Have we renamed getting old?

Language is lazy, not literally, some language is extremely energetic take the word: zap! *for example. However, the way we use language can become a linguistic equivalent of fast food. It’s quick to get out, satisfying at the time but not very helpful in the long run. No-one is truly renaming the aging process but frailty is too often substituted for a more precise description of what frailty means- particularly in older age. The increasing number of polarised young and very old frail patients makes this all the more complex. We now have super-agers; nonagenarians who leap and fizzle their best life next to those in their 60’s whose list of physiological woe make every breath a challenge no less significant than the task of Sisyphus. Although with fewer boulders.

In a world then where age is not a precise marker of frailty and where medicine in all specialties aspires to individualised approaches what does old age mean? Age is not as important as it has been considered when managing many conditions. This is true of cancer, severe valvular diseases and more. However, the temptation to say that age is just a number is a fallacy wrapped in a truism. Or as a colleague of mine said when he asked the patient’s age- the response was that the patient was 89 but that age is just a number- to which his response was: “yes, but it’s a rather high number”.

It is a very human thing wanting to quantify the unquantifiable. If a day goes by when I am not asked how long a person may live then it is because I have retired. Yet we have numbers accessible to us and age is a very easy number. In medical shorthand it can be that age is substituted for poor outcomes. Our patients and their next of kin generally see through this and so it lies upon us to start nuancing such discussions with a more open approach. After all, the young sometimes die young and the old sometimes live until extreme old age.

Despite this we can’t ignore the challenges in recovery that come from high numbers in the human chronological clock. As we get older our health may not be determined by our age alone but our chances of robustly defying the effects of pathological impact upon physiological processes. Quantifying such things is never within our grasp, yet if it were would we want such knowledge? Instead it seems that the lesson of evolving demographics and medicine is that we should not equate age with frailty but we should be aware that whatever the number -higher is rarely better in medicine.

*The exclamation mark is mandatory.