AGE - From the Anatomy of Life to the Architecture of Living
With this book Crosstalks wants to contribute to escape routes out of a society driven by competition and profit and divided by class, income, race, sex, education and age. The result is a mix of empirical studies, academic research, reflections, projects, a rallying cry against ageism, and even Three Rules for Aging Disgracefully.
Make the most of your day; don't forget to breathe, speak out, and act. Whenever you can. Don't hesitate. We hope this book will give you a reason to get out of bed, if nothing else does.
May your hands always be busy
May your feet always be swift
May you have a strong foundation
When the winds of changes shift
(Bob Dylan, Forever Young, first recorded in 1973)
In 2011 Crosstalks, the interdisciplinary platform at Vrije Universiteit Brussel (VUB), Belgium, launched the project ‘Active and Healthy Aging’. The project followed a series of interdisciplinary seminars on the future role of medicine (2005-2009) and an initiative to improve transparency and communications between the concerned actors in health care (2009-2011). For ‘Active and Healthy Aging’, Crosstalks examined the medical, social and economic challenges of the increase in life expectancy in the general population. During the process, discussions on budget ceilings and efficiency of care related to older age groups and the end of life predominated, and became interwoven with the factors and countertactics of aging, ageism and ‘youthism’. For the publication that concluded the project, the adjectives ‘healthy’ and ‘active’, and the suffix ‘-ing’ were dropped, leaving us with Age. Age offers a counternarrative, celebrating life and solidarity between generations and the empowerment of people with regard to their well-being, whatever their age. Every age has its vulnerabilities. Yet, frailty and old age are often mentioned in the same breath. Amid a lot of prejudices about aging, this misconception must be the most stubborn of all. If you have good genes and live a healthy life in a country with high living standards, you can become old. But even if you were born in the right place, as a baby you are by far the most needy and vulnerable species on this planet. At about every stage of early development, human babies develop much slower than infants of any other species. However, it is precisely this slow physical and cognitive development that allows human beings to develop a wide range of sophisticated abilities. For many decades, the reduction of mortality among infants and children has been an indicator of progress. Yet, longevity and fighting frailty among older people is nowadays often discussed in terms of ‘an economic burden’, at least in countries with social welfare. While average life expectancy may be rising, there is still inequality in how health and life expectancy are distributed around the world. And although this inequality has decreased over the past decades, there seems to be more investment in healthcare in places where people’s lives are valued the most, economically. More cruelly stated: the absence of health care is a deferred birth control. In 2013, life expectancy at birth in Hong Kong was 86.7 for girls and 81.1 for boys which was comparable with Japan, South Korea, Australia, Taiwan and Western countries (Wan et al., 2016). In Swaziland (a country in Southern Africa) the average life expectancy is about 32 years for both sexes mainly because 26% of the population is HIV positive (Anekwe, 2012). While one in five Europeans is 60 years or older, only one out of 20 Africans reaches the same age (Norman, 2008). Remarkably, some areas in different parts of the world – coined Blue Zones – have an exceptionally high number of centenarians. Research by Michel Poulain et al. unraveled the secrets of these Blue Zones and the Blue Zones Project by Dan Buettner translated them into nine principles for a long and healthy life (see p. 274).
The struggle against death The 16th century English philosopher and statesman Francis Bacon divided medicine into three functions: preserving health, curing disease and prolonging life. Definitions of ‘good health’ and ‘a good death’ vary according to cultural and historical norms. The Ars Moriendi (Rosenwald L.J. Collection, circa 1493) was the first Western DIY manual, carved on woodblocks in the Netherlands around the beginning of the 15th century. The idea of the Christian creators of the manual was to learn or even memorize it while in good health and to use it when the fatal clock was ticking. The short version consists of 11 woodcuts with instructive images on how to prepare for death: from the art of weeping and blowing your nose, to the art of playing chess, and of course praying and dying itself. People were learning the steps for the last dance. Physicians either assisted in healing or they were called on to help those who could afford it towards an easy and speedy death – euthanasia is not a recent phenomenon, its regulation may be. In Western Europe, the rise of the bourgeoisie in the late Middle Ages ended the idea of equality in death: those who could afford it began to pay to keep death at a distance. Aging became a way of capitalizing life: rather than life’s aim, death became life’s end. The bourgeoisie would no longer accept a ‘natural’ death unless it happened when they were in good health at an active old age. For a lot of people the only death that was ‘natural’ was the one that would overtake them at their desks. The history of ‘natural’ death is the history of the medicalization of the struggle against death, according to philosopher Ivan Illich, one of the unrivaled social observers since the 1970s. Keeping death at bay through medical care became a mark of distinction, and for doctors treating the middle classes a timed death with a clear-cut cause became the ideal. The era of anxiety In China the population’s median age is now 35; by 2050 it will be 49 and from the same source we learn that ‘elderly’ people in Brazil, now 7% of the population, will make up nearly a quarter in 2050 (Berreby, 2013). But what does ‘elderly’ mean? And what can we learn from these kinds of numbers? A sound judgment on this issue was made in an article in Le Monde Diplomatique by Jérôme Pellissier (2013), who in a couple of sentences unraveled the biased portrayal of an aging society and the obsession of economists and politicians to overrate the target social group. Pellissier’s introduction can be summarized as follows: currently France has about 14 million minors compared with 11 million people older than 65. There are three times more young people (30% of the population is younger than 25) than old people (9% is older than 75). In the foreseeable future, those older than 60 or 65 will never make up a majority because in 2060, due to the current baby boom, the population will be almost equally divided in three parts: one younger than 30 years old, one aged between 30 and 60 and one older than 60. It would be wise for policymakers to act on this kind of demographic analysis i nstead o f o n t he i nverted p opulation p yramids i n w hich o lder people – ‘the retirees’ – outnumber younger people, who are often miscast as active or of working-age, and who need to pay for the ‘retirees’. ‘Active’ and ‘working age’ are often used as synonyms, while reality is much more complex. Just as gender, race, class and age are discriminating criteria, the ‘outnumbering’ argument is very short-sighted and unproductive. Life expectancy, health and well-being depend more on education and income than on age. So let’s think intergenerational and nurture the social and cultural maturity of older generations, while in the meantime invest in education and in fighting social inequality. Becoming aware of discrimination based on age is to understand the struggles around the world against racism, sexism and class distinction. Ageism is a huge threat to freedom of choice, independence, income, quality of life and mental resilience. When did we stop celebrating life? And at what age exactly do birthday wishes become less genuine? Young people try to look older and older people try to look younger. The generational matrix, as Aagje Swinnen calls it (see p. 68), ‘is a ghetto minded state imposed on aging, also known as ageism.’ Although scientists have been trying for decades to unveil the secrets of longevity, higher life expectancy has become suddenly a major problem for society. Hadn’t scientists, governments and politicians seen this coming? Maybe they did, but probably they decided to ignore it until financial crashes and economic recession made it possible to blame the aging population (Liedtke and Schanz, 2012) in part for the difficulty in resolving economic and social problems. However, acting against ageism and restoring the social glue called solidarity might be a better bet than expecting more from technology than from each other, an observation Sherry Turkle made in Alone Together (2012). Our world has deep divisions and scars, and uncertainties about the future. Despite the great progress made in knowledge and technology, we are living in an ‘age of anxiety’. What is the role of technology in all this? Is technological progress part of the solution or part of the problem, wonders Geerdt Magiels (see p. 110). Linda Stone (2015) points out that our current use of technologies, with their many pushing stimuli, puts our bodies in a constant state of low-level ‘fight-or-flight mode’, for example, while checking our emails or social media, our breathing becomes irregular. A sign of fear, if ever there was one. In the meantime Francis McGlone argues that we are losing touch (p. 98) and Nathalie Van Renterghem (p. 182) urges us to restore conversation as a tribute to humanity and as a resistance to further degeneration of our existence as social beings. In 2013 Crosstalks interviewed the Belgian researcher Erik Schokkaert about the ethics in health services and cost analysis, and how budgetary deadlock could be avoided. Devastating stories about elder abuse and neglect kept popping up, mostly cause by a lack of time, space and support. Schokkaert suggested that fewer resources should go to real estate developers and more should go to nursing staff and to people in low-skill jobs assisting older people still living at home. An apparent shortage of money for care simply illustrates that our society does not want to spend money on older people. So the decision to do so, Schokkaert said, has to come from citizens and voters. Which political party will be the first to put this on its agenda? During our conversation Schokkaert said that people would never support the idea of refusing an expensive therapy for an 80-year-old, just because he or she is too old. What is truly shocking is that in a survey by a Belgian sociologist Mark Elchardus in that same year (2013), 40 to 50% of people in Flanders do support that idea (see p. 138). As Pierre Missotten et al. (p. 376) write, ageism is not always recognized as such while the consequences are all too often disregarded by health professionals. For every technological innovation and investment, some emotional or intellectual value is lost. It is as if accepting any kind of of support means you let go of your intellect or your dignity. When it begins to hurt, age is never the only factor. Of course health care costs increase the older the population becomes, because health care is improving and the oldest population group didn't exist a few decades ago. This should not be a reason to panic, rather it should be an opportunity to reflect on care systems worldwide and learn from local care systems. Living in a globalized world, the differences should be inspiring, not suffocating. The preservation of a species The increase in life expectancy is a great achievement but this is a challenge for the welfare state (Phillipson, 2015) and puts more emphasis on private (individual) than on public (collective) services (Judt, 2010), not to be mistaken for patient-centered care. Solidarity and common objectives are being systematically dismissed in the eye of the beholder. Research in the Blue Zones (p. 274) shows that family ties and close social relations in the local community contribute to longevity. The same goes for volunteering (Sarah Dury, p. 124). Research has shown that volunteering not only has a positive effect on the volunteers themselves, but that it benefits society as a whole. So, ‘Think like a Group’ could be the baseline, if ‘Getting Old’ were the title. The American activist Maggie Kuhn (1905-1995) was one of the first sociologists to speak up against the disempowerment of older generations. According to Kuhn, co-founder of the Gray Panthers, gerontologists too often fail to challenge the system and its social controls. The Polish anthropologist Bronislaw Malinowski (1884-1942) argued that death among primitive peoples threatened the cohesion and therefore the survival of the whole group. The cohesion of the group was saved by turning natural events, like death, into social rituals. This is in contrast to the impersonal rituals of industrialized medicine today. Death in hospital has become a goal of economic development and would succeed in almost erasing all other deaths if not for the strong wish of many people to continue to live at home as long as they can and to die there. The architects Shusaku Arakawa and Madelin Gins (p. 388) offered a totally different perspective on life and death. They came up with the concept of ‘architecture against death’, not to be misunderstood as a desire for immortality, but rather as a way of life. The way they thought about life and death was an inversion of how these terms are commonly perceived. Death is no longer an event, it is a constructive process of resistance. The longevity of humans is relative in comparison to that of other species, and of the earth itself, as Philippe Claeys describes in the final article of this book (p. 398). Aging takes very different forms in nature, and the driver of this process, a comparative biology of aging, is a growing field of research. Some elements of nature are very good at aging. Hillary Rosner (2014) called them nature's anti-aging secrets. In California's White Mountains, researchers found bristlecone pines that are nearly 5,000 years old and show no sign of age-related decline. Natural selection avoids senescence and some plant species even show negative senescence – a situation in which death rates actually fall as the years pass. Plants are not the only organisms defying the aging process as some species of turtles and lizards also show negative senescence. An interesting case is that of the longest-living rodent, the naked mole-rat, which can live up to 30 years in captivity. Breeding females – mole-rats colonies are organized like insect communities with one single breeding queen – remain fertile into their third decade. In August 2016, Danish researchers discovered a more than 400-year-old Greenland shark. The females are only able to reproduce after their 156th birthday. Sadly, the sharks are on the edge of extinction because they often end up at an early age in trawling nets that are spread to catch other fish. Discoveries like these put the preservation of a species into perspective. It's one thing to invest in human egg freezing, in the creation of cyborg tissue or in regenerative medical therapies and quite another for a Greenland shark to wait more than a century to have sex. Comes a time Humans have a strange relationship with time. The urge to pin happenings or events on a timeline, concern for the exact measurement of time and the awareness of the simultaneity of events, has created a specific framework for an individual's identity. This identity is developed in relation to a sequence of events rather than the completion of a lifespan. Time is gauged by memorable events (Wittman and Lehnhoff, 2005), and there is only a weak association between age and a person’s perception of time. Despite the widespread belief that perception of time changes with age, empirical results from the survey ‘Effects of age on the perception of time’ proved to be different. Every participant in the Wittman and Lehnhoff survey, regardless of age, thought that time was passing quickly. The answers to the question ‘How fast did the last 10 years pass for you?’ showed a tendency for the perception of the speed of time to increase with age, a pattern that peaked at the age of 50 and remained steady until the mid 90s. The time perception of smaller intervals like an hour, a week or a month did not change with age. Putting age into perspective or reflecting on its relevance is a comparatively complicated matter. While age as such is not a dominating factor in a person’s lifespan, society is managed according to age. From the educational system, to getting a driver's license, being able to vote, to buy and consume alcohol, to have sex, to work and to retire... most of these age limits are continuously adapted, often because of economic considerations. All the more reason, therefore, to be careful about using age limits and requirements in research, in the media, in legislation and in daily conversations because there is a major and real risk of stigmatization and ageism. With Age we want to contribute to escape routes out of a society driven by competition and profit and divided by class, income, race, sex, education and age. The result is a mix of empirical studies, academic research, reflections, projects, a rallying cry against ageism, and even Three Rules for Aging Disgracefully. ‘Opening our minds to what is possible instead of clinging to accepted notions of what is not, can lead to better health at any age’, the psychologist Ellen Langer wrote (2015). Those words are the underlying inspiration for the following pages.
Age wants to contribute to the escape routes out of a society driven by competition and profit and divided by class, income, race, sex, education and age. Discrimination against age is deeply rooted and an immense and often not recognized threshold for many human oriented initiatives for a better world for everybody. Age is a counter narrative, celebrating life, solidarity and the empowerment of all people with regard to their own health, whatever one's age. This 6th Crosstalks book is a carefully selected mix of studies, research, reflections, projects and activism uncovering ageism and exploring the opposite. Philosophy and art are brought for their capacity to provide culturally driven contexts in which to think free and to activate slumbering senses and sensibilities.
Not acting one’s age, whether it is intentional or not, is both a dangerous and a promising enterprise - Aagje Swinnen
In many ways, age in men often equates with the concept of 'sage;' ironic, since we all know ma ny older men who are complete doofuses. There certainly seem to be more male role models who are reaching their older years with dignity and grace while in the public eye, compared to the number of high-ranking women in the fields of government, science, religion, education, politics … do I need to continue the list? - Ellen Snortland
AGE - From the anatomy of life to the architecture of living
Marleen Wynants & Goedele Nuyttens – Age comes without an invitation. Reflections on age, aging and ageism
1. The Arrow of Life
Ellen Snortland – Three Rules for Aging Disgracefully
David Gems – What is aging?
Arto Strandberg – The Helsinki Businessmen Study. Actions in middle age secure a healthy and happy older age
Jean Paul Van Bendegem – I’ll be 90 in 2043
Bengt Lindström – Salutogenesis. From H- to H+
Aagje Swinnen – The performativity of age. (Not) acting one’s age in Benidorm Bastards
Tornar – Portfolio - Seppe Baeyens, Danny Willems
2. Health & Healing
Francis McGlone & Susannah Walker – Losing touch. An unrecognized consequence of aging
Geerdt Magiels – The mighty patient. The shape of health to come
Sarah Dury – Volunteering in later life is worth gold
Marleen Wynants – The tragedy of the commons in health care. An interview with Ri De Ridder and Mark Elchardus
Vinciane Wojtasik, Sophie Germain & Eric Salmon – Cognitive rehab. A social perspective in cognitive rehabilitation and support for caregivers
Sara Engelen – Based on health, not age. A roundtable discussion with four icons from the Belgian pharmaceutical industry
Nathalie Van Renterghem – Improvisation theater for a better care
Mater Museum – Portfolio - Vincent Glowinski, Agnès Debizet
3. Working & living
Cor Wagenaar – Finding their place. Positioning the elderly
Olivia Vanmechelen – Caring communities. Zooming in on Brussels: from principle to practice
Anne-Sophie Parent, Nhu Tram & Julia Wadoux – Age-friendly environments in Europe
Luc Lampaert – Home in a range. An overview of alternative housing solutions
Michel Poulain, Anne Herm & Gianni Pes – Blue Zones. The enigma of extreme longevity
Patrick Deboosere & Hadewijch Vandenheede – Live longer, work longer? The creation of a new paradigm
Sara Engelen – Age is Bliss. Interviewing Frank Van Massenhove
Beyond Words – Portfolio - Huis Perrekes
4. Framing age
Louise & Jonathan Rosenblum – Now playing: two friends
Ashton Applewhite – This chair rocks. How ageism warps our view of long life
Eileen Chubb – Blowing it. Edna’s law or the importance of protecting whistle-blowers
Pierre Misotten, Stéphane Adam & Sarah Schroyen – Ageism and youthism – Healthcare
professionals disregard the consequences
Léopold Lambert – Architecture against death. The legacy of Shusaku Arakawa and Madeline Gins
Philippe Claeys – One upon a time