Is it time to redefine old age

Vedamurthy Adhiyaman is a geriatrician working is North Wales. Here he discusses why we should redefine old age. He tweets @adhiyamanv

Western literature arbitrarily defines old age as people above the age of 75 (Oxford textbook of geriatric medicine, Wikipedia etc). Few authors subdivide old age further as young old (75-84), old (85-94) and old-old (95+). This would make our reigning monarch ‘old-old’ and the next in line to the throne and our patron, old (not sure whether he would like to be called old…). And definitions of old age vary according to different parts of the world. For African countries, the United Nations set the age 70+ and the WHO defines 60+ as old. Dictionaries define old age as a later part of normal life without defining any numbers. Decades ago, in 1920s set the age 55+ and in mid-1960s defines 65+ as old.

Nowadays a majority of people above the age of 75 remain very active, healthy and refuse to accept that they are old. A recently retired 75-year-old doctor wrote that he is still very active and working and did not want to enjoy the benefits of old age, like the free bus pass. A common saying is that old age ‘creeps up’ but we do not just get old as time passes, instead we continue to grow and mature until we reach a certain period which varies from individual to individual as ageing is multidimensional.

Generally, people don’t like being called old and many get upset when they are under the ‘care of the elderly’ either as in-patients or in outpatient clinics. However, many people use the term ‘getting old’ to justify some of their actions like forgetting to do things, to retire early, or to receive benefits.

If age is just a number, when does old age start? Perception of old age changes when people mature and a survey revealed that it ranged from 59-73 years of age. True age is not the numbers of years one had lived but should also include the effects of health and cognitive function. The disease spectrum associated with old age is constantly changing and we are recognizing many conditions in older people previously thought to affect only the younger.

One could argue that there is very little to gain by defining a person based on their chronological age, as we provide a need based care and started using the frailty model to prognosticate and measure outcomes instead of using the chronological age. But many hospitals in the UK use a cut off of 75 as an admission policy to the care of the elderly units and 65 as a cut off of for admission to frailty units. But this is totally obsolete, because it has no scientific basis and hasn’t been revised for many decades despite the increase in life expectancy.

So, is there a need to define old age? Yes, and some examples include: in epidemiological studies to monitor disease patterns with relation to age, to use age as one of the variables to study outcomes, effect of age on treatment outcomes, impact of age on symptoms etc. I suggest we define chronological old age as above 75, middle old as above 85, old-old as above 95 and very old as above 105 in developed countries, even though there might be concerns about its impact on the retirement age, pensions and other benefits linked with old age (like free bus pass). Since there is no consensus in the Western literature, I call upon the expertise of the BGS, celebrating its 70th anniversary to take forward the process of redefining old age with a clear emphasis that it should not provide a political cause for depriving the social care for people who need it most.