Desmond O’Neill: One hundred years of flautitude

Desmond O'NeillNo geriatrician could pass up on the opportunity: a performance of a flute concerto written by a living composer in his 100th year by one of the greatest orchestras in the world, the Boston Symphony Orchestra.  It took place without any formal linkage to the almost 4,000 delegates attending the Gerontological Society of America (GSA) congress in the city during the same week-end: could it mean that we have so accommodated to the “new” ageing that such an event should occur without any fuss? Or more possibly it was a missed marketing opportunity for both the gerontologists and the musicians – sadly, there were some vacant seats at the concert.

Both the congress and the concert were superlatively good. Gerontology, the collective term for the sciences of normal ageing in the first instance, is the constant backdrop to the hectic theatre of geriatric medicine. To attend a well run gerontology congress reminds us not only of the positivities of ageing, but also wider issues such as income, housing, environment and transport.

The GSA is the largest and best organised annual congress of its type in the world, and divides the activities into four broad pillars: social gerontology, psychology of ageing, biological gerontology, and health gerontology. Given the breadth of research and interests, it was daunting if not totally surprising to find up to twenty parallel sessions on the go at any one time.

This was tempered by adequate coffee breaks, a very friendly atmosphere, and excellent plenary sessions so that a sense of relative intimacy could be sustained and networking facilitated. There were also much more active and enthusiastically attended poster sessions than would be the norm in European meetings, and these were very stimulating. 

While much of the topics were those that might be expected, every turn seemed to provide new insights, from online dating among older people, through experiences of pain by older married people, older prisoners, to the degree of transcendence among older Chinese people. Occasionally the titles suggested deficits of irony: one title, “Dietary supplementation with coffee improves motor and cognitive performance among older rats,” may come in handy the next time I have the last speaker’s slot before the coffee break at a conference!

A particularly interesting highlight was an assured and polished presentation by Dan Buettner, a reporter who had investigated locations associated with health and longevity – such as Okinawa and Sardinia – for the National Geographic. Marrying gerontological knowledge with a keen pedagogic eye, he outlined the factors critical to healthy ageing and longevity in these Blue Zones, with a particular emphasis on environment, social connectedness, healthy routines, and work-life balance. While the omission of any reference to the WHO’s Age-Friendly Cities Programme raised a little concern over the balance between the entrepreneurial and the academic, nonetheless this was a sentinel lesson in advocacy and communication.

As for the concert, Wagner would have surely termed it a Gesamtkunstwerk (total art work). Symphony Hall, one of the three finest concert halls in the world, is a striking palimpsest of the huge influence of Germanic culture in the USA up to 1917. In the most extraordinary display of orchestral versatility that I have heard in a single concert, the ensemble turned on a series of dimes with a widely varied menu of romantic, classical, contemporary and expressionist music – Le Corsaire by Berlioz, Mozart’s 25th piano concerto, the Flute Concerto by Elliott Carter, and Bartok’s savage Miraculous Mandarin.

Carter, still composing in his 102nd year – three more world premieres will be performed in New York in December for his 103rd birthday – has had a reputation as a knotty composer, passing through a severely atonal phase in the 1950’s, and with complex polyrhythms distributed among the instruments. His (very) late orchestral works are more approachable, delicate and filigree in nature with smaller, almost chamber-like ensembles using a rich pallette of percussion.

The Flute Concerto, co-commissioned by the Boston orchestra which has a proud history of commissioning works by Stravinsky, Prokofiev, Respighi and Poulenc among many others, draws the listener into an intense narrative, at once beguiling and challenging. The soloist was the orchestra’s principal flautist, Elizabeth Rowe, who handled the complex part with deceptive ease. The emotional directness of the concerto is of a piece with much great art of the longevity dividend, where the artists seems to be able to pare their art to the bare essentials, whether the paintings of Titian, the nocturnes of Fauré, or the plays of Samuel Beckett.

Such a performance, and its embedding at the highest level of cultural infrastructure, is one of the most eloquent expressions of the attractions of working in geriatric medicine, particularly for those who may not immediately see the fascination of working with lives simultaneously at their most enriched and their most vulnerable.

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