An occupational hazard of being a geriatrician is that not infrequently I am asked at social occasions: “So, Des, when do you become ‘old’?”  The questioner is usually a fit middle-class older person, often still working in one of the liberal professions. Inherent in the question is the sense of an impending instant rebuttal should one be bold enough to respond with any of the range of the chronological cut-offs in current usage, usually phrased between gritted teeth as: “So, you’re saying that I’m ‘old’!”

It has taken me some time to formulate a response that makes sense to all parties, and was reminded of this recently when preparing a pre-concert talk for our national symphony orchestra. This wonderful and flexible ensemble has engaged in a number of medical humanities projects, including a symposium and concert dedicated to music composed after stroke and dementia, as well as highlighting music composed after 60 throughout one entire season. This year it joined with a major European geriatric medicine conference for an opening ceremony which included presentations by Seamus Heaney and Mary Robinson, and a concert of music of mature creativity.

The pre-concert talk, on ageing and the artist, preceded music by Richard Strauss and Mozart. The link to Strauss was fairly straightforward: his Metamorphosen, Four Last Songs, oboe and second horn concertos, all composed in his 80s, are a lucid testimonial to the demographic dividend in art. Indeed this creative output is sometimes misleadingly referred to as an Indian summer, ignoring the fact that he completed five major operas in his 70s.

With Mozart, at first sight the connection with ageing seemed less obvious, although the composers are naturally paired. Both composed from an early age, were notable for being equally gifted in both opera and orchestral works, worked with the greatest librettists of all time (Da Ponte and von Hofmannsthal respectively), are popular with musicians and public alike, and were not overly fussy about the high art/low art divide. Mozart worked with what was effectively a music hall troupe for the Magic Flute, and in 1926 Strauss created an orchestral score for one of the most bizarre popular art projects of all time, a silent film of his most popular opera, Der Rosenkavalier.

One possible reflection, given the extraordinary ongoing development in his music, is what we might have gained if Mozart had been able to take advantage of the longevity gains of the 20th century. However, at a more profound level, it is the Marschallin in Strauss’ Rosenkavalier who provides a different and more potent linkage, by reminding us that ageing and its effect are shared across generations, and are not the exclusive preserve of later life. Her character’s awareness of time and her age in her relationship with the much younger Octavian shapes the underlying philosophical thrust of the opera, and her role far eclipses that of the young lovers and coarse Baron Ochs. In a number of arias and set pieces she reflects on how age and time are the forces that shape our destiny.

This is caught subtly but with great impact in the aria Die Zeit, die ist ein sonderbar’ Ding  -Time is a strange thing.  Strauss reduces the orchestration to Mozartian proportions, and the text is affecting and pensive: “Time is a strange thing/When one lives for the moment, time means nothing at all/And then, of a sudden, one is aware of nothing else/It is all around us inside us, even!/It shifts in our faces, swirls in the mirror, flows in my temples./It courses between you and me silent, as in an hourglass./Oh, often I hear it flowing, irrevocably./Often I get up in the middle of the night and make all the clocks stand still.”

Yet she is only 32, not far off the age of Mozart when he died, to Octavian’s 17 years. She is a potent symbol of how unconsciously and/or consciously we are adapting, anticipating and incorporating ageing at all stages of our life – ageing is growth and loss at all stages of life, a concept transformed in the transcendent final trio from the opera: “Now or tomorrow; if not tomorrow, very soon.”

So, when as to when one is old, I now have a triple strategy. The first is to ask the questioner to consider at what age does one begin to suffer negative consequences because of increasing age  – perhaps the late 20s for women in lead roles in Hollywood, and increasingly in the fourth, fifth and sixth decades when seeking any new employment, before even discussing the rampant ageism in health services at later ages.

The second is to ask whether they have any problem with the concept of being “old,” and if so, to consider a healthy dose of late Strauss, Verdi, Eastwood, Kurosawa, Lloyd Wright, Picasso, Bourgeois, PD James, Heaney, Leonard Cohen or George Burns, depending on their tastes.

Finally, (if we are still on talking terms) I would like to invite them to reflect on whether they too have a role in reversing the negativity popularly associated with ageing. All generations will benefit from this wider sense that ageing, with its growth and losses, is our constant companion, and unchecked negativity to ageing at all ages leads to what the late, great Robert N Butler saw as the real challenge to all of us: “the tragedy of old age is not the fact that each of us must grow old and die, but that the process of doing so has been made unnecessarily and at times excruciatingly painful, humiliating, debilitating, and isolating through insensitivity, ignorance, and poverty.”

Desmond O’Neill is a consultant physician in geriatric and stroke medicine, Dublin.