Old age: Wisdom or dementia?

Screenshot Sims 2 - elderly sims hobbying

At least my Sims stay vital until the last!

In olden days, a society where most people were gray-haired elders would have seemed like an impossible dream. Today it seems like an unavoidable nightmare. What changed? When did the natural condition of the old stop being wise and start being demented? When did they stop being a resource and start being clients? Has something physically changed, or is it just our perception of old age that has changed? Perhaps a bit of each?

It strikes me when reading books from centuries ago that old people were held in high regard all over the world. Clearly the young were stronger even then, but the wisdom of the old was expected to rule the strength of the young. While wisdom did not always come with gray hairs, there was expected to be a much higher chance of it. It was accepted as a fact of life that the old would grow frail and eventually die, but dementia seems to be either absent or very rare. Today this is considered the natural end of life for most people.

Perhaps dementia was always common, but it was just bad form to talk about it? The old were respected and looked up to, and children owed their parents and grandparents a debt of gratitude for being in the world in the first place. Honor your mother and your father! That might not go along well with recording their descent into babbling helplessness. ¬†Still, you’d think there would be more references to it, even if in an indirect and opposite way, like “do not look down on the old when they become witless”. But there is no such commandment that I can remember.

Perhaps the old were not really that old? In a world where the average lifespan was 35 years, perhaps someone aged 50 was considered old and someone aged 60 ancient? At that age they would have almost all of their life experience and not yet much chance of dementia. But the figure of life expectancy includes a massive infant mortality. Even later in childhood, you were still vulnerable to epidemics: There were no vaccines against smallpox, polio, diphtheria, or even measles which could easily kill underfed children with no medical recourse.  A third of those who were born died while they were children, and then many young men were killed in war. Childbirth was not entirely safe either. So those who lived to 40 had already run the gauntlet; they stood an excellent chance of living till they were 70 or 80. Indeed, a normal lifespan of 70 Р80 is mentioned in the Old Testament, with a maximum of 120 (barring divine intervention). This is practically the same as today, except now most children grow up to experience it for themselves.

I have even considered whether there could be a genetic difference: The current civilization is largely dominated by people from Europe north of the alps; but if you read anything older than 500 years, it is likely written somewhere else in the world. What if the Germanic and Celtic tribes shared some particular weakness to Alzheimer’s or brain stroke? But if so, it ought to be all over the medical textbooks by now. There are indeed some ethnic groups who seem to be less susceptible to it, notably in the Far East, but this could be due to lifestyle rather than genes.

First, I think we should bear in mind that the current generation of elders, and the couple generations before, are a bit of a historical anomaly. For one thing, they are the only generations in human history where smoking was widespread. It is not just dementia that is uncommon in history, so was lung cancer and heart infarct at the age of 50. A diet rich in refined sugar and saturated fat, and a habit of smoking, were simply not possible until well after the Industrial Revolution was complete.

Some of these trends have already reversed. For instance, blood pressure is lower today than in the 1970es. More than that: Typical blood pressure is lower today in overweight/borderline obese people (BMI 30) than it was in normal-weight (BMI 20-25) in the 1970es! When hypertension occurs, it is treated at a much earlier stage and with drugs with less side effects. Since hypertension is a major predictor of stroke, this is a Big Deal. Another important flag for stroke is fat in the bloodstream, particularly cholesterol. This is also monitored much more closely today and treatment starts earlier.

There is in other words a good chance that you are not going to become demented from stroke at the age where your grandparents did. And there is a good chance that their grandparents again didn’t, either, or at least their great-grandparents.

Alzheimer’s is a little different. We know there is a genetic component, but there also seems to be geographical variations. Here in Norway, the south coast (where I live) has the highest prevalence. A study some years ago proposed that aluminum in the water might contribute to triggering the disease. This would be interesting, because a major reason for aluminum in the water is acid rain, which was very rare before the industrial revolution, and is becoming rare again recently in the rich world.

There are also a number of old people who are not actually demented, they have just always been stupid. You may have heard of the Flynn Effect, the continuous growth in IQ since the first IQ tests began in 1914. The growth is typically around 3 points per decade, so it is not something you notice at a glance, but it really adds up over the course of a long life. When someone is 80, their grandchildren at 20 will have on average 18 points higher IQ. In a family where the IQ runs a bit low already, it could be enough that the elderly person is unable to function normally in today’s complex society.

A final consideration is that when your brain function seriously starts shrinking, the last things to go are the memories from your childhood. In the past when elderly people were the libraries of the tribe, they would remember the tales they themselves listened to when they were children, even after they had forgotten the names of their own children. So they would still fulfill a valuable mission almost to the last breath.

But in today’s society, we have gone all out in the opposite direction. The knowledge of the old is held in low regard, if not actually worse than nothing. Anything that is new is supposed to be better than the old unless proven otherwise. And so the dream has become a nightmare, the secure foundation has become a heavy burden. Perhaps we should think that over one more time.

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