Second Opinion: 21st century reality check: most older people are increasingly fit and well

As the Irish public become increasingly interested in the topic of ageing and old age, I am often asked about the term “gerontology” and in what ways it differs from “geriatric” as in “geriatric medicine”.

This is an important question for both the public and those who work with older people. Gerontology is the group of sciences which studies normal ageing in the first instance.

Of its four main branches, biology of ageing examines how cells and organisms age, social gerontology concerns itself with how society views and shapes ageing, and the psychology of ageing deals with psychological changes and adaptation in normal ageing.

These aspects have been less obvious in Ireland until recently given the relative prominence of the fourth branch, health gerontology (geriatric medicine, gerontological nursing and old-age psychiatry) and negative public perceptions focusing on the losses rather than the gains of ageing.

It is simultaneously a strength and a weakness that geriatricians spend virtually all of their working week with older people: a strength that their practice is deeply embedded in the real world of older people, and a weakness in that it is concentrated among the sick and the frail.

This may lead to a distorted perspective of the reality of ageing in the 21st century, where most older people are increasingly fit and well.

The extraordinary gains of our collective increase in longevity may be obscured by what the gerontologist Kalish perceptively described as the promotion of the failure model of ageing – an emphasis on the deficits of old age, albeit ones that can be addressed effectively by geriatricians – that may inadvertently augment ageism, both within and outside the medical profession.

For example, it is extraordinarily rare for textbooks in geriatric medicine to include reference to either the longevity dividend or the cognitive gains of later life, which are the heart of successful adaptation to the vicissitudes of later life.

And so it is that some departments of geriatric medicine still refer to themselves as medicine for the “elderly”, a term rejected by older people and their advocacy organisations across Europe.

Equally, a seemingly positive concept such as “successful ageing” is now recognised to carry the implication of “failed ageing” for those who do not meet its criteria: “optimal ageing” carries a better sense of the best possible adaptation to the positives and negatives of ageing.

Life conditions

A misplaced emphasis on life conditions may also gain from gerontological insights. For example, loneliness is a condition that peaks in young adulthood, yet it is associated in the public eye almost exclusively with old age. Failing to report that many older callers to helplines are repeat callers may also augment this perception.

This disproportionate emphasis has twin risks: further stigmatising later life, and missing the opportunity for a lifespan approach which might alleviate loneliness at all ages.

Fortunately, the broader discipline of gerontology in Ireland is making great strides. It was very reassuring to see an impressive array of presentations at the 62nd annual scientific meeting of the Irish Gerontological Society in Galway earlier this month, with a particularly strong showing from the Irish Centre for Social Gerontology at NUIG.

Understanding ageing better is not just a personal priority, but also a societal and industrial one.

The Raku-Raku phone in Japan provides a wonderful example of what to do (and not to do) in terms of designing products for older people.

Designed as a simple phone for older people, it was a commercial disaster. However, a radical rethink produced a slick and attractive case, marketed as the simple smartphone for everybody: it is now the second-best selling phone in Japan with a high market penetration among older people.

If the company had consulted a gerontologist, it would have been alerted to a range of issues, from ageism through fears of social exclusion to universal design, which would have prevented its costly hiccup, and have made the company bucket loads of money – a win-win-win situation for older people, the general population, and business alike.

Irish gerontology will have a further opportunity to shine next April when we host the largest gerontology congress in Europe this decade in Dublin.

Initiatives such as Age-Friendly Ireland show our willingness to embrace ageing proactively: combining this effectively with the sciences of gerontology would make Ireland a leading light in an ageing world.

Prof Desmond O'Neill is a consultant physician in geriatric and stroke medicine and professor of medical gerontology at Tallaght hospital and Trinity College Dublin Trinity Centre for Health Sciences, Tallaght. See ageandknowledge.ie