GROWING OLD

Thomas Rudd, M.D., M.R.C.P.

FOREWORD

Darling, I am growing old, Silver threads among the gold, But my darling you will be Always young and fair to me.

I WAS REMINDED of these lines of a well-known song very popular in days gone by, when I received the script of the new pamphlet by Dr Thomas Rudd entitled Growing Old. The problem which he examines so carefully will bring home to us that in many cases old people are not the darlings of the community.

The writer says 'the case of the frail and unwanted elderly person capable of being managed at home, but for whom the community has no real use, is surely one of the great moral problems of the day.

We are well aware of the devoted work done by our religious Congregations, whose members are dedicated to the care of the aged. We have seen their work at close hand and realize what happiness they bring into the lives of old people of any race or creed. Whether old people are received into Homes or visited individually, the care given to them is inspired by the charity of Christ.

Every season of life, like the seasons of the year, has its beauty, and the autumn and winter of our days on earth have their own attraction. Dr Rudd lays stress on this fact and, by reminding his readers of the normality of old age, suggests various ways in which true Christian neighbourliness can be shown to those who, having borne the burden and heats of the years, are now moving towards life's close.

We think that all who read this pamphlet will be convinced of the importance of the problem of the care of our old people and will consider in what way a real personal contribution may be made to provide the remedy. There are countless lonely old folk who would appreciate the personal service of those who, for the love of God, would visit them and minister to their needs. The scope for such admirable work is well indicated by the author and we hope and pray that many will read what Dr Rudd has written, and be moved, not merely to pity the lot of those who spend old age alone, needy and unbefriended, but also to that true brotherly charity to which Our Lord referred when He said: 'Believe me, when you did it to one of the least of my brethren here, you did it to me (Mt. 26 : 40).

WILLIAM Archbishop of Westminster

I

THE NORMALITY OF AGEING

WE SHALL, of course, all of us grow old: subject that is to the hazards of life and limb which all of us face daily. Few of us look to be cut off in our prime. Should we not then expect old age to be regarded as a natural stage of life, as normal to the individual as childhood, adolescence or maturity? In point of fact, we seldom look upon old age in such a way. The fixation of the school-leaving age and, at the other end of life, the age for retirement on pension, seems to have given rise to a false division of life into stages, of which the first is looked upon merely as the preparation for wage-earning, and the last as a sort of 'post-script', a period of uselessness and marking time while waiting for death. This attitude goes, of course, against traditional philosophy and is certainly contrary to the teaching of the Christian religion. It is no doubt part of what we have inherited from the age of materialism, in which for more than 200 years we have been living.

Old age, therefore, we can, and must, accept as a normal and (for many people) a necessary stage in life, one which, like the other stages of life, has its own characteristics, its opportunities, hazards and temptations, which are peculiar to itself: and like the other stages in life, its own particular contribution to make to the life of the community. In other words, old age can be said to have its own 'work'. This will be discussed later: it is enough to say here that, while the 'work' of old age is obviously very different from the 'work' of childhood or maturity, it is nonetheless valid and of equal significance, not only to the individual but to the entire community.

Reaching retirement age should not, of course, mean that a man or a woman must necessarily stop working. Those with the necessary physical strength should, in any justly-run community, be allowed to continue their normal employment, or be free to seek some alternative occupation. The decision between retirement or continued work should be a personal one, ideally to be solved by the inclinations of the individual, who should be equally free either to go on working or to take his leisure. Nonetheless, by the time the normal age of retirement has been reached, a man's life should be dominated by values different from those which have ruled him during the years of maturity. The desire for power and to 'get on', the instinct to accumulate material things, these have served their day, and the man who wishes to work into his old age should beware not to be ruled by values whose validity he has outgrown. Better values for him now are pride of workmanship, the giving of devoted service to his occupation and the teaching of his craft and its ethical values, in however humble the sphere, to the rising generation.

Nowadays, far more people than formerly have an opportunity of living into post-retirement years. For this we can thank scientific progress which has so improved the hygienic conditions of life and led to such advances in preventive medicine and treatment that men and women enter their sixties not only more often than they used to, but with greater health and physical resistance. Thanks also to social legislation, state and industrial pension schemes have made it possible for many people to choose retirement and to live thereafter with some degree of security. Such a change in social conditions must be expected to have its disadvantages, and it is these which are apt to dominate the picture which we draw for ourselves, of old age in the modern world. There are, undoubtedly, many people who have been rescued by modern medical science from premature death due to pneumonia or epidemic disease, but who in post-retirement years fall victim either to a slow deterioration of mind or body, or who are visited by some sudden 'stroke' which leads to paralysis and a prolonged terminal illness. These types of illness place a severe strain on younger people, often members of the sufferer's family who have to provide the home care that is necessary. A similar strain falls on the hospital and state-welfare services which have either to help, or sometimes to assume full responsibility for the sick person's care for the rest of his life. It is undoubtedly true that such illness in old age is, in a way, a burden just as the care of children during school age can be considered a burden on their parents. To look upon the matter entirely from this viewpoint would be, however, to assess the situation quite wrongly. The problems of old age are, in fact, the price we are paying for our own chances of happy and healthy survival into old age. To evade them would be to evade our normal moral responsibilities. This can, with fairness, be put more strongly, and it is no exaggeration to say that we have no right, as individuals, to benefit from longer years of life if we are unwilling to take some share of responsibility for the care of other people in their old age.

II

THE CHRISTIAN LOOKS UPON OLD AGE

THE PICTURE that the modern social worker sees of old age is a very varied one. He sees human nature at its most glorious, the spirit soaring above its trials and enforced sacrifices, in dedication to God. On the other hand, he also sees it at its most degraded, in its filth, its despair and its meanness. In between these two extremes is a whole gradation of different approaches: some predominantly good, others predominantly bad, but generally very mixed. Next door to the old woman, actively striving despite repeated failure to serve God according to her lights, is the old man whose only concern is his next meal. All are in need of help, bodily, mental or spiritual. Not all of them will agree that they need any help, least of all in the spiritual sphere. Poverty, ill health and loneliness cry out loudest for relief, .though there are many who express their sense of need forGod's forgiveness. This seems usually for unspecified-and not very obvious falls from grace, and is a welcome sign, indicating as it no doubt does what Fr Riccardo Lombardi S.J. calls 'the minimum expression of indispensable faith' on which ultimate salvation may depend. On the material side, the social worker will find many needs, for medical and nursing help, for domestic assistance, for company by day and by night and for adequate housing either in private dwellings or in some form of community home. For only too many, loneliness colours all their material needs. The old who are alone nearly all their lives feel neglected, rejected and lacking in all significance. When family relationships are concerned, once again a varying picture is seen. As many as 30 per cent. of persons of pensionable age have no near relations in any younger age-group; some have devoted children living at a great distance, some a single son or daughter unable to help in a really effective way, while others may have children who are frankly neglectful and lacking all sense of personal responsibility for their old parents. Time after time, the worker is almost overwhelmed by the size of the problem and the absolute inadequacy of all the statutory and voluntary means available even to touch the fringe of the matter.

When it is suggested that the Welfare State is inadequate to deal with the problem, no criticism is implied. Much indeed has been done to mitigate the hardship of the aged. The population at risk and in potential need is unfortunately about one-tenth of the total national population and any organised plan to cover the entire need would involve the employment of so many people that the country's economy would be disrupted. Clearly the National Health and Welfare Services must be maintained, and whenever possible expanded. Equally clearly, the magnificent work of the many voluntary organisations prominent in the social world today must be encouraged and supported in every way possible. Everything cannot, however, be left to their efforts. We cannot, in fact, contract out of our moral responsibilities for our fellow-citizens, whether they are members of our family or not. In Great Britain today we have still managed to retain within the family a sense of cohesion and mutual responsibility, and this in spite of the serious social strains resulting from small families, difficult housing conditions and the movements of population, especially the migration of younger workers to new industrial sites. Even in family relationships, there are signs that all is not well, and that the next twenty years may show a great deterioration of family devotion towards their elders. The problem is, however, a wider one than that of family cohesion, and those who have no aged relatives themselves are by no means unconcerned in the moral values involved. As a nation, we must ask ourselves, not only the question: 'have I a duty to support my parents?' but, also 'am I my brother's keeper?' The answer to this question will be considered later. Meanwhile it can be stated that the uncertainty which so many older people today feel about their position in the community and the lack of real regard which they find paid to them, is undermining not only their health and happiness, but also the psychological health of the generation who will be the next to draw their old age pensions. It is probably no exaggeration to say that many people in their fifties are consumed by a secret, perhaps unrecognised, fear that they too will be rejected in the time of their own old age, and that this fear colours their whole approach to growing old, both in themselves and others. The fact that they cannot bear to think of their own future, makes them even more intolerant of the reality of old age in their family and acquaintances. This is, in itself, a source of great unhappiness in the community. It remains true that old age is for many of us an unwelcome, undiscovered country. Nevertheless, many travellers have found their way through it in safety and have unearthed precious treasures which remain for others to find also. The passage is clearly a time of risk, as indeed is every other stage in life. No one thinks of approaching manhood without some preparation through formal or informal education, and that preparation should include a knowledge of the risks involved and how to meet them. Surely the same should apply to entry into old age. How many people, in fact, give serious attention to this matter? Perhaps they are held back by excessive preoccupation with the material aspects of life: whether that be so, or not, too few people seem to be facing up to their old age, its problems, the renunciations likely to be demanded of them, and the lessons they may have to learn. Rather, they banish the whole subject from their consciousness, until the hard reality of the years is suddenly upon them and they find themselves in battle, entirely without armour.

III

SOCIAL RESPONSIBILITY AND MODERN PROBLEMS

THE SOCIAL CONDITIONS surrounding the elderly, for which we as a nation are collectively responsible, are serious and difficult to solve. We are faced with a mass of need, greatly outweighing the facilities available to deal with it. Many of us are familiar with the problems of the hospitals for the elderly sick and the mentally ill, and the difficulties in securing admission thereto. We know of the long waiting lists for admission to Residential Homes provided by Local Authorities and voluntary housing societies. We may also know of the great shortage of workers, not only in the spheres of nursing, but also of medical technicians, radiographers, physiotherapists and occupational therapists and that such shortages are cramping the efficiency of hospitals as well as the residential homes. What we don't often realise is that there are in hospitals, both for the elderly chronic sick and for the mentally afflicted, many old people whose medical conditions do not warrant their continued stay there as in-patients, but who cannot be discharged home because they have no homes to which they could return, or relatives able or willing to care for them. This situation has to be viewed against a background of full employment, where there is every attraction to women, married and single, to leave their homes and earn big wages, where much industrial output is concerned with such luxury goods as cigarettes, cosmetics, wireless and television, catering for the rising standards of living enjoyed by the Western World. Behind this is a level of taxation as high as wage-earners will tolerate without demanding that each fresh increase shall be balanced by rising wages so that their personal living standards shall be untouched. The opportunity for women to earn good wages in industry, with fixed hours and minimal demands on the personality is, at first glance, an extremely attractive one, and is a major obstacle to old people being managed at home in times of frailty and also to their being returned home from hospital when treatment has been completed.

The case of the frail and unwanted elderly person, capable of being managed at home, but for whom the community has no real use, is surely one of the grave moral problems of the day. The misery caused to countless lonely old people through this attitude of rejection, has already been mentioned. Legions of these 'unwanted' spend endless months in chronic sick and mental hospitals because they have nowhere else to go. The dislocation of the hospital services arising from having to retain such patients in overcrowded wards, and the consequent delays in admitting cases of urgency for whom the hospitals have a duty to perform, is only one side of the problem. Clearly, it should be possible to discharge such recovered frail patients, either to their own homes, to those of charitable people or to specially designed premises for the communal care of those who are physically or mentally feeble-if only Christian charity, expressing itself in personal service and money, were available. Meanwhile, the unfortunates whom we are now considering are a submerged section of the community, whose interests, nay, whose physical and mental health, are being sacrificed by the young and the healthy. In such a connection, the term 'sacrifice' is not too strong to use, as the victims could well be relieved, though only at the cost of some personal inconvenience to the remainder of society. Not unnaturally, we find the mentally sick undesirable companions, and prefer, in our own interests, as well as in theirs, that they should be segregated. Granting this, can we still feel as Christians that we have the right to be neglectful of their best interests as to be careless about the overcrowding and dinginess of the surroundings which are the lot of so many mental patients, to the distress of doctors, nurses and hospital committees who are powerless to remedy the situation? When nearly half the hospital beds in the country are occupied by cases of mental disease or mental deficiency, enormous expenditure would be required to upgrade this part of the hospital service to the level of general or children's hospitals. Are we, as Christians, willing to face this problem: are we, in other words, willing to pay more in taxes, or to surrender some the benefits we enjoy from the National Health Service, so that the old and mentally sick shall have a fairer share? Are we, above all, prepared personally to shoulder some of the burden by working among the aged and the mentally afflicted, encouraging our sons and daughters to do the same? The present mature generation is rightly preoccupied by thoughts of old age and will find no real peace of mind until it has solved its moral problem. For it knows, consciously or subconsciously, that its comforts are enjoyed at the expense of the older generation. In mythological terms, the community is sacrificing itself to itself, and is haunted by the thought that before long the position may well be reversed, and that today's priest may be the victim of tomorrow. It is a modern repetition of the lifehistory of the Priest of Diana at Nemi, referred to by Macaulay 'the priest who slewthe slayer, and shall himself be slain (l).

And at the back of the scene stands the figure of the Suffering Servant, crying out: 'Is it nothing to you, all ye that pass by? (2), and Our Lord Himself, saying: 'Inasmuch as ye did it not to one of the least of these, ye did it not unto Me. (3).

(1) T. B. Macaulay: 'The Battle of the Lake Regillus.

(2) Lamentations 1:13.

(3) St Matthew 25:45

IV

HOW TO SERVE

IN A FIELD so wide, and where there is the greatest need in every part, opportunities for Christian service should not be hard to find. No one is too young or too old, too poor or too rich, or too busy to be able to do something, for the one thing required in the giver is Christian Charity.

In the home, where Charity should begin, many opportunities can be found. Families that have room enough, but who would not normally receive paying guests, can take a homeless old person, otherwise forced to remain in hospital, as has so often been arranged under the successful 'boarding-out' schemes of the Councils of Social Service of Exeter and Ply- mouth. The fact that fair payment is taken for services rendered does not destroy the value of the action. Every member of the family can give his spare time as well as money, denying himself part of his leisure or some minor luxury, towards the many charitable efforts made for the aged, in the form of clubs, pensioners' societies, leagues of Hospital Friends, as well as those made by the big voluntary societies such as the Red Cross-St John organisation, the W.V.S. or the various Old People's Welfare Committees which act as local co-ordinators of local efforts. Personal service is needed as badly as. money, and many services, such as visiting the elderly in their homes and the supply of 'Meals on Wheels' fall short of what is needed because of the lack of volunteers. Visitors may indeed be found to make brief calls on old people, to take a few flowers, make a few bright remarks and then pass on. How much more valuable (but how much more costing to the giver is a prolonged stay of perhaps three hours with a dull, querulous old woman, in a stuffy, dingy house, while the daughter, otherwise as house-bound as her aged mother, is released for a visit to friends or to the cinema. To deliver mobile meals twice weekly may be an interesting piece of social work to a leisured woman-but two hot meals weekly are a poor contribution to the proper nutrition of an aged couple trying to maintain their home life. To deliver the meals not twice, but five times, weekly, surrendering much of one's personal liberty in doing so, comes nearer to the example of the saints. There are many devout Christians unable to go to church because they have no one to take them by car or wheeled chair. Here is an opportunity for the young. Holy Communion given by the priest at home doesn't fill the gap in the heart of the devout Catholic who longs once more to join in offering up Mass in his parish church before he dies.

The professional worker is in a special and privileged posi tion, however humble his or her role may be. 'Professional excellence' in their vocation is, of course, demanded by the Church of its members, as part of their service to God: work with the aged and the mentally sick calls for, over and above this, a constant display of holy charity which must be particularly acceptable to Our Lord. Professional excellence demands not only hard work, but study of the problems with which we are face to face, so that we shall attack them in the best way. Charity, if it is to be continually forthcoming, in all the trying circumstances associated with the care of the old, needs constant prayer. Professional workers, whether they be doctors, nurses, or attendants in old people's homes, to say nothing of those who render faithful service to old people, such as 'Home Helps', are rightly reticent about the religious faith that animates them. True charity is, however, a thing that cannot be hidden, and old people, even when mentally feeble, soon come to learn the well-spring of the kindness shown to them by those who care for them. This, in itself, may turn the thoughts of someone, grown careless, to the faith which he learned as a child. Many a lapsed Catholic, in hospital during a terminal illness, has been brought back to his religion by the devotion of a Catholic nurse, while many other practising Catholics at their death owed their receiving Extreme Unction to the vigilance and devotion of a nurse.

With the increasing needs of the aged and mentally ill, an enormous field has been opened up to the Religious Communities at a time when, as if by the finger of God, their services to needy children are in decreasing demand. In spite of a shortage of vocations, it is still the religious orders which have the untiring devotion, as well as the personnel, that this kind of work demands. And when this effort, comprised of work supported by prayer, is turned in greater force even than at present upon these problems, who can tell what stream of fresh vocations will appear, rivalling those of the glorious early days of the Fransciscan Order and be Jesuits? Even today one can see the great works of St Vincent de Paul reappearing among the followers of Don Orione, the Sons of Divine Providence.

All these are external works of mercy, capable of being done only by those who are active in body or specially trained. Not any less in value are the works of prayer, and these can be offered by those who can serve in no other way, even by the aged themselves who, even though bedfast, can still play this, their small human part, in the work of Divine Redemption. Denied all forms of external activity, they can still pray, and a task of the magnitude of this can flourish only with much prayer. Doctors, nurses, and indeed all concerned, need constant prayerful support. Those who cannot serve themselves can pray that others may find their vocations, either inside or outside the religious orders. Especially can they pray for those whose lives are as yet undirected, or for those who have lost their way in life, having the leisure but no idea how to use it, that such may find themselves in serving the needy. Finally, they can pray for others who are old, that among the deprivations that old age brings, they too may offer their sufferings in union with the sufferings of Our Lord in His Sacred Passion.

V

LEARNING TO GROW UP

BUT TO BE ABLE to pray for others, as a major work of old age, needs hard work in earlier years. It also requires a complete reorientation of our lives, not only of the attitudes we have taken up in our mature years, but also in regard to those which are accepted by the world as proper and normal to old age itself. We are well aware that we live in an age of materialism. What we do not always realise is how much we are unconsciously influenced by the values of the world in which we live, even when we consciously vigorously reject them. It is customary for the more liberal writers on old age to stress the psychological needs of old people, their rights to security, to freedom of choice within the bounds of what is practically possible, and their need of respect of their personality. All this is true and very necessary; but we have need to take care not to overstress these values. Childhood also has its rights, especially the right of security in material and emotional spheres: but a child brought up to consider only its rights and none of its responsibilities and duties will grow into a bad man. Much the same is true of old age and modern attitudes are unfortunately teaching old people to over-emphasize their rights and to exert political pressure to secure them, careless of the effect on the national prosperity. Preoccupation with one's rights is both disastrous psychologically and wrong religiously. Post-retirement happiness is an aim which we may validly seek for ourselves and for others. It can, however, only be attained if, together with the reasonable satisfaction of basic psychological needs, the subject has a well-developed sense of responsibility as a member of the community of which he is one of the elder brethren, and a mind well-adapted to the changed environment which comes with age.

Adaptation is a slow business and we cannot therefore start too young. It must certainly be begun during our fifties. Recent American sociological studies have shown that happiness after retirement depends largely on pre-retirement attitudes. The same principle undoubtedly holds in the wider field of ageing. Those who look forward to their old age, being unperturbed by the knowledge that loneliness, loss of health or the faculties of vision and hearing and some degree of loss of worldly status are more or less inevitable, are likely to grow old gracefully. Those who shut their minds to the possibility of such things happening to themselves will age badly and grow yearly more narrow and resentful. It is on such people that the tragedy of senile dementia most heavily falls. Physical failure may be inevitable, though even here, a philosophic mind in a body free from excesses (especially the excess of food, which is perhaps the greatest hazard known to the western world today)-what the ancients described as 'mens sana in corpore sano-is likely to come off best. The mind is the dominant factor and the best prescription for healthy old age is surely a mind devoted to God. The physical capacity of our present Pontiff is a wonderful example of this. Those who best know the lives of the saints of the Church are unable to recall the life of a saint ending in senile dementia as known to psychiatrists.

The work of old age is the adaptation to a changed environment, devised by a loving God for the perfection of a soul. Part of this work is the learning of lessons which have somehow not been learned earlier, as well as certain lessons which are peculiar to old age. The ability to renounce things, previously felt to be vital to life, is an important feature. Sometimes this renunciation is forced upon us by the conditions of life, and the demands of our fellow-men; at other times, it is imposed on us by God, who presents us, as it were, with a 'fait accompli', and leaves it for us to learn the lessons of the new situation. These renunciations all take the form of 'little deaths' which are essential if the personality is to mature. This is what St John of the Cross means when he writes

I live, but no true life I know,

And living thus expectantly

I die, because I do not die.

To approach old age in this way puts the whole matter into perspective-and we see it three-dimensionally, as a thing

consistent with the will of God, and no longer as a caricature of humanity, to which the Eternal Power is sublimely indifferent. In other words, it enables us to reorientate towards senility in ourselves and others, in those who have ceased to originate either thought or action and who live on a purely vegetative plane, often with remarkable sweetness to those who care for them. No one this side of eternity can tell what proceeds within these brains, but one is forcibly reminded once again of St John of the Cross,

Now guard I no flock, nor have I now other office.

For now my exercise is in loving alone.

Old age undoubtedly has its glorious achievements and triumphs. To see them, you have to know where to look. They

are often triumphs of sacrifice, in many cases as willingly given as the sacrifice of youth in some great national cause. In many ways, old age is a martyrdom, one likely to be, for many of us, the fulfilment of the prayer we say each Sunday, in the Mass, 'for some part and fellowship with Thy holy apostles and martyrs. But the only earthly crown we shall gain is a crown of thorns. For in the words of the old Latin hymn Si vis vere gloriari,

Dost thou truly seek renown,

Christ His glory sharing?

Would'st thou win the heavenly crown,

Victor's meed declaring? Tread the path the Saviour trod. Look upon the Crown of God, See what He is wearing.

THE SONS OF DIVINE PROVIDENCE (Followers of Don Orione)

DON LOUIS ORIONE (1872-1940), saluted at his death Father of the Poor by the late Pope Pius XII, lived literally the command of the Gospel 'Thou shalt love the Lord thy God with thy whole heart, with thy whole soul and thy neighbour as thyself, and he believed that Christian love could conquer the world.

It is only eighteen years since Don Orione died and yet his memory is as fresh as ever, and his Congregation, whose members are called the Sons of Divine Providence mentioned in the foregoing text, is scattered all over the world serving the human rejects.

The task of the Sons of Divine Providence in gathering the dregs of society is to invest them with the importance of souls, to re-fit them into society as useful members, and profitably so in the light of God's economy.

The Sons of Divine Providence, priests and lay brothers, helped by a parallel family of women, are engaged in manifold activities: Schools, Orphanages, Boys' Towns, Parish Churches, Boys' Clubs, Technical Colleges, Day and Boarding Schools, Houses for Abandoned Children, for Cripples and War Wounded Boys, for Blind Children, for Mental Cases, for the Sick and Aged, Hostels for Workers. . . .

Their present work in Great Britain is to care for the Aged, for whom they have opened two houses, one of which is well established in Streatham and the other at Hampton Wick.

To enable the aged to spend their remaining days secure in the knowledge that they will be cared for to the end, houses for the Aged Sick must be built.

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