Second Opinion: Optimal ageing and the midnight sun

Helsinki in summer is a delight, its streetscapes of Russian-influenced architecture illuminated and lifted by the interplay of the midnight sun and the ever-present sea. The occasion earlier this month was the triennial joint congress of five Finnish societies for more than 800 scientists, researchers and clinicians – a very impressive number for a population not much bigger than ours.

Once again, I was reminded why meetings and congresses make sense, even with all the video- and tele-conferencing possibilities open to us. The interaction of delegates, the emergence of fresh ideas, the sense of community, the human interest and, in particular, humour are a formidable counterblast to the inevitable routine and the grind of research and practice.

As an invited speaker, finding local resonances has many benefits. In addition to returning the compliment of hospitality and engaging the hearers more fully, it opens new horizons and avenues of thinking. In Finland, there is no shortage of interesting examples of ageing.

Challenges
At least three figures spring to mind. The key late works in Helsinki of the ground-breaking architect Alvar Aalto, including the Finlandia Hall, are highly visible markers of late-life creativity. Field-Marshall Mannerheim is a prime example of the longevity dividend, his greatest military and political achievements all occurring after the age of 72.

But it is the great Finnish composer Sibelius who provides a more challenging, if potentially revealing, interpretation of the subtleties of ageing.

Most great artists continue creating into later life, with Elliott Carter providing the most extreme example, composing into his 103rd year. However, after his seventh symphony was completed when he was 59, Sibelius was wrestling with an eighth symphony for a number of years.

Sometime in the early 1940s, he suddenly decided to burn a large number of manuscripts, including the work so far on the eighth symphony. His wife, Aino, provided a telling commentary of this episode: “ . . . after this my husband became calmer and gradually lighter in mood”.

This is a neat example of the resistance in later life to fall into easy and simple categories: yet a deadening simplification is one of the biggest challenges older people face from policy-makers.

Although concepts such as “successful” ageing, and “active and healthy” ageing may seem on the surface to be an improvement on earlier perspectives, a moment’s reflection gives grounds for concern.

Are those who do not meet the parameters of “successful” ageing to be considered as “failed” ageing? Are those who are not, through any fault of their own, neither active nor healthy in later life in some way to have achieved a lesser citizenship?

Is Sibelius’s more happy state not a form of ageing that we should also laud, even if less apparently productive? Eminent gerontologists have noted how official conceptions of active ageing are strongly “productivist” rather than embracing a wider view of ageing.

There is little room in this vision for other ways of living, as brought to mind by Robert Louis Stevenson in his wonderful defence of idleness, where he opined that "extreme busyness is a symptom of deficient vitality" whereas "a faculty for idleness implies a Catholic appetite and a strong sense of personal identity".

We need to develop forms of expression that value older people – us as we age – for what they are, regardless of their state and productivity, without in any way lessening our public health impulses to promote activity, social engagement and health to the greatest extent possible, and as desired by the older person.

Tyranny
It would be a pity if previous miserabilist attitudes to ageing were to be replaced by a different form of tyranny where we all have to be active, happy and sociable. Admirable and worthy as these attributes may be, just try to imagine what short shrift Victor Meldrew, the wonderfully irascible anti-hero of ageing in One Foot in the Grave, would make of them?

With ageing, we grow more complex and more individual in both our strengths and weaknesses: “optimal ageing” is a term which is justifiably gaining traction as a more flexible and less productivist phrase which suggests the best possible match to the values and wishes of the person rather than externally imposed concepts such as “successful” or “active” ageing.

A version of this column originally appeared as a BMJ blog

Prof Des O'Neill is a consultant in geriatric and stroke medicine