Caring for the elderly: Lessons from history?
According to various reports in the press this week (before petrol took over as the predominant theme!), Arlene Phillips (ex Strictly judge and choreographer etc) has delivered a public rebuke to David Cameron about the state of geriatric care provision in the UK today. Depending on which newspaper you read, Ms Phillips either “grilled”, “challenged”, ”confronted” or “blasted” Cameron about conditions she had recently witnessed in a Hereford hospital. Among the litany of failures she raised were elderly patients calling out for help and being ignored, and some being left alone for long periods. As some officials are noting, there is a “very real crisis” in elderly care provision, not least in the issue of how to train nurses and carers to undertake what is a very challenging situation. At a time when life expectancy is ever increasing, the economic effects of an ageing population are very much in policymakers’ minds at the moment. But how to maintain dignity in later years appears less of a concern. In fact, how to care for, and indeed treat, the elderly has been a constant issue throughout history. It is worth looking back at the seventeenth century to see how things, in some ways, may even have been better.
It is easy to think of the seventeenth century as a relatively young society. After all, the average life expectancy at the time was roughly 37 years. But this average is greatly skewed by the extremely high levels of infant mortality, which bring the average down. It was not the case that people reached their mid thirties and then quietly prepared to drop off the perch. If you reached this age then, due to the fact that you had probably developed a good level of immunity to many common conditions, you stood a fair chance of making your three-score years and ten. As such, there was a significant (although not easily quantifiable) elderly population in Britain at that time.
In principle, the early modern period witnessed a ‘gerontocratic’ system where age was respected. It was no coincidence that the majority of officeholders, whether in central politics or local administration, were middle-aged or above. The latter years were seen as a time of mellow reflection; a time when people could look back on a life well-lived, set their affairs in order and prepare their souls for the final journey. Unlike fiery youth whose hot-headed tempers regularly got them into trouble, those in their later years had learned restraint and, perhaps more importantly, were regarded as repositories of accumulated experience. This was one view of age.
The other was more derogatory, and the figure of the bumbling old fool was a comic staple in cheap literature. Age took its toll on mental facility and physical capacity, leaving the elderly person weak and vulnerable. In humoural medical terms, age made the body cold and moist, while bitterness and regret clouded once-sharp minds. At the extreme end, it was poor, elderly women, perhaps living alone on the fringes of society, who were most susceptible to suspicions and accusations of witchcraft.
A combination of hard physical work, poor diet and a lack of effective palliative medicines all took their toll on early modern bodies. People would have looked older at a much younger age than today. A man of forty in 1650 would probably look closer to a modern man’s sixty. There were also a myriad different deadly diseases which could weed out the elderly and weak, with winter being a particularly dangerous time. Winter was the time of epidemic fevers and influenzas which could sweep the already vulnerable away, if harsh weather and lack of adequate heating hadn’t brought the coup de grace already. Sickness might be acute and fatal, but it could also be painful and lingering. In these cases, who looked after the elderly? Were they simply put out to pasture and forgotten about?
The structure of early modern families meant that it was very unusual for people, and especially married couples, to continue living with their parents into adulthood. It was a prerequisite for prospective couples to be able to demonstrate that they could afford to buy and run their own home. As such, many elderly people in this period lived with their spouse or, as commonly occurred in a period of high mortality, by themselves as widows or widowers. But we shouldn’t assume that this necessarily meant that no help was available.
There were, for example, a wide variety of ways in which the community could intervene to look after the elderly or poor in their midst. Visiting the sick and elderly, for example, was a common social ritual, and one undertaken by neighbours as well as local clergy. Surviving diaries from ministers attest to the numbers of daily visits that this might include, and while little physical care was provided, company was doubtless important.
Secondly, the parish, through the monies collected via the Poor Law, could provide money to give support to the old and infirm. This might consist of money to purchase clothes, food or firewood – especially in hard winters. It might provide funds to cover medical expenses such as visits by a practitioner or to purchase specific remedies. In some cases, though, the parish might even pay people to actually move in and care for the elderly and infirm. In such cases, the elderly person had access to a relative level of care that many do not have today. The allotted person might cook and clean, perhaps administer medicines and, most importantly, provide companionship. The gratitude of the recipients of this type of care is reflected in the fact that they often bequeathed what little they had to these (to use the modern term) ‘carers’, even if it was a few bedclothes or ‘wearing apparel’. This level of care for that period is quite significant – and also pretty shameful given reports of the state of modern geriatric care alluded to by Ms Phillips.
We can’t argue that old age in the early modern period was some sort of golden age – it wasn’t. It was often a bleak, painful and harsh reality, especially for the very poorest who had no family, no money and few friends. There are plenty of accounts of such people who saw out their days in hovel-like cottages with only a few posessions and a meagre diet to bring them comfort. But there was a moral invective to help those less fortunate which perhaps operated at a deeper level than that of today. Whilst we undoubtedly have the ability to provide far superior medical care, far more comfortable surroundings, to extend lives far beyond that of our early modern counterparts, and provide a greater quality of life for those in their later years, it is important that we pay attention to mind and body – to dignity and respect – and this is a lesson to which we can turn to the past for inspiration.