9 Jan, 13 | by BMJ Group
When viewed through the perspective offered by an anthropological lens, “care of elderly people” is an extraordinary phenomenon in Western culture. Reading the masterful survey of what we might learn (and reject) from extant or recently extinct traditional societies in Jared Diamond’s “The World until Yesterday,” I was struck by the way in which the biomedical resources Western societies pour into sustaining the life of our elderly population seems at odds with the social isolation we engineer for them. An isolation that evidence suggests is as closely linked to increased mortality as the more familiar suspects of alcohol and tobacco.
Of some traditional societies, Diamond asks, “how are burdensome old people jettisoned.” With broad and apologetically brutal brush strokes, he lists five approaches. There is the more passive method, favoured by the Inuit, for example, of merely neglecting elderly people until they die. Then there is intentional abandonment of sick or elderly people when the camp moves on, used by the San in the Kalahari, among others. Next there is the active choice made by elderly people, or with encouragement from others, to die by suicide. Fourth there is assisted suicide—”Among the Kaulong people of southwestern New Britain, strangling of a widow by her brothers or son immediately after her husband’s death was routine until the 1950s.” Finally, there is violent death. Diamond documents an interview by two anthropologists of an Ache Indian man, who tells them, “I customarily killed old women. I used to kill my old aunts while they were still moving.”
Diamond also describes tradional societies where the elderly enjoy far greater respect and satisfaction in their lives than the “jettisoned.” All the examples he cites as contrasting to our own throw into relief the peculiarities of the “dismal existence,” as the care minister recently put it, experienced by many of the UK’s pensioners. I wonder to what degree western societies’ cults of individualism, celebrity, and technological fetishism drive the social isolation of our elderly people. And in turn, given the evidence for the effect of this isolation on morbidity and mortality, in what ways might “care of the elderly” (or the more clunky sounding geriatrics), be a rather crude plaster on a sore hiding a deeper societal malaise. Advances in life expectancy are so often celebrated as a triumph of modern medicine, but this surely must be tempered by an exploration of the quality of the lives being sustained, as well as the ways in which the two might actually be in conflict.
Jonny Martell is an FY1 doctor in Newcastle.