new years to life - our objective must also be to add new life to those years.”
- John F Kennedy
A change in cognition, too, can alter personal and public narratives of ageing and the light in which this is viewed, irrespective of the wishes of the person to whom it is happening. Cognitive changes with advancing age can be mild and expected, or more severe and ultimately lead to a diagnosis of, for example, dementia. The public narrative of such conditions is one of fear. Misconceptions and stigmas around the conditions are prevalent. Any diagnosis can affect mental wellbeing, with older individuals at risk of loneliness, depression and anxiety. The effect of ageing on cognition and mental wellbeing should therefore also be handled with respect and care, and language use considered.
The BGS strongly believes in the ethos of person-centred care - treating older people as individuals, and tailoring support around what matters to each unique person. Older people are more than their age, their health conditions, or what they can no longer do. Age is not a condition to be treated, but rather a transient stage of the lifecourse that is no more or less meaningful than any stage before it.
Talking about older people as people is a good first step in framing conversations and discussions about ageing. Our choice of language around ageing reflects how we perceive it, and it is important that we try our best to get this right. There are many negative and diminutive words or phrases relating to older people, and their usage contributes to a pervasive cultural narrative that ageing is something to be feared or ashamed of. Just like age, frailty is a spectrum, and there is no such thing as a ‘typical’ older person with frailty.
It is important too, that we consider that while these people may cross our paths as a consequence of their experience of ageing, additional facets of their identities may also be referred to with inappropriate and outdated language. The relationship between ageing and these identities is often profound, and acknowledging these represents another important aspect of person-centred care.
We have put together a guide to help people select language that is both age-positive and clinically accurate when talking or writing about older people. It discourages dehumanising words such as ‘elderly’, instead preferring terms such as ‘older people.’ It also sets out how to frame frailty as a condition that someone is living with, rather than an adjective to describe or define a person. We also offer additional suggestions for how to approach language around some minority groups within the ageing population.
Like people at any other stage of the lifecourse, older people are individuals with diverse backgrounds, values, priorities and lifestyles. Altering the language used to describe older people and their experience of health or illness may also help to reframe some of the imposed stigma around the universal process of ageing, and ultimately help people to enjoy living longer lives.
