Second Opinion: Nordic insights into the art of ageing and dying well

There is a growing interest in cultural gerontology, an evolving field of inquiry into the social, philosophical and humanistic contexts of ageing, one of the richest and as yet underexplored phases of life

I hate to miss the opening ceremonies of European geriatric medicine conferences, with the individual interplay between this most complex of medical specialties with the national characteristics of the host nation.

Norway is notable for its ability to fuse simplicity and sophistication, typified by the striking new Oslo Opera House, where the sloping roof provides not only a promenade for its citizens but also echoes of its mountainous and snowy landscapes. It is also home to an energetic and cheerful body of geriatricians who hosted the well- organised and cutting-edge 2015 Congress of the European Union Geriatric Medicine Society in Oslo earlier this year.

Cultural gerontology

Its opening session was thought-provoking and original, easily matching previous ceremonies which have featured Nobel prize-winning poets (Seamus Heaney in Dublin in 2010) and astronauts. These forays beyond the conventional boundaries of geriatric medicine are not just superficial entertainment but reflect a growing interest in cultural gerontology, an evolving field of inquiry into the social, philosophical and humanistic contexts of ageing, one of the richest and as yet underexplored phases of life.

This was manifest in a discussion on life and ageing between the 108-year-old Karl Falck and Anette Ranhoff, professor of geriatric medicine in Bergen. With a twinkle in his eye and in excellent English, Falck talked about how he attributed his longevity to good genes, humour, a little drink every day and walking in the hilly forests enveloping Oslo.

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In a moment reminiscent of the near-centenarian comedian George Burns, he demolished one of the most persistent canards of bar-stool gerontology, that what older people want is quality of life and that quantity is of lesser import.

Asked as to what age he thought he would like to live to, he said that he used to think 110, but now he was more inclined to opt for 112.

His unsteady gait necessitated assistance to ascend and descend from the platform, provoking interesting discussion at the reception. A minority felt that the episode should have been videotaped to spare him the effort, but most felt that the vitality in the face of disability encapsulated the essence and complexity of optimal ageing.

The session closed with a captivating lecture on the portrayal of ageing through the self-portraits and words of Edvard Munch from a senior curator at the national museum. Never one to shy from the angst of the human condition while creating art pulsing with energy, the iconography of his progression from fiery young artist to solitary older man living in his estate in Ekely outside Oslo was absorbing.

The array of images drew not only on familiar paintings but also on a wide range of graphic art and watercolours that were novel to the audience: Munch produced an almost unparalleled 200 self-portraits over a 62-year period.

The expertise of the art historian illuminated afresh celebrated pictures such as Death in the Sickroom, and how Munch highlighted the persistence of grief. Although his sister, the central focus of the painting, had died when he was 14 years old, all the figures are represented at the age they were when the picture was painted 16 years later.

Anxiety about life

Two particular aspects struck me as a geriatrician. The first was Munch’s awareness of how critical our intrinsic vulnerabilities are to our identities and work. The haunting quality of his Night Wanderer mirrored his words that “anxiety about life has followed me since I make aware . . . it is necessary for me as is sickness: without anxiety and illness, I am like a ship without a rudder”.

Of equal interest was his tearing up the tracks of another cliche of ageing and death, the wish to die peacefully during sleep. Death and dying track like a leitmotif through his work and self-portraiture, and he wrote: “I don’t want to die suddenly or without consciousness of it, I want this experience as well.”

This resonated hugely with what I witness among my patients, albeit largely unarticulated and complicated by the differing perspectives of their bereaved relatives.

Nordic art is often characterised by the particular nature of its light. In harmony with this characteristic, we are grateful to our Nordic colleagues for reminding us of how the narratives of older people and great artists can illuminate ageing, death and dying not only in our clinical practice but also in our personal lives.

A version of this article appeared as a BMJ Blog. Des O’Neill is a consultant physician in geriatric and stroke medicine, and a professor of medical gerontology at Trinity College Dublin and Tallaght hospital.