Woman's Hour - Getting old

Episode Date: December 30, 2020

More and more of us are living longer but we don’t talk enough about what it means to be old, according to Consultant Geriatrician Dr Lucy Pollock. The author of ‘The Book about Getting Older’ tells us about what she’s learnt about looking after the old and their families over many years, and the practical things that people can do to make things happier in old age. We also hear from Anna Dixon, CEO of the Centre for Ageing Better. Exercise - and building muscle - can help you stay healthier longer into old age. Dr Niharika Duggal from the University of Birmingham explains how muscle improves our immunity. Janine Rickus from Extend, an organisation that specialises in exercise classes for older people, gives advice on the moves that'll keep you on your feet in old age. Presenter: Jane Garvey Producer: Dianne McGregor

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BBC Sounds. Music, radio, podcasts. Hi, this is Jane Garvey and this is the Woman's Hour podcast. It is Wednesday the 30th of December 2020. Hi there, good morning. We're live from Broadcasting House and we want you to get involved in a conversation about ageing, about the challenges of getting older. But of course it's not all bad, far from it. There are all sorts of good things about your later years

and you can make them better if you do the right things. Ageing is happening to us all. I've certainly aged during the time I've been on Woman's Hour. I think everyone will agree with that. 84844 on the text. Of course, you do have to bear in mind

the cost of that. 84844 at BBC Woman's Hour on social media. We have a cracking lineup of guests on the programme today. Dr Lucy Pollock, consultant geriatrician, author of a book called The Book About Getting Older for People Who Don't Want to Talk About It. We'll talk to Anna Dixon, the CEO of the Centre for Ageing Better. We'll get the view of Dr Neharika Doggle of the University of Birmingham. She's going to talk about exercise and the benefits of Dr. Neharika Doggle of the University of Birmingham. She's going to

talk about exercise and the benefits of that. Janine Rickus works for an organisation called Extend that specialises in exercise classes for more mature people. And we'll chat too to Joyce Williams, who is 85 and started to blog about tweeting and about the positive side of ageing when she got to 80. Joyce is hugely positive and we'll hear from her a little later. Lucy Pollock, first of all, good morning to you. How are you today? Good morning. I'm well, thank you, Jane. Now, you are a geriatrician and why did you want to do that actually? Why specialise in that side of medicine? I didn't really want to when I was a very junior doctor.

I hadn't realised that it would be a good idea. And then a sensible senior doctor said he thought he hoped I wouldn't be offended, but he thought I should do geriatric medicine. And the minute he said that, I thought, absolutely. Older people are so interesting and different and individual. And everybody has their own story to tell. Their medicine is incredibly complicated, which makes it very interesting. And you can easily get it wrong, which makes it very challenging. And you can get it right. So it's immensely

rewarding. I absolutely love being a geriatrician. Yeah. Isn't it interesting, though, that he was a little bit uncertain about recommending it? What does that tell you? Well, I think it tells you that it was 25 years ago. So actually a lot has changed. And geriatric medicine is now the second biggest specialty in the country. I think a lot of people don't realise that. And it attracts fantastic junior doctors who realise that they learn their medicine

when they're working with older people. And I think they're attracted for the same reasons that I am. So, in fact, it's a specialty that's really going places and it's become very, very popular. On the cover of your book, there is an elephant. And that does suggest that ageing and the business of ageing is a subject many of us would perhaps choose to avoid. So let's just do all the, I was going to say the nasty stuff. Let's get rid of the taboos right at the very start. What are the things that people in your experience do not want to engage with, but they should? That's a good question. And we have to remember that people are leading

happy and fulfilling lives. But there are some really tricky bits that can happen. And we don't like talking about them. So they divide up really into some of the practical things that are either contentious like should my dad still be driving and if not who's going to stop him because he's not listening to me or falls which are simply frightening or continents which is just embarrassing and then the other really big existential issues like you know should I be for recess or or really importantly how do I speak on behalf of somebody who can't speak for themselves anymore? What's the role of a family in that situation? And that's poorly understood and we need to have a really good conversation about that. Can we also talk about dementia, about the fact that sometimes there's a

feeling that it must be inevitable. It isn't though, is it? It doesn't happen to everybody. Absolutely, exactly. And dementia is a really important topic. And it really illustrates a difficulty for a lot of people as they get older, which is trying to work out what's just normal, and you should expect it and it just happens. And what's common, but isn't actually normal, like dementia or falls or becoming having problems with continence and making sure that you ask the right questions and get the right treatment in those situations. So I talk about a patient, Margaret, who is is definitely losing her memory, but her husband is is sort of not covering up for her, but just doing things, taking things on, assuming responsibility for things. And he's so kind.

And he and Margaret just don't want to talk about it. And they suspect that this might be dementia, but they don't feel able to say anything about it. And it goes on for several years. In fact, if they talked about it earlier, got a diagnosis, a lot of their worries could have been allayed and they can make better plans for the future. Well, that's interesting you mention that. That's a subject that people have been asking about in terms of dementia. Is it sometimes the better

option not to know? I think it's a very individual response. And there are some people who really will find it very difficult but in fact there's a parallel with the old taboo that used to be cancer and about 30 years ago we realised it was a very good idea to talk about cancer and we don't have a problem with it now. Dementia is in much the same book. In fact if you talk about it and reach a diagnosis it makes a lot of difference for the person themselves and often people are much less upset about being given a diagnosis of dementia than you'd think, because actually naming it puts some of the fears straight away. And then also for their families, it makes a phenomenal difference to acknowledge that this explains some of the behaviours.

Yeah, it explains some of the behaviours, but what is there to be done? What you can do if you know that you have dementia is first is don't panic because actually life goes on just the way as it did the day before you got a diagnosis of dementia. You still got to do the shopping and so on. So adaptations can happen quite slowly, but you can also make plans and you can talk to your family about what your hopes and fears are. And you can do some advanced care planning and also actually live well. I mean, I know it's impossible during the pandemic. It's so difficult. But when we're at the other side of that, as I sincerely hope we will be soon, you can start embracing life and using the time that you've got to build up some really special memories. There's a question here from a listener about her mother's medication. She says her mum is 90. I won't read it out in too much detail, but her mum's on a particularly strong form of

pain relief. She's been on it for an incredibly long period of time, it seems to me, for back pain. Why are so many of our older people on so many medications? This is a really big challenge. And some of the, you know, the increasing medicalisation of our society is a big problem. And older people often see lots of different doctors because they've got many different conditions. And what can easily happen is a medication is added for one condition and then for another and then for another all in accordance with good guidelines about how to manage that condition but without realising that there are interactions between these medicines and that

actually sometimes people really aren't benefiting. So older people really deserve a good conversation with their doctor where they go through, I say, I go through a drug chart with a tooth comb. Everything on that chart has to be worth it as you get older. And tablets that are worth taking when you're 50 sometimes simply aren't worth taking when you're 90. Not because you're not worth it, but because they're not really working anymore and making enough difference to make it worth it. So a good, honest conversation. Don't, for goodness sake, hide your tablets in the back of the cupboard and don't stop taking anything without talking to your doctor. But you do deserve a really good conversation. And is that something that a child or a carer or a friend could do?

Say to an individual, hang on, why are you taking so much stuff? We need to have an audit of all this and work out what it's doing to you. That's exactly it. And I strongly recommend people to write down a list of their medicines and why they're taking. So many of my patients don't actually know why they're taking something. And it was started ages ago by a specialist. And you always do what the specialist says. And nobody thinks to stop it. So absolutely, I think families and carers have a great role in this. I love care home staff who challenge us on why their residents are taking these medicines. And we can sit down and have a

really good think about it. Can we just answer the question about driving? Because people are asking about this. Here's one here. My mum's 83, my dad's 94. He's still driving, not far and not every day, but by any means, but still regularly. And judging by the bumps and the scratches around the car, he is pretty regularly knocking into things, too. What do I do about it? Right. What do they do, Lucy? OK, it's a really emotive one, isn't it? Because it's all about somebody's independence. And most older people are very good drivers and also most older people know instinctively when to stop driving. But there are people who lack insight into their driving ability.

When somebody's got a diagnosis of dementia, the rules are very clear. The DVLA has to be informed and they make the decision. It's not a medical decision. It's the DVLA's decision about stopping driving. But when it's not dementia and it's something just about judgment or reflexes and so on, it can get very difficult. And I think families do struggle with this. Finding good words to say, you know, you've always been a fantastic driver. I've always admired your driving and I'm worried that something bad is going to happen. And I wouldn't like you to stop on a bad note. That can be one way of suggesting it.

Or organising a test, which can be done. If somebody is being really stubborn about driving and is clearly unsafe and the family are really worried, then the way forward, I'm afraid, is to report them to the DVLA. And that's a perfectly acceptable thing to do. But I would always counsel having an honest conversation first. Well, it's all about honest conversations. They are actually often, though, the very hardest to start, aren't they? Perhaps we can go on to discuss exactly how you go about that a little later.

Anna Dixon from the Centre for Ageing Better. Can we just talk briefly about independence, Anna, and driving? Because that's an aspect of that, obviously. What do you think? Well, I think we want to support people to stay active for as long as possible. And obviously, if you're in a rural area, being able to drive is critical to still being able to live a full and active life. But it's really important that we think about these things earlier before we get to the sort of crisis situation where we start to lose our independence. And that means thinking about where we live. Do we have access to services? Is it walkable? Can we get to the shops and the GP? Is our home well adapted? And so the things that we're trying to encourage people to think about at the Centre for Ageing Better is actually how do we prepare for later life? How do we take action and support our loved ones to do things to get their home ready, to think about these sorts of aspects of life that are going to maintain our independence for as long as possible. It isn't easy, is it, to take responsibility? I'm just looking at our social

media here and a listener says, taking responsibility for an elderly relative is a big one and not one that you get any training for. I've had to find my way and I question my decisions every single day. Now, of course, some people listening to this programme will be carers in any number of different situations. Other people will be being cared for. Other people will be proudly independent older people. It's not easy to be a carer and it's not easy to be cared for, is it, Anna? What do you say about the responsibility of someone who's actually being looked after? Because that isn't always that easy either. Yeah, I think it's really important to recognise that we may be supporting a loved one or relative in a sort of light touch way one day, but if their health deteriorates

significantly, we might suddenly find ourselves in a position where we're doing many more hours of more intense caring. And that is a huge impact on our own lives. If we become a carer, we can find it quite isolating. We may find that it's hard to juggle work and caring. So it's really important to have honest conversations with your employer about how they can support you with things like carer's leave and flexibility so that you can juggle those things. But it does, you know, it does impact how the loved one is accepting that care. We often, and I think we've heard it there, fight that loss of independence and actually don't want to make changes in our lives until it's sort of almost too late. And we see that in our research, whether that's making alterations to our home, we're often, you know, struggling up the stairs, even crawling to get to the upstairs loo. Why aren't we thinking earlier about putting in a

downstairs loo? These sorts of changes to our homes could make a massive difference. Well, if you can afford them, of course. Lucy, you do write in your book about the cliche of the fiercely independent, and it is usually an older woman, isn't it? Yes. And the smaller she is, the more she's likely to be described as being fiercely independent, and it is usually an older woman, isn't it? Yes, and the smaller she is, the more she's likely to be described as being fiercely independent. That will be me, by the way. I can't wait. Carry on. But actually, being fierce is pretty good. And I think it does say something about the fact that we do guard our independence and that transition into becoming somebody who needs more help can be difficult and you know forget I mean you're Anna's absolutely right making big adaptation to your home can be very

important but I've got lovely patients who will not move a rug that they're going to trip over because they like it like that and allowing people to make their own decisions and take some risks is actually important. One of my colleagues describes it as helicopter parenting, but directed up a generation. And sometimes we need to step back from the parents that we love and say, OK, I know you're allowed to do that. And, you know, you can carry on doing it your way. It's not what I would choose, but you're choosing to do that. Here's an email which illustrates that rather brilliantly from a listener called Wendy. She says, my mother lives 100 miles away from me

and I visit fairly regularly, or I have done in the past, but she is independent with a support network of her own design. She is 93 in May, but in her own words, nothing wrong with her software, but her hardware is not what it was. She uses her money wisely to pay others to shop and clean and garden. She recently had another heart attack, a spell in hospital and has just bounced back again. She just will not be beaten. My feeling each time I leave her to go home, though, is overwhelmingly that I am leaving an unaccompanied child alone.

However, she proves me wrong every time and gets on with the daily routine once more. It kills me that she misses us all so much, but she never plays on this. Lucy, that story there from Wendy, who describes herself as one of the sandwich generation. It's very moving and it's not at all untypical, is it? No, it's a really beautiful story and she uses exactly the right words about it. I wonder if, Wendy, change your mindset from the worry to being so proud of that mum. I mean, hats off to her. She is doing all the right things, including paying for care. So that admission that you might need a bit more help, that's a really big step for people to take, you know, and it's really impressive when somebody makes that move when they didn't want to. So

I just think, you know, absolutely high, high, high five to Wendy's mum, really. Yes, but it's that feeling of the child and by the way Wendy is in her 60s, the child who then leaves the mother in what she regards as a slightly childlike state, it's pretty devastating isn't it? It is, I think it is and of course it's become more so in this last year but I think it is also about accepting that somebody is making their own decisions and taking that step back. So and Wendy herself is obviously doing exactly the right things too. She's being hugely supportive and concerned. It would be wrong not to be worried. Yeah. Something that I wanted to mention was the fact that I think I spoke to a demographer,

it must be 10 years ago, possibly more, who told me that the person who was going to live to be 120 in the UK had already been born. Ageing is something that ludicrously we still, Lucy, do not talk about enough. We need to mention social care and the crisis around that. I don't think that's too strong a word. Is that something that you are deeply concerned about as a geriatrician? Absolutely. And social care is vitally important. And if one tiny silver lining comes out of the pandemic, it will be the spotlight that has been thrown onto social care and onto the incredible good work that is happening up and down the country in social care. And the big move towards integrating health and social care had started long before this pandemic,

but I think is going to be accelerated and that's going to be a very good thing. There are really good people working very hard to get that right. Exercise is something that you recommend, Lucy. I mean, it's no secret. But is it OK to start exercising perhaps in your 70s or even your 80s? Could you still benefit? Absolutely. And the really good news about exercise is that the people who do least at the baseline to start with, who benefit most from just doing a tiny bit more. So, you know, the people who are running marathons in their 80s, fantastic.

Well, well done them. But actually, they're not going to benefit from running two marathons. Whereas somebody who simply gets up out of a chair, once an hour, instead of sitting in that chair all day is going to really benefit doing exercises. And I know that sounds modest, but it makes a huge difference. Simply lifting a can of beans 10 times every morning, each arm, is going to make a difference to your strength. So people can modify exercise regimes. They don't need special advice. They certainly don't need to squeeze into a leotard. And you just do what you can. And if it makes you a bit puffed out and you feel a bit achy afterwards, fantastic. Big reward. you've done the right thing. Dr. Niharika Duggal is a lecturer at the Institute of Inflammation and Ageing at Birmingham University. Good morning to you.

Good morning. Tell us exactly what you do and what you lecture in. So I'm an immunologist with over 10 years of experience in how your exercise or your physical activity could have a beneficial effect on your immune system. Yeah, this is what intrigues me. So if you are an older person and you can go out for some form of walk today, you are in some way, might you make yourself less vulnerable to COVID as simple as that? Definitely. In short, that would be definitely. So what happens with advancing ages, we see a remodeling of our immune system. So as a result of this, this is a big contributor towards the poor health that we see with advancing age. And it is this remodeling that is responsible for the increased risk of infections, inflammatory conditions in older adults. And what's important to remember is that our immune system does not

operate in isolation and it is influenced by our environmental factors, our lifestyle choices, and one of the biggest ones being the amount of physical activity we do. So a lot of people aren't aware that our skeletal muscle is actually a very important immune regulatory organ. What our skeletal muscle can do is it can generate proteins. So these are known as your myokines. And these proteins are known to have an immune protective effect. So even those few steps can have a big, big impact. When you say few steps, should you, if you are a complete novice in the exercise department, and maybe you are in your early 80s, how far is a good distance to start with, Niharika? So in the current scenario, I would say even doing little things at home.

For instance, we have seen a lot of associations in our own research between your muscle strength and your immune system. So small things that you can even do at your home. So we discussed about these arm raises with a little bit of weight. That's excellent. And even strengthening your legs. So if you do the chair stance, that's shown to be very, very effective. Or just small things like climbing up the stairs. So start by doing that a couple of times and then just build up your capacity.

The other thing that's absolutely the worst is being sedentary. And I think it's definitely the sedentary behavior has increased now with a lot of older adults, especially who are isolating. And what we have known for a long time now is smoking, it's your sedentary behavior is the new smoking. So even if we can reduce that, so even if you're watching your telly in the evening, just give yourself a little bit of a break and try and stand for a couple of minutes and watch your telly. I think that's a brilliant way of describing it. Sitting down is the new smoking. I won't be able to forget that. Thank you very much. Janine Rickers works for Extend, which is a non-profit organisation running exercise classes for people over the age of, is it mid-50s, Janine, you start?

Yes, yes, yes, mid-50s, yes. Now, is a leotard required for the classes that you get involved with? No, no, no, no, no leotards are allowed in our class at all. So it's just yourself, a happy smile and, you know, enthusiasm. That's all that's needed. And are they all over the country, your classes? Yes, we've got a network of Extend teachers throughout the UK, about 300 odd teachers at the moment, and we're all over. Again, we do classes in care environments

leisure centers working with the councils and also in the community as well in the village halls and and these classes can be sought out on our website um online classes as well because land classes at the moment depending on the tier that you're in know, it can be quite difficult and we're not allowed to do. So, yes, we're supposed to say, OK, over the UK, yes. Yeah, OK, so that's important. At least you can do some stuff online if you are able. And do you get people turning up, Janine, who've never done any form of exercise before?

This is almost a first for them. Oh, yes, yes, very much so. And again, you know, yes, yes, very much so. And again, you know, they come with, you know, instruction from their doctor or some of their friends have joined the class and say, we know what a marvellous it is. But we get all sorts from, I'd say, all ailments really, from heart issues to arthritis, etc.

So all are welcome, yes. And presumably, does it help with sleep? If you've had some form of organised exercise during the course of your day, does it make it easier to sleep at night? Do you get people saying that? Yes, yes, we do. And again, being active is most important. Going back to Wendy's letter that you announced earlier,

I'm also a carer for my parents. And, you know, they are self-isolating as well. And on a daily routine, we do exercise with them, with apparatus in your own home, like was mentioned, with the tina beans or with no apparatus at all, etc. So, yes. Great. Thank you very much indeed, Janine. Really appreciate you being part of the programme today.

We are getting questions from people who say, you know, it's all very well talking about your family and having conversations with your family. I don't have a family or I have no immediate family. Lucy, can we just address that issue to people who do feel frankly, alone and possibly have never felt more alone than in the last nine months or so? Yes, I think loneliness is a really big issue. And it's something that's built into our society and has become more so as we seem to have separated older people from younger people. And once this pandemic is over, I sincerely hope we will look at the structure of our society to try and build things in that mean that older people are more integrated and not separated. People who are on their own and are contemplating their own future and feeling very understandably uneasy and fearful. I think that's hard. There are still

people you can talk to. The first person I'd suggest is probably your GP and they will be able to signpost you to other organisations. And there are so many lovely voluntary groups that we often are unaware of. So getting in touch with Age Concern to find somebody that you can talk to locally, or even on the telephone. Their wonderful teamwork with the Silverline charity is just fantastic. Silverline is absolutely excellent. We should get the number actually for Silverline. And I'll make sure I read that out before the end of the programme. I'll just bring in some listeners. Marilyn emails to say, I just need to live until I'm 90-ish to enable me to see how my grandson, age nearly six in Australia, will turn out. I've got other grandchildren who range from 22 to 36.

So he was a nice surprise. I do drive out of necessity. I walk. I belong to social clubs and I do go to yoga and aqua fit. I read, I garden and I listen to you. I've got a great hairdresser and lots of friends. So here's hoping Marilyn sounds all right to me. I mean, a good hairdresser should keep you going. Julia emails to say Lady Diana Cooper said it all as far as I'm concerned. First, you're young, then you're middle aged, then you're old, then you're wonderful. I really want to be wonderful. That's good, we'll remember that one.

Carol says, I'm not yet 70, I'm in good health, but I've already told my daughter that if she ever feels I would be safer in residential care, she should get on and organise it. There will be no emotional plea of promise you won't put me in a home. Okay, let's address this one then, Lucy. A lot of people, when they're nowhere near going into residential care, say things like that. It doesn't mean that's the way they'll feel when they are a bit closer, perhaps, to considering residential care. What do you think? Yes, I think that's true. And a lot of people actually find a transition into care incredibly positive. And my own aunt, I remember her profound relief when she actually moved into care and she didn't have to worry about whether the tap was

going to freeze and flood and whether she could afford the bills at home and so on. So actually, it can become a very positive thing to do. And if you find the right place, that's fantastic. I think there is a very difficult issue when somebody has said, you must promise never to put me into care. And families do sometimes make that promise. And to be honest, I would try very hard not to make that promise if you can, or I'm afraid you're going to have to keep your fingers crossed behind your back some of the time. Because actually, things can happen that make it impossible to look after somebody at home. And the most loving and well-meaning families sometimes simply can't. So I think those are very difficult situations and they need a lot of courage and honesty.

And often they need a third party present for that conversation. Yes, we all there is a certain amount of bravado, isn't there, about all this. And you do, I mean, I'm sure I've said it myself, oh, I just, there's no way that I'm not going to be a nuisance to anybody. I'm not sure whether I really mean that when I'm 90. And I think if there is longevity in my family, I may very well, if I'm lucky, I should say, if I'm lucky, I may very well get to 90. Yes, absolutely. And I think the difficulty is that, as one of my patients, Derek, said, he said, I don't want to think about this. I'm fine as I am now. And one morning I'll just wake up dead.

And I know exactly what he means. And I think that's what lots of people hope will just happen. But actually, it is better to be clear eyed about the fact that that may be what happens. You may go to sleep one night and not wake up in the morning. And that's what a lot of people in very old age, that's their hope. And that's completely fine to hope that. But that may not be the case. And I think you don't have to dwell on this subject and talk about it every day and get completely obsessed about it. That would be completely miserable. But if you talk about it once, honestly and clearly, and sit down and make some plans with people that know you and can speak for you.

And if you can, you can write them down if you like to. But even just a verbal conversation is a really good start. Once you've done that, you can stop thinking about it and get on with having fun and having a glass of Baileys. Is that your tip? I can't believe that's your tip, Lucy. My husband made homemade Baileys this Christmas. It was absolutely delicious. Yeah. And somebody asked, how long does it last? And the answer is till about 11.30pm. The silver line number, by the way, is 0800 470 80 90. I should have known that. 0800 470 80 90.

That is a brilliant idea, silver line. We can talk to Joyce Williams. Joyce, good morning to you. Good morning. Now, you started your blog. Tell me, what inspired your blog? Why did you do it? I found a class that said blogging for beginners and I didn't know how to do blogging and I wanted to have a go at something different so I started it and it was great fun and a chance

to write which I enjoyed enormously. And what did you largely blog about? The positive side of aging because I'd got to 80 and I'd discovered to my great surprise and delight that it was actually very nice being old and i was totally enjoying it and so were so many of my friends who were all saying it was the best bit of life i thought nobody's saying this it needs to be said how brilliant so yeah it's great that your friends were getting together and actually saying what's not to like about this yes indeed we all say it's the best bit because you get to the point where you're confident about who you are. You're confident about yourself, your own skin now.

You've done it. You've made it. You're not pushing in the same way anymore. You've got there and you've got this maturity, I think, that says, OK, I can cope with life. I know how to do things. I've put up with things. I've beaten things before. I can do it do things. I've put up with things. I've beaten things before. I can do it again. And it's a very nice feeling. And you're still very active and interested in life.

You're very happy with friends and family and hobbies. It's a great time of life, time to really expand and be somebody that you weren't before. Enjoy being the new person you are at that age. In your working life, you were a physiotherapist. So I'm assuming that you've kept yourself fit. That's been a part of you. Yes, yes.

And that's got to be a help, Joyce. Yes, it has. But when I say fit, I don't mean going running marathons. I actually mean just making sure, for example, that you stand on one leg every day, perhaps when you're brushing your teeth or waiting for the kettle to boil and do balance and while you're sitting watching television every time an advert comes on do some exercises stand up sit down wait you know keep moving one finger one thumb keep moving just keep moving all the time right that's the important thing and you have had um those so-called difficult conversations with your family is that right i have indeed yes because i wanted to make sure

that they understood what i wanted and i've done a living will i've done it with my lawyer and i've given a copy to my son and my husband and my doctor and they all understand i think what i want and that is that i do not wish to necessarily be kept alive unnecessarily. Particularly if there's any kind of brain damage, it means it wouldn't be me that survived. It would be somebody that wasn't me. And I don't want to be resuscitated if that's not needed. And I think that's important to get that said and done.

And things about your funeral funeral how you want to die where you want to die i think the choice should be mine it's my life and it shouldn't be just left to doctors to have to decide it i think i should be deciding it and telling everybody how i wish it to be how was it when you raised it with your family what did they react well or were they awkward about it no they weren't awkward I think my husband has second thoughts, but that's because he'd missed me, I think. But I think they've understood exactly that that's who I am and what I would wish.

They know that that's how I feel about it. Now, when I was chatting to you earlier this morning, you raised a really good point. I thought it was really interesting. You said you weren't entirely sure whether the hospital would know about these arrangements that you'd made. Yes, I had to go into hospital last week and I was rushed in as an emergency. And my husband hadn't found my living will for me to take in with me.

And I didn't know that the hospital would know that I had one. And that they might resuscitate me when I didn't wish to be resuscitated. And I don't know if there is any system for hospitals knowing about that. Well, we've got a geriatrician with us. There appears to be a sort of alien intervention on the line there to Joyce. I hope they're enjoying it on Uranus this morning or wherever they're listening to us. It sounded very peculiar. Lucy, what about that?

Do hospitals know? No, is the answer. And we've got a real problem with this and we are tackling it and lots of areas are getting better at it but it's very disjointed and at the moment you may have to you know if you have made a decision that you would not like to have a resuscitation attempt you may need to tell quite a lot of different people that and things that are on your gp records aren't instantly accessible in hospital. Everybody thinks that we've got shared medical records and we absolutely don't.

So this is a big problem. And people can end up with different forms of their wishes being recorded in different places. So there isn't a single point of truth about somebody's wishes. So that's very important I would strongly recommend that you talk with your GP about it and make sure that whatever your wishes are are recorded clearly in your in your GP notes and then if you are somebody who's going into hospital again take a copy with you when you leave hospital if you're an older person somebody should have given you the opportunity to look at a form together and fill in your wishes. And that should go home with you and you should keep a copy of it.

But yes, we haven't got a national system for this and individual areas are doing it piecemeal. I think we have, well, via the good services of Joyce, we have alighted on a bit of a problem here. It's all very well encouraging people to make these decisions and tell their relatives if it's not joined up. That's not a terribly reassuring, it's a very honest answer from Lucy, but not desperately reassuring, Joyce. No, it isn't. In fact, I'd already started composing a letter to my local health authority to ask them what the situation was here, because I'd already realised we've got a problem.

So I shall continue with that as a new campaign, I think. Right. Well, yes, absolutely. Thank you very much. And I know that you're someone who has embraced technology and your gateway bit of tech, I think, is the iPad, isn't it, Joyce? It is, yes. Which you recommend to others? I would. It's the simplest thing to use for most people a simple tablet and i think they can do what they like they can do a bit of emailing to friends they can

do zoom on it and they can watch streaming things on it it's ideal for most people it gets you in touch with the world keeps you and if you join something like twitter you can talk to the world every day it's really nice. Tell me about it. I know. But the trouble with that is it can become all-consuming. I'm currently trying to give it up for the 400th time. Joyce, we should say you're 85.

And what are you doing for the rest of today? Oh, no. She's gone to that point. We'll find out. We'll find out what Joyce is doing for the rest of today. Oh, I told you the aliens were listening. Kate on email says, I'm one of four children with a mother who lives on her own with carers three times a day. She hasn't left her bungalow in 18 months because of mobility issues, but she reads, she does word puzzles.

And until recently, she wrote letters on issues when she felt deeply concerned. She's very healthy, despite having been born prematurely and having had a hysterectomy for cancer at the age of 30. And we children laugh at the fact that she will live longer than we will. I should say we are now all in our 70s. She will be 102 in March. A role model to us all, says that listener, Kate. I'd love to know your mum's name, Kate. It would be fantastic to give her a mention on the programme. But isn't that brilliant? What a fantastic illustration of a life that continues to be well lived.

And Anna Dixon of the Centre for Ageing Better, this is what you're all about, isn't it? Well, absolutely. There are going to be many more of us in the future celebrating our 100th birthdays, and it's really important that we all think about ageing. There's also going to be many more people over the next 20 years as the 1960s baby boomers sort of turn 60 and beyond. to this huge change and think differently. And we've heard some great examples from Joyce about how to think positively, about the need for keeping active, for doing those strength and balance exercises

that have been talked about, for embracing things like digital in the such positive way that Joyce has to be enabling us to stay connected, even if we do towards the end of our lives, perhaps have a shorter period of disability or mobility issues. So, yes, really important that we start to make changes now. But, of course, as a wider society, we continue to fetishise, I can never say that, youth.

I mean, all of us. I mean, I know myself the amount of money I spend on so-called anti-aging creams. Lucy, this is a wider conversation, but we're all part of this, aren't we? And it is a bit of a nonsense. I think what tends to happen is that as people get older, they begin to accept it. And we go through a phase where we don't want to talk about it. And then actually, a lot of my older patients are rather like Joyce. They are really enjoying life and they're embracing being themselves and they're not worried about wrinkles. Although some of them still use very expensive wrinkle cream, which is fantastic. That's fine. I will be that woman. But go on.

Yeah. And the joy is that actually we're all apprentice older people. If we're lucky, we'll get old. And making plans, as Anna says, that mean that we can go on living really joyous and fulfilled lives and can tackle some of the stuff that we don't want to talk about. That is going to be really important. And also just recognising that the older people around us are individuals, are real people with real lives, real stories, real hopes and fears, and are often an absolute giggle as well. And just embracing that and not keeping people, older people separate from the rest of our society. That's going to be a really good step forward. Thank you so much for

your involvement this morning. Appreciate it. Dr. Lucy Pollack, her book is called The Book About Getting Older. And very briefly, Anna Dixon, I know you've written about this morning. Appreciate it. Dr Lucy Pollock, her book is called The Book About Getting Older. And very briefly, Anna Dixon, I know you've written about this too. What's your book called? So The Age of Aging Better and a question mark, a manifesto for our future.

And I really do tackle as well these negative stereotypes we have about age and ageing and really agree with Lucy. We've got to change. We've got to see these longer lives as something much more positive. And that was Anna Dixon of the Centre for Ageing Better.

Our thanks to her and to Lucy Pollock and to all the other brilliant contributors on the programme today. And to you. So much stuff from you. This is a listener called Caroline. My mother, two and a half years ago, had wanted DNR. She had a heart attack. And if the hospital had known, she'd be dead now. She has reconsidered this even at 93, still enjoying her life.

It has made us rethink. Another listener says, Wishing so much that my mother, at 72, had done anything about ageing or care or death before she fell very ill in March. A lack of any acceptance or planning for ageing has made this year hellish for me as an only child. On the subject of DNR again, this is from Anne who says, Joyce, just get a tattoo on your chest saying, I have a living will or DNR. Yep, OK, I suppose that might be one option. There is a shared health record, the summary care record. You can add additional info like end of life wishes,

just tell your GP, says another listener, Judith. And what's this here, sorry. When my mother died, we took the decision to move away from the Cambridgeshire village where we'd raised our children, downsizing and moving to the Newcastle area as one son and family were there and our other son and family were in Lancaster. Our choice of location included walking distance to the metro, a GP's, bus stops and beach. We have just celebrated our third Christmas here and there is no doubt that although the move and the adjustment were hard, we are so glad we did this before we had to. Another five or even ten years and it would have been so much harder.

That's from Kathy who made a big decision and one she obviously is very glad she made. Not easy, though, to do, is it, change? I think those of us, well, I certainly struggle with it. It can be very, very hard when you're contemplating doing it. But often, absolutely the right decision, as in your case, Kathy. Susan says there should be a compulsory eye test whenever a driving licence is renewed. A short driving test for renewal at 70 plus. It solves the problem about stopping. And what about this? Listening to your programme today, talk regarding older people and medicines. I'm a pharmacist working to review housebound frail

patients at home. A comment on the focus on doctors reviewing patients' medication. However, it's pharmacists who also have the knowledge and the time to review older people on multiple medications much of the time. GPs often don't have time to achieve this type of holistic medication review with multiple follow-ups to change or stop medications. When patients visit hospital consultants, they often don't bring their medications or don't tell the doctor about the whole picture at home in terms of their medications. Yes, it's a complicated one, isn't it? From Jackie, my 85-year-old dad fell off a wall trying to dig out a tree root in his drive and had to go to hospital as he'd cut his head. He sat in the waiting room and looked at all the posters on the walls, then turned to my mother and said, I'm not geriatric, am I? From Penny, I am 80, and I get fed up with healthy older people in particular moaning and talking about losing their independence. Take responsibility for yourselves the way we expected our growing

children to do. 30 years ago, I did, and enduring power of attorney, advanced directive, will and plan for my funeral. I did them all. We all die and many of us get infirm. These mean that I can still ensure my wishes are respected and my children will not be burdened. We didn't get on to things like lasting power of attorney. There's only so much you can achieve in 43 minutes.

But I do urge you, if you have any questions about that, there are excellent guides online, of course. But Lucy's book is worth exploring because there's plenty of material in there about lasting power of attorney in particular. From Marilyn, I'm 84 and I don't have any health issues. My form of exercise had always been just turning the pages of a book but since I got to 80 I've exercised every morning. I noted that my older relatives

lost the use of their legs or went very wobbly. So many of my exercises are to do with strengthening my legs and balance. I do planks and lunges and squats and I stand on one leg and I count to 20 with my eyes open and then with my eyes closed and a tai chi routine as well my aim says Marilyn is to stay independent and mobile from that sounds really good Marilyn by the way it sounds like you're on exactly the right track Mary says I recognize the thoughts of Wendy. It is so difficult not to worry about your parent when you live apart from them. However, big thanks to the doctor, that was Lucy, who put such a positive spin on it. A listener asks, how do you deal with someone who fiercely guards their independence, but then needs family to potentially drive 100 miles at short notice to get them out of fixes even when they've

been invited to stay. Yeah, I mean, I do get that. I think that might be something that crops up quite frequently. Independent one minute and then in need the next and it's hard for you if you're some distance away. Juliet says my mum is nearly 93, no medication other than glaucoma, can walk unaided more than a mile, stopped cycling at 88 after an accident, but she has recently been diagnosed with dementia. This is challenging, difficult to know how to manage the issue. Don't want to put her in a home as that would be a prison. Is it worth keeping fit? I understand why you're asking that, Juliet, but ultimately, obviously,

there are grey areas and you've drawn our attention to one there, but on the whole, it is better to maintain fitness. I'm absolutely convinced of it. Here's a question I wish I'd had time to put to the experts. I'm 50 and I had a hard time at my last birthday feeling it was the end of youth. My hair started greying in my late 20s and I've always wondered if this means I have a shorter lifespan. What do the experts think? Okay, well, I am not an expert, but I'm here to tell you now that even without any expertise, I am sure the answer to that is no, you do not have a shorter lifespan. I think the age at which you go grey is just entirely genetic, isn't it? I mean, I don't think it can mean that you are destined to live a shorter

life. Anyway, let's end with this listener who says, my children say I need to build muscle as this is beneficial for health and immunity. I'm doing this, but is it really true, as I much prefer yoga? P.S. It's great getting older, as we begin to understand that very little matters that much, and we concentrate on the few things that do. Well, to that listener, who has the fantastic name of Atalanta, yes, I love that P.S. I don't know whether the yoga is, if you like yoga, Atalanta, carry on doing it. Again, I'm no expert try not to focus too much on the negativity that can surround our later years if we let it. And of course, it's all dependent on your own good

fortune, isn't it? And how healthy you are able to be at that time in your life. So tomorrow, it is my final edition of Woman's Hour. Looking forward to it. It's going to be, well, I don't even know what's on the programme. I told no nothing, says the inspirational producer Diane so I'll just weep for 44 and a half minutes and then we'll have a bit of Edwin Drood, how about that join me then anyway I hope today's reasonable, yesterday seemed to go on forever but maybe today will be quicker

I'm Sarah Treleaven and for over a year I've been working on one of the most complex stories I've ever covered. There was somebody out there who's faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth.

How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story. Settle in. Available now.