The medicalisation of old age

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Abstract
“A fair innings?” “The years of our life are threescore and ten, or even by reason of strength fourscore; yet their span is but toil and trouble; they are soon gone, and we fly away” (Psalms 90, 10). Traditionally the biblical threescore and ten years have been misinterpreted as a natural limit, but the psalm is concerned with the nature of life and not its span. For example, Williams states, “Anyone who achieves or exceeds this is reckoned to have had a fair innings…”6 However, the fair innings argument as a means of rationing healthcare resources has limitations. Without compulsory euthanasia at the end of the innings, palliative care may prove more expensive than therapeutic treatments.6 Concerns about medicalisation of old age may hide a desire to reduce costs.8 It is dying in hospital—not an ageing population—that costs money. If people die later the costs of health care will fall later, but this is the cost of dying, not of ageing.9 As Skrabanek commented, “Since life itself is a universally fatal sexually transmitted disease, living it to the full demands a balance between reasonable and unreasonable risk.”10 Even among individuals who indulge in risky lifestyles a minority succeed in exceeding the age of 70 years.11 Elderly people today are probably fitter than those of two decades ago, but old age still covers a wide range of conditions and needs, from the fit to the frail. Although ageing is a natural process, it would be wrong to conclude that the diseases that accompany it are also natural and should be excluded from medical attention. Myriad trials have shown the benefits of treating rather than ignoring the health problems of older people.12 Evidence from trials of blood pressure lowering and statins shows us that old people are no different from younger people in their response to treatment, but because of their higher levels of risk, gain greater absolute benefits from effective treatments. Effective treatments for cataract, hearing impairments, angina, osteoarthritis, impotence, depression, and other common conditions exist and should be used.