Do we respect, fear or embrace old age?

Ageing is a process that awakens anxiety for many, young and old alike. We may be preoccupied about older relatives, fearing their eventual physical and mental decline or uneasy about how we might care for them in an increasingly fragile state. We worry about our own ageing: the deterioration that may make us burdensome for our families, or the visible signs that, for many people, are reviled and preferably reversed rather than accepted or even embraced. It seems that Western society has increasingly developed a negative attitude to the ageing population, regarding them as a bore, a nuisance, and a drain on the economy. With the decline of the extended family structure, the elderly seem to be less valued and revered than in the past.

Ageing can often seem - and be depicted as - a gloomy prospect, an inevitable journey towards pain and enfeeblement ending in death. Yet it is not simply mental distress but mental impairment that many dread with ageing. The medical identification of senile dementia - the irreversible deterioration of cognitive function associated with ageing - evolved over the 19th century and was consolidated by the 1880's. A deeply affective lithograph of a man with the condition was used as a plate in Baron Bramwell's Atlas of Clinical Medicine published in the 1890s. Bramwell writes that the plate "represents a man aged 82, an inmate of the Craiglockhart Workhouse, affected with senile dementia. His sight and hearing were dull, he took little notice of his surroundings, spoke little, and seldom responded to questions. His appetite and general health were good."

A turning point in the understanding of dementia came in the first decade of the 20th century, when Alzheimer's disease was identified. Since then definitions and diagnoses of dementia have become increasingly precise. Modern brain imaging technologies are becoming an invaluable tool in the diagnosis of the disease as well as in the assessment of current and developing medical treatments.

The deterioration of the intellectual functions is but one burden of ageing; physical pain and infirmity is as great a threat to an increasingly fragile body. Advice on how to preserve health and vigour and control physical decline (and its psychological effects) in old age has been proposed since antiquity. In 1724, in what is regarded as the first English treatise on geriatrics, Sir John Floyer published 'Medicina gerocomica: the Galenic art of preserving old men's healths'. Although the underlying theories may have changed over time, the regimen he recommended still seems relevant: gentle exercise, a moderate and balanced diet, bathing, sufficient rest, and fresh air. Floyer himself lived to the impressive age of 85 at a time when life expectancy was, at best, around half that.

Whilst the most destructive problems of ageing afflict the mental and physical faculties, many people - predominantly women - are preoccupied by the changes that it wreaks on their appearance. The industries devoted to anti-ageing measures - both cosmetic and surgical - have grown exponentially in recent decades, promising to attenuate, conceal, or erase the signs of ageing such as wrinkles, spider veins, flaccidity and greying (or receding) hair. An advertisement for Sunlight soap from the 1880's asks, "Why does a woman look old sooner than a man?" emphasising the greater burden on women to look youthful. and offering Sunlight soap as a remedy.

Yet as the Roman Stoic philosopher Seneca (c.4 BC-AD 65) observed, "As for old age, embrace and love it. It abounds with pleasure if you know how to use it. The gradually declining years are among the sweetest in a man's life, and I maintain that, even when they have reached the extreme limit, they have their pleasure still."