Abstract
How has the construct of ageing, and attitudes towards it, changed over time? How have human beings from various historical epochs, cultures, and perspectives viewed ageing? What impact have these views about ageing had on individuals and our broader society? ‘Ageing, a brief history’ considers these questions and shows that from the ancient world to the modern there have been conflicting views on ageing. It examines historical trends in longevity and lifespan, and factors influencing life expectancy and ageing. We are now at a point in history where the number of individuals over the age of 65 will surpass those aged 5 and under, across the developed and developing world.
The afternoon knows what the morning never suspected.(Swedish proverb)
Ageing is a subject that is perhaps uncomfortably familiar, particularly in this modern age, with its focus on ways to overcome, thwart, resist, and, in a few but growing quarters, embrace, one’s ageing.
Have we always approached ageing with such ambivalence? How has the construct of ageing, and attitudes towards it, changed over time? How have human beings from various historical epochs, cultures, and perspectives viewed ageing? And what impact have these reflections and assertions about ageing had on individuals as well as our broader society? These are the main topics addressed in this first chapter.
Growing older is an activity we are familiar with from an early age. In our younger years upcoming birthdays are anticipated with a glee that somewhat diminishes as the years progress. Our younger selves feel that time moves at a glacial speed, whereas, with advancing years, time seems to flit by at an ever-quickening pace. And late in life, or when a person is faced with a terminal illness no matter what their age, the sense of a finite amount of p. 2↵time remaining becomes acute, and there may be a renewed focus on making the most of one’s allotted time in life.
For some, the subject of ageing may not seem relevant, or engaging, or of benefit—particularly since we cannot avoid the process and in most cases, cannot intervene greatly in its outcomes. But current demographic trends make the importance of ageing throughout the world impossible to ignore. As Figure 1 illustrates with data from the United Nations (UN), we are at a point in history where soon the number of individuals over the age of 65 will surpass those aged 5 and under, across both the developed and the developing world. And as this graph clearly illustrates, this is not a passing trend or a blip confined to the Baby Boomer generation—this is the way of the future for humanity throughout the world.
Historical reflections on ageing
Throughout history, in varying locations across the globe, there have been writers, philosophers, and commentators who have had in themselves a more acute sense of ageing, and felt moved to p. 3↵reflect on their observations and thinking on the subject. Many of these historical themes and observations regarding ageing, some stretching back to ancient times, are reflected in modern public discourse on ageing. Indeed some of these themes, such as older persons’ roles in society, are a subject of discussion and debate throughout recorded history. It is important to note that although a relatively small number of people may have lived to advanced ages in ancient times, to speak of ‘older’ individuals at that time generally included those aged 50 and beyond.
The ancient Greeks and Romans had much to say about ageing, its effects, and how to prepare oneself to live well in one’s later years. Sophocles (Greek, c.496−406 BCE), who himself lived to quite an advanced age (by most accounts, he lived to age 90 or thereabouts), appears to have weathered his own ageing well. Texts from that time record a story of his sons trying to declare that he is mentally infirm in order to challenge his will, to which Sophocles responds by declaiming from memory a long span of text on which he is currently working. Sophocles also demonstrated in his own life that declines in creativity and cognitive functioning in later life are not inevitable, as he continued to produce well-respected works at the latter end of his life as a dramatist.
The philosophers Plato (Greek, c.429−347 BCE) and Socrates (Greek, c.470−399 BCE) both felt that one of the benefits of growing older is the ability to use accumulated knowledge and experience gained earlier in life. This is a view held in both Eastern and Western cultures, for example in sub-Saharan Africa, where traditionally older persons have been viewed in a positive light, as repositories of knowledge and wisdom. However, the ability to employ such knowledge wisely was not, as far as Socrates was concerned, ‘an automatic consequence of old age’ (Socrates, Laches, 188c). Similarly, in many cultures, both ancient and modern, chronological age is an imperfect indicator either of functional status or social standing.
p. 4Plutarch (Greek, c.46−120 CE) recognized the value of older citizens’ experience and knowledge, encouraging such persons to take a greater interest and role in public affairs in his treatise Should the Elderly Run the Country? This can be contrasted to modern times where, for example, in Great Britain people are excused from jury duty when they reach age 70 (it is currently under consideration to raise this to age 75). Notable modern efforts to enhance older persons’ civic engagement include United States (US) President John F. Kennedy’s National Service Corps, which was envisioned as providing service opportunities particularly for younger as well as older adults in the 1960s. The Harvard School of Public Health in 2004 made the observation that the Baby Boomer generation ‘have the potential to become a social resource of unprecedented proportions by contributing to the civic life of their communities’ (Harvard School of Public Health/MetLife Foundation 2004: 8). Coupled with global demographic trends, the potential for older adults to continue to contribute in a variety of ways, including through volunteering as well as both formal and informal engagement in local community contexts, will continue to grow and will be discussed in more detail later in this text.
However, at the same time that many older adults are able and willing to contribute to their families and communities, there are others who require care and assistance at this time in their lives. Plato comments upon support for older persons in society in his book Laws, wherein he argues that parents should be cared for and venerated by their children. However, Plato makes this argument precisely because in his society at that point in history this was very far from the case. As is the case with many subsequent writers and philosophers, comments about the condition and care of older persons often took the form of admonishments or descriptions of utopian ideals. In general, protection from abuse in later life has not been routinely p. 5↵enshrined in more formal public legal contexts compared to regulations regarding the care and welfare of children. (However, it should be noted that equally the welfare of younger persons was not particularly scrutinized throughout history until relatively modern times.) A recent example of strong legal regulations regarding the care of older persons comes from China, where the ‘Protection of the Rights and Interests of the Elderly People’ law asserts that children must care for their parents’ ‘spiritual needs’ as well as their physical needs (the latter being already enshrined in a previous ruling)—including visiting them on a regular basis. This view of the importance of supporting older persons, and particularly ageing parents, stems from the strong Eastern concept of filial piety. Support (or lack thereof) of older adults by children as well as by the state has fluctuated through history and also has varied by culture—again a topic to be explored later in this book.
While Plato and Aristotle (Greek, 384−322 BCE) viewed ageing as a disease, the Greek physician Galen (129−200 CE) viewed ageing as both natural and inevitable. Much lauded as a thinker and medical researcher who was ahead of his time, Galen emphasized individual differences in the ageing experience. One of the first to argue that the brain, rather than the heart, was the location of reason and thinking, Galen even questioned whether cognitive decline was necessarily simply inevitable in old age, or whether it was rather reflective of a disease or diseases that could strike individuals at various ages. He also believed that how one experienced the later years of life was to a great degree dependent upon what the individual chose to do earlier in life. Galen argued for preventative measures rather than cures for ailments in later life. He advised care to be taken in nutrition and also recommended regular exercise, echoing modern research on longevity and staving off disease, including illnesses such as Alzheimer’s disease, with attention paid to lifestyle modification.
p. 6Plato echoes Galen’s focus beyond chronological age in seeking an explanation for better or worse circumstances of the individual:
… For if men are sensible and good-tempered, old age is easy enough to bear; if not, youth as well as age is a burden.(Plato’s Republic)
Galen was a believer in balance in all things, in terms of not only eating and drinking, but also exercise and rest, as a path to avoid illness. Medicine in ancient times was characterized by a belief that imbalance in the organism, particularly of the four ‘humours’ (blood, yellow bile, black bile, and phlegm), resulted in illness. Although many thinkers at that time, including Aristotle and Galen, believed that a creeping ‘dryness’ in the body upset the balance of humours and could lead to illness and decay, it was also widely agreed that this process could be hastened by a lack of balance in the exercise of physical as well as sensory desires. As Cicero (Roman, 107−44 BCE) points out in his treatise On Old Age, ‘immoderate youth hands on a worn-out body to old age’ (section 27). Modern research on centenarians supports the idea that the interplay between genetic factors and a balanced lifestyle (e.g. moderate physical activity and healthy nutrition) contributes to well-being and longevity.
Irrespective of the longstanding idea of balance and moderation practised earlier in life as mitigating the negative physical and mental aspects of ageing in later life, old age as a period of the lifespan has often been characterized quite negatively. Horace (Roman, 65−8 BCE) in his poem on the ‘Ages of Man’ wrote quite scathingly of the attributes of old age:
Many ills encompass an old man, whetherBecause he seeks gain, and then miserably holds aloof fromHis store and fears to use it, because, in all that he does, heLacks fire and courage, is dilatory and slow to form hopes, isSluggish and greedy of a longer life, peevish, surly, given top. 7Praising the days he spent as a boy, and to reproving and condemning the young.(Ars Poetica, pp. 169–74)
We find a more contemporary echo of this in William Shakespeare’s (1564−1616) famous verse ‘All the World’s a Stage’:
All the world’s a stage, And all the men and women merely players;They have their exits and their entrances,And one man in his time plays many parts,His acts being seven ages. … Last scene of all,That ends this strange eventful history,Is second childishness and mere oblivion,Sans teeth, sans eyes, sans taste, sans everything.(As You Like It, Act II, scene VII)
The Eastern view of ageing, for example in Buddhist or Hindu philosophical systems, similarly contends with ageing from a variety of perspectives, emphasizing over time both positive and negative aspects of ageing, but consistently recognizing a need to grapple with the meaning and significance of the ageing process. By medieval times, though ageing may have been viewed as harmful and destructive at the physical level, set against a backdrop of karma (intentional actions bearing consequences), the maturational process at the metaphysical level was seen as allowing one to progress from initial student to final ascetic stages.
In the 17th century, the haiku master Bashō (1644−94), the most famous poet of the Edo period in Japan, expressed his own ending life with simple dignity in his final recorded poem:
Falling sick on a journeyMy dream goes wanderingOver a field of dried grass.
p. 8In his poem ‘Ulysses’, Alfred, Lord Tennyson (1809−92) offers a view of ageing that recognizes loss while signalling a desire to nevertheless go forwards and explore, echoing sentiments expressed later in this book about successful ageing:
Old age hath yet his honour and his toil;Death closes all: but something ere the end,Some work of noble note, may yet be done…For my purpose holdsTo sail beyond the sunset, and the bathsOf all the western stars, until I die … Tho’ much is taken, much abides; and tho’We are not now that strength which in old daysMoved earth and heaven, that which we are, we are;One equal temper of heroic hearts, Made weak by time and fate, but strong in willTo strive, to seek, to find, and not to yield.
Old age holds fears for both poets and society. The ancient world shares with the Middle Ages and more modern eras the realization that while a long life is desired, actually achieving old age is met with at best mixed emotions. Cicero describes old age as something which all persons wish to achieve, but which, once they achieve it, they reproach (De Senectute, De Amicitia, De Divinatione, Section 4). The early Middle Ages through to the 17th and 18th centuries were characterized by a combination of respect for older persons mixed with pity (or self-pity) for those who had achieved a long life, particularly those most dependent on assistance from others. For example, Chaucer (c.1343−1400) describes his older characters such as the Wife of Bath as still active, with the ability to find continued participation and contentment in life. Goethe (1749−1832) in youth wrote more disparagingly of old age, whereas in his own later years he was able to describe old age as a positive time of reflection and activity, as well as contentment: ‘That p. 9↵which one wishes for in youth, one finds in old age.’ It is not uncommon to see thinkers change their views of the potentialities and drawbacks of increasing age as they themselves enter later life. In his earlier writings, Freud (1856−1939) viewed persons over 50 as incapable of benefiting from psychotherapy, but (somewhat) revised this view when he himself reached that age.
By the 18th century, a greater knowledge about the physical aspects of ageing, including a proliferation of medical texts based more on observed reality than moral inference, foreshadows the gains of the scientific revolution with respect to research on ageing in the century that followed. Attempts were made to identify the illnesses associated with various ages, so that care could be directed accordingly. The increasingly secular nature of European society in the 18th century meant that attention shifted from a focus on the afterlife to how to cope with the last years of life, particularly among those of reduced circumstances. Earlier texts had described the latter years often in terms reflecting the devaluing and suspicion associated with older persons. Bishop Bossuet at the end of the 17th century wrote of old age as ‘ordinarily … soiled with the filth of avarice’, echoing sentiments which go back to pre-Christian times. By contrast, at the end of the 18th and the beginning of the 19th centuries, the new Age of Enlightenment is reflected in J.H. Meister’s writing of the continuing creativity of older persons, the pleasures of grandparenthood, and, most significantly, that the current age, with its progress and ambitions, belonged equally to persons of all ages.
Unfortunately events in many parts of the world, but particularly the developing world, have changed the nature of the ageing experience across cultures. Regional conflicts, migration to flee conflict or economic hardship, rapid modernization conflicting with traditional societal norms, and the effects of disease, particularly the impact of HIV/AIDS in sub-Saharan Africa, have had differential impacts on older persons. Increasingly, global p. 10↵surveys of ageing are expanding knowledge of the experiences of older adults, but for some populations, including indigenous peoples, isolated populations, and sub-Saharan Africa and parts of the Middle East, it remains unknown to what extent older persons are able to participate in the progress and ambitions of the modern age alluded to in the previous paragraph.
There is a range of contemporary writings on ageing, sometimes positive or meditative, sometimes forceful and directive, as Welsh poet Dylan Thomas’s (1914−53) lines from his famous poem illustrate:
Do not go gentle into that good night,Old age should burn and rave at close of day…
From the ancient world to the modern there are conflicting views with respect to ageing. On the one hand, there is recognition of the potential benefits that may accrue with ageing, and the good, even noble, characteristics associated with increasing age—wisdom, experience, continuing vigour and engagement with life. At the same time, within individuals or even societies, age is viewed with fear and dread. Ageing from this perspective is tied to incipient declines in mental, social, and physical functioning, with the loss of friends and family over time decried, and increasing societal irrelevance met with despair. Individual persons as well as the many scientific disciplines and societies which have at some stage focused on ageing have also displayed this dualism, with at times greater or lesser attention paid to the virtues and drawbacks associated with ageing and a long life. This conflict is reflected in Dewey’s paradox of ageing, which in effect states that while we value maturity yet we fail to value ageing.
Historical trends in longevity and lifespan
Table 1 Life expectancy at birth and at age 60 by WHO region, 2009
WHO region
|
Life expectancy at birth (years) male/female
|
Life expectancy at 60 years (years) male/female
|
|---|---|---|
World
|
66/71
|
18/21
|
Africa
|
52/56
|
14/16
|
Americas
|
73/79
|
21/24
|
Eastern Mediterranean
|
64/67
|
16/18
|
Europe
|
71/79
|
19/23
|
South East Asia
|
64/67
|
15/18
|
Western Pacific
|
72/77
|
19/22
|
WHO (2011). World Health Statistics. Geneva: WHO. With permission from John Beard.
Most people have an idea that ‘lifespan’ refers to how long a person lives, and that how long individuals are living has increased over time. However, ‘life expectancy’ (a prediction based mostly on actuarial tables and often incorrect) differs from the concept of either usual or maximum lifespan. Life expectancy is calculated by averaging the age at death for all persons who have been born in a country, including those who have lived into old age and those who died shortly after birth; those who died in early adulthood; those who died by trauma or disease; and so forth. (See Table 1 for life expectancy figures across various regions of the world.) Lifespan, by contrast, refers to cumulative records of the span of years individuals have lived that have not been averaged out. Maximum lifespan refers to the purported maximum lifespan humans are currently believed to be able to achieve based on current biological knowledge, and is better thought of as an upper limit to survival rather than an average of the age to which one p. 12↵might live. Modern gerontology, the scientific study of ageing, places the theoretical limits of ageing at approximately age 120.
Precisely how long are people living, across various historical time periods and societies? Due to the fact that throughout history, including in modern times, there are so many persons who die very shortly after birth and before the age of 1, it is arguably better to calculate life expectancies by looking at populations no longer in early childhood, and this also will help us to better understand factors affecting lifespan. For example, in Roman times life expectancy taken from birth was around 21 years, whereas taken from age 5 it increased to 42 years. This pattern is repeated in various societies and cultures, where historically very young children have experienced high mortality due to several factors including disease, malnutrition, and poor hygiene. High rates of morbidity (illness) and mortality (death) in young children have only changed relatively recently, and these changes are a phenomenon still in progress throughout most of the developing world.
Although the relatively old age recorded for the philosophers and writers cited earlier (e.g. Plato and Sophocles) appears accurate, longevity, and moreover ideas about longevity, have fluctuated over time. In literature, for example in the Bible, we see testaments about people living to great ages. For example, Adam is said to have lived for 930 years, Noah for 950 years, and Methuselah (appropriately) for 969 years. Many cultures, including ancient Greece, contain stories or myths about the ages of long-lived individuals or groups in the distant past, with a progressive trend towards shorter lifespans driven by increasingly decadent ‘modern’ lifestyles. Such stories of extreme lifespan in ancient times are archetypal of an antediluvian theme, returned to periodically by writers throughout history.
The antediluvian theme can be contrasted with the hyperborean theme (literally ‘hyper’ meaning ‘beyond’, and ‘boreas’ meaning p. 13↵‘the North Wind’), originally about long-lived cultures that existed in the extreme northern lands of Europe. A wide range of explorers, from Alexander the Great to Ponce de Leon, searched widely but in vain for the fabled Fountain of Youth. These stories have resonance today in literature and films about mythical places of long life, for example Shangri-La as portrayed in James Hilton’s book Lost Horizon (1933), which exemplifies the modern search for answers about living longer among isolated peoples with great longevity. A popular contemporary take on the hyperborean theme is reflected in National Geographic’s exploration with author Dan Buettner and longevity scientists of places around the world (so-called ‘Blue Zones’) where people are said to live very long lives. Indeed, some research points to people surviving to age 100 ten times more often in Blue Zones than in other places.
Throughout history, people have sought to extend longevity, or years of life lived, ideally avoiding illness and disease. In both antediluvian and hyperboreal stories, people either lived forever or with greatly expanded lifespans, into the hundreds of years. Often the means to such long life were quite creative. For example, in many societies, gerocomy, the belief that intercourse with younger women could delay or even reverse ageing, was common. And today, unfortunately, this belief persists in sub-Saharan Africa, where sex with younger women in pursuit of health benefits has contributed to the spread of HIV and AIDS.
Although the modern perception may be that achieving a great age is a relatively recent phenomena, there is ample evidence throughout history that some percentage of persons have always achieved what we would today characterize as a ‘ripe old age’. For example, in ancient Greece and the Roman Empire, roughly 6−8 per cent of the population would have lived to age 60+, with perhaps 3 per cent living to age 80+ (Parkin 2003: from Coale-Demeny Model Life Tables). Similarly in medieval times those over age 60 constituted roughly 8 per cent of the population p. 14↵at any given time, although this figure could rise to roughly double that in the aftermath of plagues, as these events killed proportionately more younger than older persons. In the 17th and 18th centuries, first in northern Europe and later more widely, the number of persons over age 60 began to slowly increase as a proportion of the population, to around 10 per cent on average. Gains in longevity at this point in history were due to a range of societal advances. These included improved storage and transportation of food, and improvements in well-being due to social welfare programmes and other attempts to ease the plight of the poor (for example, the later rise of public service pensions in Britain, France, and Germany).
However, the modern era is characterized by the high percentage of older adults in some countries, forming 20 to 25 per cent of the population, with rates of births lagging behind deaths in many of these nations. Modern gains in longevity in the 19th and 20th centuries are a product of continued gains in sanitation, food safety and abundance, and societal programmes to support persons in reduced circumstances, coupled with medical advances in the prevention and treatment of disease. This then is a new and interesting point in history, where significant numbers of older adults are contributing to and influencing society, through their actions and their sheer numbers.
Of countries with over ten million inhabitants as of 2002, projections are that at least ten will have close to or over 30 per cent of their population aged 60+ by 2025; these include Japan, Italy, Germany, Greece, Spain, Belgium, the United Kingdom, the Netherlands, France, and Canada. Also by 2025, China is expected to have nearly 300 million people over age 60, with India projected to have the second highest absolute number of such persons (close to 170 million).
Moreover, societies are reaching the point where significant portions of their populations are over the age of 65 at varying rates. p. 15↵For example, whereas France as a country took nearly 120 years to double its number of persons over age 65 as a percentage of the overall population (from 7 to 14 per cent), South Korea, one of the fastest ageing countries in the world, will achieve the same milestone in less than twenty years. Such rapid growth in numbers of older persons within a country or region has consequences for how generations interact, how states plan for retirement and a social safety net, and the expectations of the roles of older persons in the family and wider society. When a society adapts to such demographic changes slowly, persons can adjust gradually at the family and community levels, whereas in the face of more rapid shifts in demographic distributions, changes to social structures may shift more abruptly, with the potential for an uneasy transition. Today many parts of the developing world are experiencing such rapid shifts in increasing numbers of older persons as a proportion of the population, due to health and medical advances. In these countries, challenges to infrastructure, health services, and economic safeguards for older persons are often particularly acute.
Since some proportion of people were living to age 60, 70, and beyond even in ancient times, traditionally old age has been said to start somewhere between ages 49 and 70, and most systems of breaking the lifespan into segments have included some version of young, middle, and old age, often broken down more finely. For example, in France historically there is a division between the ‘first age’ (youth), the ‘second age’ (maturity), the ‘third age’ (the period after children have been raised), and a final ‘fourth age’ (old age). The University of the Third Age (U3A) international movement is inspired by the French ‘troisième age’ to encourage those in this period of life to pursue self-learning and enrichment, organized by and for similar-aged peers. U3A operates in France, where it originated, as well as in many other European countries; it also has a virtual presence (vU3A) aimed particularly at those who, due to health problems or other barriers, cannot attend U3A meetings.
10 years—a child20 years—youth30 years—a man40 years—standing still50 years—settled and prosperous60 years—departing70 years—protect your soul80 years—the world’s fool90 years—the scorn of children100 years—God have mercy
In modern gerontology there is a distinction made between the ‘young-old’ (aged 65−74), ‘old-old’ (aged 75−84), and ‘oldest old’ (aged 85+). There is renewed interest in studying this latter group, particularly as globally, longevity increases on average by about three months per year, or about five hours per day. The numbers of centenarian studies (examining those aged 100+) and supercentenarian studies (focused on those aged 110+) are increasing internationally, and have as their subject of inquiry everything from biological markers of ageing to social and political activity in these individuals.
Historically, as societies experienced decreased birth rates and increased numbers of older adults surviving for longer, a shift occurred in the composition of the population. What might previously have been described as a population pyramid, with large numbers of younger persons at the base, narrowing towards a peak of fewer persons at later ages, now began to shift in shape. In modern times this shift has accelerated further, with the population pyramid now more resembling a rectangle, with more equal numbers of persons in the age bands from birth to old age.
p. 17The discipline of cross-species studies of longevity is one of the newer fields of study to contribute to the science of ageing. Many scientists, beginning with Darwin in his On the Origin of Species in 1859, observed that various species live for greater or lesser periods of time. Ageing differs dramatically between species. Some whale species live over 200 years, as do some species of koi fish, while many mammals live less than one year, and some insect species live for mere days.
While many theories have been espoused to account for varying lifespans within the animal kingdom, such as metabolic theories influencing longevity, there is still much debate in this field. Even today, scientific theories of ageing, explored further in Chapter 2 on biological ageing, cannot fully account for the diversity of lifespans observed in nature. More research is required in this area before we can unravel the reasons for this variation in lifespan across species.
Factors influencing life expectancy and ageing
Life expectancy in humans over time has been affected adversely by historical events, such as wars and pandemics. The bubonic plague in the 14th century, and the flu pandemic of 1918, are examples of widespread disease outbreaks which impacted life expectancy at those points in history. Many armed conflicts have severely impacted the societies in which they have been fought, influencing population distributions for many years post-conflict. For example, many wars disproportionately claim young male lives, and in the Paraguayan War in the late 19th century, estimates are that as much as 70 per cent of the adult male population of Paraguay perished.
Occupation influences mortality, and is tied in many cases to gender. Throughout history and including modern times, men have traditionally taken on more hazardous occupations than p. 18↵women. However, the impact of an occupation on ageing processes, particularly in the pre-industrial age, could be marked. For example, sailors and miners, predominantly male, suffered a variety of ailments (such as lung disease and scurvy) that curtailed their lifespans, often severely. An occupation such as lacemaking, predominantly pursued by women, could lead to premature blindness and loss of function due to arthritic fingers. On the other hand, those in religious orders, whether male or female, generally enjoyed relatively longer lives compared to peers. The generally homogenous and gentle conditions favourable to ageing offered by organized religious orders were used by David Snowdon, an epidemiologist and neurologist at the University of Kentucky, whose longitudinal studies of ageing nuns afforded insights into the effects of early life influences on ageing and risk of dementia.
Gender itself plays an important and only partially understood role in mortality; up until medical advances in the 20th century greatly reduced death in childbirth, women’s life expectancies were lower than those of men. At the current time, in all countries where such data are available, women outlive men. A recent study by Beltran-Sanchez and colleagues in 2015, using data from thirteen developed countries, suggests that increased male risk of cardiovascular disease in those born after 1900 is one modern driver of this phenomenon, with the excess male mortality specifically located in the 50−70 age group. Having enjoyed greater longevity worldwide for many decades, women now represent 90 per cent of supercentenarians. With the exception of birds, for almost all of the species of animals that have been studied, females are longer lived than males.
Unfortunately, women also report greater physical and mental health symptoms than men in later life (and in fact throughout their lifespan), and although some of the data are mixed, most research from a variety of nations supports this assertion. Why might this be the case? The most common explanations p. 19↵of women’s health disadvantage reflect biological differences between the sexes, different patterns of illness and health behaviour reporting, physicians’ diagnostic patterns, and differential healthcare access, treatment, and use.
Despite their greater longevity, women in later life (and arguably women at all points in their lifespan) have not been well-regarded historically. Many of the texts, treatises, and pieces of literature which comment on ageing in the ancient world through to the Middle Ages often refer exclusively to men. Some of this can be attributed to the fact that, for example, as military service or government offices were for the most part only open to men, women were not mentioned specifically in official records. From Roman times onwards, older women were at best marginalized within society, and at worst cast as ineffectual, described by many authors as debased in thought and behaviour by ungovernable desires (e.g. for sex or alcohol).
Although until recently women in all social classes experienced higher mortality due to deaths in childbirth, other circumstances pertaining to women’s roles in society also contributed to historically lower mortality for females. While men disproportionately were involved in individual or communal conflicts, women had a disproportionate responsibility for caring for the sick and injured (a circumstance which remains today) and, thus, particularly before the advent of modern medicine, they were exposed to illness and infection at higher rates than men.
The age gap between heterosexual partners in ancient times through the Middle Ages and even into more modern eras (with men tending to marry women younger than themselves) contributed to the relatively higher proportion of widows to widowers, rather than this being a consequence of women’s greater longevity. In antiquity and through the Middle Ages, and to a lesser extent into more modern times, widowers tended to remarry at a much higher rate than widows, and to remarry p. 20↵relatively younger spouses. The social norm of women traditionally marrying older men, even today, tends to mitigate against higher rates of remarriage for older women. However, many older women are also cautious of remarrying later in life, particularly if they experienced intense caregiving responsibilities in their prior relationship.
Globally, mortality rates still vary widely. Japan, the longest-lived society, has both males and females on average living past the age of 90. Life expectancy at birth is over 80 in more than thirty countries. In contrast, in sub-Saharan African countries, life expectancy may range from mid-30s to mid-40s due to both armed conflict and AIDS and other diseases. The UN in 2002 estimated that if HIV/AIDS did not exist, lifespans in South Africa, Botswana, and Zimbabwe would be around 70 today.
However, longevity can also vary greatly even within a society. For example, life expectancy for children born in 2014 in the UK ranges from 67 to 105, depending on where they live. And in Glasgow, this disparity in life expectancy is one of the highest in the world, with males in the economically deprived Calton area expected on average to live to 54, while males living in more affluent Lenzie on average live to 82.
Medical advances as well as public health advances have had a great impact on raising life expectancy globally during the 20th century. The simple act of practitioners washing their hands when delivering medical care has had a disproportionately large impact on mortality by curtailing the spread of pathogens during surgery and childbirth. In the past, public health services contributed to programmes such as vaccination efforts, which had a large impact on decreasing acute illnesses. Now that the incidence of many acute (severe, sudden onset) illnesses experienced relatively early in life, such as polio, has decreased dramatically, chronic (long-developing) diseases contribute proportionately more to disability and death in most societies. Thus public health efforts p. 21↵globally have shifted at least somewhat in response to the ageing of societies by placing increasing focus on education about chronic illnesses of later life, such as diabetes, cardiovascular conditions, and cancer.
Today life expectancy plays an increasingly important role in public policy. For example, life expectancy is one of the factors used in the calculation of the Human Development Index (HDI) of nations, along with education and standard of living. Increasing life expectancies contribute to the rising median age of countries, with social and economic impacts of, for example, an ageing workforce. And in both the developed and the developing world, rising numbers of older persons find themselves living in poverty. While poverty has often been the fate of older persons throughout history, medical advances have increased the numbers of older persons reaching advanced ages who have to cope with such consequences of biological ageing. Physical and biological aspects of ageing are the focus of Chapter
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