When we glance in a mirror, we can be taken aback – how did we get to this age? Yet the process starts before we are born. What happens in our bodies over time? And how can we embrace our later years?
It’s a fact that many of us don’t want to face: with every tick of the clock, every one of us is ageing. It feels scary. But it needn’t.
“Being human and living our lives is all about change, and that’s what ageing is, it’s change over time,” says Professor Julie Byles, a social gerontologist and researcher at Newcastle University.
Ageing is intrinsic to the living species on this planet but how we grow old, and the factors that influence the process, are complex and unpredictable.
Credit:Illustration: Dionne Gain
“Ageing is universal but not uniform: it’s universal because it happens in all cells and all species, but it’s not uniform in that we don’t all go through it in the same way,” Professor Byles says.
Australia has one of the highest life expectancies, ranking ninth among OECD countries behind Switzerland, Iceland, Italy, Norway, Japan, Sweden, Israel and Spain.
An Australian born in 2019 can expect to live to about 83, some 34 years longer than people born in the 1880s (in Japan, the average age expectancy is just over 84). Today, about one in seven Australians are 65 or older. By 2057, it’ll be almost one in four.
As the World Health Organisation says, with good health a longer life brings opportunities: to pursue new activities, a long-neglected passion or even a fresh career.
We may feel more empowered to make those extra years as fulfilling and meaningful as possible if we understand how ageing happens – that it’s a lifelong process, not just some switch that gets flicked in your 60s, says Peter Lange, a University of Melbourne clinical associate professor in geriatrics. “There is a lot of nihilism about ageing and a lot of people think that disease is inevitable; that they’ll go into a nursing home or develop dementia. That’s not true but, by believing it’s going to be the case, they end up failing to take action to prevent it,” he says.
Can we slow ageing? How does it happen? And how can ageism be a form of self-sabotage?
How do we typically age?
While most people don’t start feeling the effects until at least their 30s, the seeds of ageing start when we do.
“It’s happening all your life. It starts even before you’re born, from the very first cell division,” says Byles. That’s because ageing comes down to a gradual accumulation of problems, starting with tiny DNA transcription errors from the very beginning.
Our cognitive processes peak about the time we’re 20. In fact, most of our body’s systems are thought to peak when we are between 18 and 30, says Leon Flicker, a professor of geriatric medicine at the University of Western Australia. “That seems to be when the ageing process … starts kicking in, and you have a progressive decline,” Flicker says.
Ageing is not programmed, though. As we move through the world, we suffer little bits of damage – it could be from sunlight, bacteria, a sprained ankle, a shonky DNA copy, bad food – that the body then works to repair.
“It’s happening throughout every second of our existence,” says Flicker.
But over time our physiological reserves drop, so we’re left accumulating damage that our body gradually can’t keep up with fixing – and this can manifest in all sorts of ways.
“The thing about ageing is it’s affecting every system of the body and different parts get impacted differently. No two 80-year-olds will be the same.”
The changes we experience as we age are neither linear nor consistent, and there is an extraordinary level of variability among older people.
“The thing about ageing is it’s affecting every system of the body and different parts get impacted differently. No two 80-year-olds will be the same,” says Dr Kate Gregorevic, Royal Melbourne Hospital geriatrician and author of Staying Alive: The Science of Living Healthier, Happier and Longer.
There are certain hallmarks of ageing on a molecular and cellular level. For example, Gregorevic says, we collect damage in our DNA. One way is that each time our cells divide, the little protective caps on the ends of our chromosomes, called telomeres – which are often likened to the plastic tips on shoelaces – gradually shorten, which affects our ability to copy DNA properly.
When DNA is damaged, over time more cells can die or become cancerous. More cells also become what’s called senescent – they stop dividing. On the one hand, this defends against cancer but these senescent cells also take up space without contributing, causing inflammation and overstimulating the immune system, which can’t keep up with removing them.
Then there are the changes we often notice from our 40s, says Lange: skin loses elasticity; hair turns grey as pigment cells in our follicles slowly die; we become long-sighted as the lenses of our eyes stiffen; in some people, hearing dulls.
Muscle loss, or sarcopenia, is another typical part of ageing. One study observed that muscle mass decreased between about 3 and 8 per cent each decade after age 30 and the rate of decline was higher after 60. “We know that with age we can lose muscle strength,” Gregorevic says, “particularly, we lose fast-twitch muscle fibres – they’re the ones you use when sprinting or when you catch your foot on the pavement and need to steady yourself fast.”
At the same time, bone density drops while ligaments and joints stiffen, becoming more at risk of injury, and taking longer to heal. Also common are weakening lungs. Our cardiovascular system is impacted, and there are certain hormonal changes, with people exposed to a higher level of cortisol (the stress hormone) as they age.
The pile-up of all these changes gradually increases our vulnerability to disease or “insults” – such as a seemingly minor fall leading to bone fracture – and eventually leads to frailty, which is a loss of physical reserve that affects almost everybody by their 90s.
“If you’re frail,” says Gregorevic, “your body is already working so hard at the best of times just to get through daily life. So, when you get a cold it takes all your energy.”
But it’s not all bad news.
Credit:Illustration: Dionne Gain
Does ageing necessarily involve disease?
There’s a lot of confusion between the implicit processes of ageing and diseases associated with getting old, says Lange. A good example is our minds. As brain tissue gradually decreases with age, it’s normal for our memory to shift, to become slower and less efficient.But forgetting entirely and suffering from significant impairment is not universal, it’s a symptom of dementia (which is itself an umbrella term for many diseases).
In 2014–15, almost three-quarters of Australians aged 65 and over reported they had good or very good health, according to the Australian Institute of Health and Welfare. But disease is more common in older people: in 2015, cancer and cardiovascular disease were the most prevalent followed by dementia, type 2 diabetes, chronic lung disease and osteoarthritis. Many of these illnesses are also the biggest killers.
Flicker says cancer is more common as people age partly because the body’s surveillance system becomes less likely to spot and destroy bad cells. We are more at risk of diabetes, in part because our body becomes less efficient at converting glucose to energy and requires more insulin.
Still, while everyone’s reserves decrease with age, we aren’t all similarly susceptible to disease. Some of us, Lange says, have higher baseline defences. So, even though someone may have pathologies such as hypertension and mini-strokes, both of which are linked to dementia, they won’t necessarily develop a form of the disease.
What difference does the life you’ve led make to ageing?
There’s a cheeky saying in gerontology, says Byles: “If you want to age well, pick your parents.”
Being born with as few DNA errors as possible gives you a good headstart in life; aspects such as a good education, financial security and access to nutritious food in childhood add to your stocks.
“You can be already on an un-level playing field, depending on what your early life is like,” Byles says. “If you get to older age and you’re big and strong, with a healthy brain, good education, a strong immune system, they all go into your reserve … you can maybe cope with having not as strong muscles or a decline in condition because you have all these other things that support you. ”
A quarter of how we age is determined by genetics, according to the World Health Organisation, and the rest comes down to lifestyle and socioeconomic factors.
More than a third (38 per cent) of the burden of disease in older Australians was preventable in 2015, according to the Australian Institute of Health and Welfare. Smoking, poor diet, being overweight or obese and high blood pressure were key contributors.
COVID-19 lockdowns, which limited exercise and socialising, have underlined just how important lifestyle is in ageing. Lange says the months in lockdown in Victoria had devastating impacts on physical and cognitive function for older people.
There are other factors outside our control.
“Being brought up in poor housing, abject poverty, poor nutrition, a whole range of other things; all of that has contributed to our elders having chronic health conditions today.”
Aunty Geraldine Atkinson at the launch of the Yoo-rrook Justice Commission in 2021.Credit:Simon Schluter
Social disadvantage is a big one. A 2020 study of 5000 Britons found that lower socioeconomic status led to an accelerated decline in ageing. The researchers pointed out that the rich tended to have, for example, better access to parks and fitness centres as well as mentally stimulating activities (social clubs, the arts), which all helped bolster physical and mental function. Meanwhile, those living in poverty usually experienced more life stresses, which affected health, and they could also be exposed to more environmental pollution.
This disparity in ageing is reflected in Australian government policy. Subsidies for aged care services usually kick in at 65, but Indigenous Australians, Torres Strait Islanders and the homeless are at higher risk of health issues and financial inequality so are eligible at 50 (or 45 if they are both Indigenous and homeless).
The life expectancy of Indigenous Australians is about eight years less than for non-Indigenous Australians.
Aunty Geraldine Atkinson, a Bangerang woman and co-chair of the First Peoples’ Assembly of Victoria, says more must be done to support healthy ageing in Aboriginal communities.
“Being brought up in poor housing, abject poverty, poor nutrition, a whole range of other things; all of that has contributed to our elders having chronic health conditions today,” she says.
Credit:Illustration: Dionne Gain
So, can we ‘delay’ ageing?
Much research is being done to find a magic anti-ageing pill, but there is no strong evidence at the moment that supplements or medications work. Scientists are trying to find treatments that could lengthen telomeres, for example, or remove senescent cells via drugs or gene editing in the hope these could slow ageing.
The medical community is keeping a close eye on clinical trials underway to determine the effects of the drug Metformin, which is normally prescribed to manage blood-sugar in diabetics, but has shown broader age-targeting potential. Research previously suggested diabetic people who took the drug outlived non-diabetics who didn’t, and it has been found to delay ageing in mice, although in high quantities it was toxic. The American Federation for Aging Research is examining whether it can also prevent heart disease, cancer and dementia.
Still, any geriatrician will tell you a balanced diet and regular exercise are key to supporting healthy ageing and, in turn, a longer life. Stimulating your mind also helps minimise disease risk, Gregorevic says.
“Just like our muscles, use it or lose it – our brains are like that as well,” she says. “One of the best things you can do for healthy ageing is just to keep having a go at things – not brain training but staying engaged in life, socialising, learning new skills, learning a language.”
It’s never too early or too late to start. Byles encourages people to start planning for old age when young. “If you’re not doing it by your 50s,” she says, “that’s when you must ask yourself, ‘Where do I go from here, what do I want to protect in terms of bodily, social and mental functions?’. Make changes that will maintain your wellbeing – and keep you pushing your capacity to do things you enjoy.”
The aptly named Professor Norman Lazarus laid out why he considered exercise, eating well and mental health a “trinity” in his book from 2020, The Lazarus Strategy: How to Age Well and Wisely. The King’s College London physician and researcher overhauled his lifestyle in his 50s to become a champion cyclist at 66, an age he said he expected to start having difficulty getting out of a chair or opening jars. At 86, he still cycles, trains at the gym, walks with his wife, watches his diet and works at the university.
“At every age, I change my behaviour so that I can do the best I can with the physiological systems I have. And I don’t look for immortality.”
Norman Lazarus, 86, kickstarted his healthy lifestyle when he was 50.Credit:Liz Seabrook
Lazarus encourages people to first accept they are going to get old, and then change their lifestyle – to truly enjoy the journey of ageing and retain their independence.
“At every age, I change my behaviour so that I can do the best I can with the physiological systems I have. And I don’t look for immortality,” he says.
The trick is to prioritise things you love, so you stick to them, he says. While he and his wife now walk on flatter, gentler trails instead of on multi-day hikes, for example, they still relish the time together. He even uses the term “exercise deficiency diseases” to emphasise how key physical activity is.
A comprehensive study in 2015 found 26 common illnesses could be positively affected by exercise, including cardiovascular disease, type 2 diabetes, obesity, dementia, osteoarthritis, osteoporosis and some cancers.
“The most effective anti-ageing option we have is exercise,” Lange says. “It produces beneficial effects for pretty much everything we’ve ever looked at.”
Exercise improves muscle strength, balance, bone density, and the immune, cardiovascular and respiratory systems. It boosts mood and supports brain and spinal health, too. Getting out and being active with people is important for cognitive stimulation; and, by stressing the body, you’re also getting it used to dealing with small perturbations.
Lange says just a small amount of activity can make a meaningful difference, and resistance training is particularly important – he has seen this transform once-bedbound patients in their 80s and 90s. He encourages people to introduce incidental movement into their day: carry your shopping bags instead of wheeling a trolley, walk instead of drive or tend to your garden.
Even if you have the healthiest exercise, diet and social regimen in the world, though, you could still suffer from disease when older (or younger, for that matter). “The harsh reality is that no matter what you do, you’re going to die. And you can live the perfect lifestyle and still get cancer. Nothing is certain,” Gregorevic says.
It’s why we must be careful not to judge people for the condition they’re in when they’re older. Byles points out that people with certain illnesses, such as diabetes or lung disease, often get blamed. “Some of it is preventable but not all of it. Some of it is by virtue of the fact you’ve been around a long time and have had a lot of chances to accumulate a problem,” she says.
Why does ageism matter?
Part of the reason people don’t notice their own ageing is because the changes are far too subtle, Flicker says. And people don’t actually think they’re changing with age – their vision of “self” is deeply ingrained.
Byles adds: “I have a theory that everyone thinks they’re 30. You have a concept of yourself, so we always think we’re younger, which is great. But then we can get a shock.”
She believes part of this is our own ageism, where we value our youth as more relevant. Indeed, we live in a culture that glorifies youth.
“The acceptance of poorer service provision in aged care reflects an undervaluing of the worth of older people.”
In Australia’s 2021 Royal Commission into Aged Care Quality and Safety, commissioner Lynelle Briggs found that ageism was systemic in Australia. “The acceptance of poorer service provision in aged care reflects an undervaluing of the worth of older people, assumptions and stereotypes about older people and their capabilities, and ageism towards them. This must change,” she wrote.
And a World Health Organisation global survey of more than 83,000 people found that one in two had ageist attitudes.
One of the great tragedies of ageism is that people internalise it and develop a negative bias against their older selves, Gregorevic says.
One common example of self-sabotage is that while young exercisers crave feeling out of breath, many older people, doubting their capabilities, take it to mean they should avoid being active, Lange says. ”[But] that’s exercise, and it’s getting you used to those challenging activities, and the next time you get sick and need some extra heart and lung function, it’ll be there.“
It’s really important not to categorise everybody older than 65 as old … There’s nothing magical about this age. It doesn’t mean people are all of a sudden decrepit.”
The idea that older people are incapable of using technology is another misconception. And Professor Linda Rosenman, board member of the Australian Association of Gerontology, says debates about retirement age generate another myth. “I think it’s really important not to categorise everybody older than 65 as old,” Rosenman says. “This is just the age that people become eligible for government pensions. There’s nothing magical about this age. It doesn’t mean people are all of a sudden decrepit.”
Not all Australian communities suffer from ageism.
“It seems not right, foreign, kind of,” says Aunty Geraldine, explaining that Indigenous communities focus not on what’s lost with age but instead on the wisdom that’s gained. It’s an approach she thinks the rest of the country could learn from.
In Aboriginal culture, an elder is someone recognised for their knowledge and ongoing contribution to their community, and they are not neglected. They are traditionally referred to as “Aunty” or “Uncle”.
“We always respect and value our elders, respect their cultural authority, respect the stories they told us … and that gets passed down,” Aunty Geraldine says. “You become an Aunty not just to your bloodline, but to other younger people as well. ”
It’s different in other countries, too.
“When you’re in Beijing and you go for a walk to parks, they’re full of older people doing tai chi, dancing. There’s no sense that, I’m too old to do that,” Byles says.
Byles, who helped create the anti-ageism Every Age Counts campaign, says people could be enjoying life more as they age.
“Ageing is a great individual and societal success. We should be embracing it,” she says.
Credit:Illustration: Dionne Gain
What do you gain as you age?
The fact is we do typically become happier as we age, with research showing older people tend to have brighter moods and fewer symptoms of depression and anxiety than younger counterparts.
Byles says it’s possible this is because older people largely do things that bring them satisfaction.“You can’t do all the things you used to do … so you are actually focusing on things that are more important to you,” she says.
“You use your brain to solve problems throughout your life … [and] each time you learn a new strategy you can apply it to other problems, and that’s wisdom.”
Plus, she says, we often care less about what other people think, which can be really liberating. And there is a sense of contentedness that comes from understanding, with time, where you and the puzzle pieces of your life fit.
People keep improving their vocabulary well into their 60s and 70s. And while brain speed and working memory peak in early life, this doesn’t make 20-year-olds equipped mentally to run the country.
Older people have what’s termed “crystalline intelligence”, Flicker says. “You use your brain to solve problems throughout your life … [and] each time you learn a new strategy you can apply it to other problems, and that’s wisdom.”
Reflecting on her own life, Rosenman considers herself to have become more patient and tolerant, and she enjoys having more time.
“You’re not trying to climb the greasy pole yourself any more, and you’re much more ready to mentor and help other people,” she says. “In many ways, life is a lot more enjoyable than when you were racing off to work and herding the kids … [and] grandchildren are a big bonus.”
“Ageing is a great individual and societal success. We should be embracing it.”
Professor Julie Byles says we should start planning for getting old at least by our 50s.Credit:Peter Stoop
How do you deal with the fear of nearing the end of your life?
There is, of course, an existential aspect to ageing. “That can be quite difficult,” Lange says. “I’ve met patients who have lived too long, and have outlived their partners and friends and even sometimes their own children, and they have increasing physical disability and sensory limitations.”
But, Lange says, most people reach a point where they no longer fear dying.
“People usually accept it will come … which is quite freeing.”
Lange encourages people to focus on ageing well rather than fixating on the idea that getting older means they’re approaching death – which is only one moment at the very end of a life journey.
Flicker agrees: “I think people eventually realise that if you’re not dead yet then maybe life is to be lived, and … really you should try to enjoy the living as much as you can, no matter what is happening at the time.”
And it’s up to all of us to talk to each other to help reframe the way we view our older years. As the aged care royal commission report outlined, “There are everyday things that all of us can do to enable older people to live their lives to the fullest extent possible … Older people should also be encouraged to think about what it is that would make them happy, and to have some goals or objectives for each day or week that give purpose.”
While many people worry they will end up in a nursing home, the reality is most Australians do not. The same report says about 80 per cent of Australians use an aged care program at some stage before their death but for most this means at-home support.
“Nobody is saying the last years can’t be difficult. You can be faced with losing people you love while also dealing with your own debilitating health problems, but the vast majority of people will be healthy enough to live independently for most of their life,” Gregorevic says.
“We need to remember that life is finite and, in a way, that that’s a real gift.”
Like all of us, Lazarus feels taken aback when he sees his older face in the mirror but says there isn’t any age that he wishes to be frozen in.
“I’m not sure where I put myself. I see this old man and I see myself, but … do I wish I were 20 again? Not really,” he says. “I can’t place myself in any decade because I’ve really enjoyed myself.”
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