My mum was due to celebrate a century of life and looking forward to getting her card from the Queen. She’d been living in an aged-care facility which had been through multiple lockdowns due to Covid. Our family started preparations for her birthday party; “hold the date” cards were sent.
On Mum’s behalf, we applied to receive the birthday card from the Queen. But early one night, after another lockdown, my dad rang. “I don’t think she’ll make it to the weekend,” he said. “Come quickly.”
As it happens, she hung on for another 18 days. The palliative nurse explained to my family that this was a time of being, rather than doing. We tried to make Mum feel loved, comfortable and with as little pain as possible as her body prepared to die.
As Prof Ken Hillman says in his book A Good Life to the End, “no matter how much we tinker with the natural ageing and dying process, biology will eventually win … nothing stops the ageing process”.
Losing a parent is a profound moment in life. First there’s shock, then a tumbleweed of grief. The death of a parent can destabilise our identities, make us reassess who we’ve become what we want in life. Sometimes, it can free us. Or not.
When your parents survive into their 90s and you have children of your own, you can’t fail to think about the trajectory life takes. My mum was an older mother. She gave birth to me when she was 40. I had my child in my mid-40s. Generations aren’t as clearcut as they once were.
I began to wonder: am I, too, facing a long life? Was my mum’s longevity due to genetics, environment, lifestyle, good luck, attitude, or a smattering of all of these? And what of her final years of disability and cognitive decline? Was that also an inevitable part of ageing?
A few weeks after Mum’s funeral, I quietly celebrated my own significant birthday. Not long after that, I was woken up by the feeling of something or someone shaking me. It was about 3am. The house was silent except for my pounding heart. I’d been thinking about Mum’s last morning and how I’d counted her breaths before realising she had drawn her last. Then a voice in my head started.
“So, you’ve turned 60! You’re officially ‘old’. You have more birthdays behind you than ahead of you. Who’s going to die next? Will you outlive your partner, your siblings? Live to see your teenager become an adult, a parent? Who’s going to look after you when you are old?”
Now I wasn’t only grieving for my mum; I started panicking about future me. I should have got up and turned on a light. Instead, I lay there in the darkness feeling stunned and helpless. My “problem” felt insurmountable, as if I’d stumbled on an unspeakable secret. I reminded myself to breathe and eventually, the first shard of daylight appeared through the window.
After the mortality alarm (which psychologists call mortality salience, awareness of the inevitability of one’s death) I wondered: at what point is a person considered old? In the 1960s, the famous Beatles song “When I’m 64” described what old age was considered back then. Written now, it should be “When I’m 84”.
In Australia an “adult” is someone aged between 18 and 64. After 65, people are considered “older adults”. For Indigenous Australians, older adults are 50-plus. Despite my personal ageing crisis, I don’t feel I belong in the same category as an octogenarian. But in 2023, how do we redefine and recategorise “late life”? I’d like to propose a new category for pre-old adults, for those beginning their ageing journey: what about “juvenile geriatric”?
The anxiety is real
In the months since my mum’s death, I’ve tried to come to grips with the ageing challenge by speaking with experts, family, friends and strangers. I’ve gauged their views on the denial of ageing, healthy ageing, longevity, disease and death.
The first thing I learned is that, like me, many people experience the mortality alarm in their 50s and 60s. It’s not always triggered by the death of a parent. Sometimes it’s set off by a life-threatening diagnosis or the death or near-death of a close friend, relative or spouse. Others have FOGO (Fear of Growing Old) but haven’t articulated it.
Some people hide their age because they worry about negative judgment in the workplace. And many more are trying to navigate young-older life in ill-heath or with fewer resources than they had hoped for by this stage. It’s a mixed picture, but the anxiety is real.
I struck up a conversation with an Uber driver who mentioned that he was about to turn 60. Apollo Kanakis told me he’d lost more than 20kg last year by cutting out junk food, fizzy drinks and desserts.
What inspired him to lose the weight? A close friend, “Fat John”, had died of a massive heart attack at 59. Six months later, Kanakis was in his garage packing his scooter when the order of service from Fat John’s funeral fell from a shelf. “Out of nowhere, this flyer with John’s picture landed right in front of me. He was staring straight at me, like he was trying to say something.”
Before his mortality alarm went off, Kanakis, a tennis and swimming coach, ate whatever he liked. “I’d have a bag of chips, a bottle of Coke, and chocolate. Then I’d have dinner. And then I’d have dessert. Before I went to bed I’d eat the leftovers from dinner.”
Tests around that time revealed Kanakis was on the verge of type 2 diabetes. After he’d started losing weight, he got a call from the doctor’s surgery. “They thought that some blood tests I’d just done must have got mixed up at the pathology lab. They asked me whether I’d be doing anything differently. ‘Well, I’ve lost 21 kilos,’” he told them.
It turns out his weight loss had a dramatic impact on his health. “I went from being on the cusp of diabetic medication to being in the middle of [a] normal blood sugar range,” he said. “After that, there was no going backwards. I just didn’t need all that other stuff I was eating.”
Kanakis’ mortality alarm had triggered something powerful.
The British public health and ageing expert Prof Sir Muir Gray (aged 78) maintains that biological ageing doesn’t cause major health problems until after 90, or very old age. In his online course Living Longer Better, he argues that much of what we attribute to ageing (stiffness, being out of breath, tiredness, weakness) is actually loss of fitness. It’s why public health campaigns encourage us to get more active and if necessary, reduce weight.
Despite the constant messaging, 55% of Australians don’t meet the physical activity guidelines. The recommendations call for either 2.5–5 hours of moderate intensity activity (like brisk walking), 1.25 – 2.5 hours of vigorous activity (aerobics, cycling) or a combination of the two, as well as two sessions of muscle-strengthening activity a week.
In her mid-80s, my mum began to feel the effects of osteoarthritis after decades as a sportswoman. Walking any distance became painful and slow. Though I didn’t know it then, walking, or “gait-speed”, is a predictor of life expectancy, irrespective of age, race or height. Studies have found that experts can predict the number of years we have remaining by observing the pace we walk at. The slower the pace, studies suggest, the fewer healthy years left.
“We can’t escape old age and dying,” Prof Kathy Eagar, a public health expert and adjunct professor at the Queensland University of Technology tells me. “Your parents’ longevity means you have excellent prospects of living to a very good age. But then, if you’re lucky to live long enough, you’ll start having problems.
“We call it the ‘geriatric syndrome’. It happened to the Queen in her last few years. You can’t avoid it unless you have a drop-dead heart attack,” she says.
The last 10% of life
Australia has the third-longest life expectancy in the world, after Monaco and Japan, according to the Australian Bureau of Statistics. Figures released in 2022 show life expectancy at birth is 85.4 years for females and 81.3 years for males.
“This is a good news story,” says Eagar. She lists the reasons for our success. “Each year we have increasingly better access to healthy choices. People understand the relationship between lifestyle and health. We’ve got one of the lowest smoking rates in the western world.
“And public policy changes have contributed: vaccination stops people dying of childhood diseases; seatbelt regulations have substantially cut road deaths. Then there’s improved healthcare. There are cancers that 10 years ago were fatal that are now treatable.”
But longevity isn’t equally shared. Life expectancy tends to be higher in capital cities compared with remote regions. Indigenous Australians expect to die earlier than non-Indigenous people. The 2020 Closing The Gap report says life expectancy for First Nations men was 8.6 years below the national Australian figure and 7.8 years lower for Indigenous women.
And then there’s something called the “compression of morbidity”. At the start of the 21st century there was hope – given health improvements over the last 40 or so years – that we could postpone and reduce the period of disease and disability experienced in old age. There have been pockets of success, but overall, on a population level this hasn’t eventuated.
“It’s fair to say that whether you’re a man or a woman, probably about 10% of your life would be with some moderate to severe disability. And for many people, that’s at the end of their lives,” said Prof Richard Lindley, a geriatrician and the deputy head of Sydney Medical School at the University of Sydney.
So how should we Juvenile Geriatrics prepare for the decades before the final 10% of life, those years of what might be illness and decline, when we can’t precisely know when that begins?
For me, discovering more about ageing has significantly shifted what’s important. There is no second chance. I have to keep challenging body and mind until I reach the finish line. Increasing my fitness has now become a daily fixture. I lift weights to build muscle mass so I can continue to run, walk, lift, swim and climb. I’ve consulted a dietician, given a family history of diabetes, and I carry a lengthening list of questions about all aspects of my health for whenever I see the GP. My journey towards ageing has begun.
Every so often I still get woken by the mortality alarm. But when it happens, I download my thoughts into a notebook, tell Mum I’m OK and remind myself that I’ve got this.
