Desmond O’Neill: Nowhere to hide

Desmond O'NeillThe large gilded hall of the Musikverein in Vienna is instantly recognisable to most people from the annual New Year’s concert dedicated to the Strauss family and their contemporaries. In real life it is no less magnificent, although it feels smaller than the images projected by the televised event. Endowed with a crystal clear acoustic and a reverberation time perfectly suited to orchestral music, it must be a terrifying prospect for any ensemble whose level of accomplishment falls short of the highest standards. Ally this to a formidably knowledgeable Viennese audience, and musically and acoustically there is nowhere to hide.

So it is a testament to the longevity dividend that we had enhanced expectations for a concert from the 79 year old conductor—Claudio Abbado—and the relative youngster Maurizio Pollini, a mere 70 years old, as the soloist. The orchestra was one of a kind, the Lucerne Festival Orchestra, which brings together high level soloists and orchestral players from major orchestras around the world to play at the Lucerne Festival in August in Switzerland and then a handful of concerts to major musical cities on a short tour in September. Its defining characteristic is to bring the spirit of chamber music to orchestral playing.

Both I, and my geriatrician colleague who had kindly invited me (it was the eve of United Nations Economic Council for Europe (UNECE) Ministerial Conference on Ageing), were fascinated by the juxtaposition of ageing, supreme achievement, and intimations of frailty.

The programme was just about as Viennese as you can get, with both composers—Mozart and Bruckner—dying in the city. The house containing Mozart’s apartment no longer exists and a department store occupies the site: however, the small house where Bruckner died still stands in the garden behind the Belvedere Art Gallery, marked by an austere plaque, at one with his modest personality.

Mozart’s piano concerto K453 opened the concert. Pollini’s playing was characterised by a steely reserve which stripped away any trace of sentiment, and in so doing augmented the affecting emotional content of music. The orchestral playing blended seamlessly with his technical mastery and Abbado’s direction was discreet and precise. The slightly hesitant gait of the pianist on the platform was in no way reflected in the fluidity and precision of his playing.

In the second half, Abbado came to the podium without either score or guard-railing, and proceeded to apparently effortlessly lead a very large orchestra through an hour of complex and ultimately thrilling music. Ascetic and distinguished in appearance, he overcame gastric cancer in 2000 and has at times had to retire from music making in the intervening period. In recent times he has rebounded, leading new orchestras—the Lucerne Festival Orchestra and the Orchestra Mozart in Bologna—and giving generously of his time, reminiscent of his founding and direction of both the European Youth Orchestra and the Gustav Mahler Chamber Orchestra.

His style was masterly and restrained, giving a strong sense of servant as leader, with a complete lack of swagger or bragadoccio. The orchestral response was breath taking without showiness, with both conductor and ensemble engaged in a wonder of skilled self-effacement, putting Bruckner’s masterpiece of simultaneous hesitation and excitement at the epicentre of our attention. Watching Abbado at work, I was reminded of Dürer’s description of Bellini in late life—“the master is old, but in painting still the best”

The performances stayed with me throughout the preparatory research meeting for the UNECE. Not only was I mindful of what we have gained with our longevity—Abbado is one of a increasingly large group of conductors who just seem to get better and better in their eight and ninth decades, including Pierre Boulez, Bernard Haitink, Nicholas Harnoncourt, Daniel Barenboim, and Lorin Maazel—but also of how important it is that we continue to develop healthcare systems that are age attuned to increased complexity of illness in later life.

For this to happen, we need to ensure that those involved with the design and implementation of health systems give priority to education and training in gerontology across the spectrum of healthcare workers, from care assistants through nursing to medicine. And yet, despite much that is laudable in the preparatory documents for the UNECE Ministerial statement on ageing, there was virtually a complete absence of mention of capacity building in gerontological education and training as a critical success factor in designing an age friendly society.

To be fair, this was a consultative session, and participating in this forum as representative of the European Union Geriatric Medicine Society I was at least able to propose the concept of universal gerontological training. In conjunction with other scientific bodies engaged with research into ageing, a lively discussion ensued.  For the hallmark of ageing is complexity, and more sophisticated approaches are needed throughout society—whether in town planning, employment policies, or healthcare—if we are not to erode the longevity dividend. If we fail to incorporate this knowledge, then we too will have nowhere to hide from the unfortunate effects of this.

Hopefully the UNECE will take this theme on board: though, as I sat and listened to a wide range of high level speakers, the thought did occur to me that perhaps this conference might usefully have started with a block booking for all delegates to hear Abbado and Pollini at the Musikverein!

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