- Brice Pitt, emeritus professor of psychiatry of old age
- Department of Psychological Medicine, Imperial College School of Medicine, Hammersmith Hospital, London W2 0HA
This is the ninth in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice
Old age can be seen as a succession of losses, gradual or sudden.1 Stopping work means a loss of the working role, of the companionship of fellow workers, and of a full, structured day; it means a reduction in income—and, for those who live with someone, less time apart. Some people feel much diminished by retirement, hardly know what to do with themselves, and suffer a loss of status. Most developed societies do little to enhance the image of the “senior citizen,” who is liable to be patronised, marginalised, or simply ignored and is seen as a problem for an overburdened welfare state.
There is a view, though, that successful ageing means compensating for some losses by making the best of change. So, the strains of having to commute, living for the job, and struggling to keep up are also lost; some pensions are at least adequate; there are concessions that make life a little cheaper for the over 60s. Having more time to oneself, for hobbies and interests, and to spend with partner are often regarded as benefits. Though it is usually a sudden event, retirement is (unless there is unheralded redundancy) expected and there is time to prepare for it.
In old age comes a succession of losses: dementia occurs in 20% of those over 80; loss of sexual enjoyment is common but not inevitable; half of octogenarians live alone
Depression in elderly people is often unrecognised; it is often caused by loss and, in turn, causes further losses
Preparation for retirement, health checks for the elderly, continued access to education, and the use of “at risk” registers can mitigate some of the …