The editorial by Watson (2009) on whether or not nursing should ‘declare neutrality’ on the ‘war on old age’ was an interesting and thought-provoking piece. He gave careful consideration to the reasons why the war is being waged and raised interesting questions about the messages it gives, particularly how it works to devalue older people. There are issues in his account, however, that I believe require expansion; namely those relating to the psychological, social and cultural factors which influence how ageing is viewed and experienced. This commentary is thus intended to complement Watson’s editorial, and highlight additional points relevant to nurses working in western societies.
Watson uses the cosmetic industry as a key example of the war on ageing that is being fought outside hospital and scientific laboratory settings, drawing attention to the long-established association between youthfulness and beauty. Indeed, the cosmetic industry is only one of a cluster of industries driving the war on ageing. The diet industry, fashion industry and pharmaceutical industry also play their parts. For example, maintaining a slim body is associated with ageing well which we can achieve by eating the ‘right’ food, exercising and/or taking tablets designed to support our efforts to lose weight. Men can reverse the signs of sexual ageing by taking sexuopharmaceuticals (e.g. Viagra for erectile dysfunction) if they so desire. And the fashion industry dictates what is stylish and ‘trendy’ in terms of appearance and that rarely includes older bodies, presenting a rather narrow ideal of beauty. Women have borne the brunt of the messages inherent to a war on ageing that aligns itself with physical appearance, and have long been persuaded to retain a youthful appearance: an incitement that begins early (the makers of anti-ageing creams are currently targetting women in their twenties) and forms a great source of anxiety for many young women (Orbach 2009). Although Watson rightly points out that ‘men have long been encouraged to hide the signs of ageing hair’ (p.1229), he neglects to mention that grey hair is often admired on middle aged men and is associated with power and status, as Sontag (1978) pointed out in her seminal essay ‘The double standard of ageing’.
Looked at from this perspective, the war on ageing is inseparable from anti-ageing. Indeed, the war on ageing entails more than delaying the ageing process, it demands that we subscribe to characteristics associated with early and mid adulthood not only in terms of physical appearance, but also mental and physical ability. It is of concern that anti-ageing has become almost synonymous with positive ageing: a movement geared towards challenging essentialist notions that position decline as a ‘natural fact’ of getting older (Gergen & Gergen 2003), and to providing ‘alternative representations of later life’ (Bayer 2005). Positive ageing seems to have, inadvertently, acquired a non-positive side:
Given the recent influx of representations depicting happy, independent, and active individuals in their later years, it seems there should be no resistance to growing old. Yet many representations of ‘mature’ health, well-being, and activity are easily confused with a need to retain and reflect youth. (Bayer 2005:14)
The extract above exemplifies the role of the marketing industry in portraying images of the positive ageing ideal and it is easy to see how such images reinforce those of anti-ageing. Advertising strategies communicate the messages of anti-ageing very well – the war on ageing is a financially viable business. (It is no coincidence that it is led by the industries that already feed into women’s anxieties about their bodies, earning billions as they do; Orbach 2009.) It is against this background that Watson’s description about people who fear ageing as those ‘who have been attacked via by the soft underbelly of vanity, sexual attractiveness, sexual potency and, ultimately, the fear of social and biological oblivion’ (p.1230) requires further exploration, because it does not account for how individuals come to be in a position where they fear growing, or looking, old. Perceptions of ageing relate to broader cultural assumptions about health, attractiveness and sexuality (e.g. ageing bodies as unattractive, ageing people as asexual, ageing health as deterioration), which relate to, and in turn inform, dominant regimes of knowledge. The process of socialisation enables us to acquire knowledge and learn about our culture as we live in it and, as psychological theory asserts, we often internalise to varying degrees the messages that surround us from our childhood. A combination of forces thus shapes our values, beliefs and attitudes. The industries involved in the war on ageing give out very powerful messages, which we are fed daily in a variety of formats. These messages may be explicit or subtle, but are nonetheless pervasive in their cumulative effect.
With regard to the implications for nursing, it is important to be aware of the different ways the war on ageing is constructed. As we have seen, it is often conflated with anti-ageing but we must take care not to manifest this in terms of ageist beliefs and discriminatory practice, for example by not attending to the sexual health needs of an older person on the assumption that sexuality is not important in later life. Nurses should take a stance of neutrality regarding the war on ageing. However, we also need to recognise that declaring neutrality may have different meanings to different people depending on environmental and personal factors. Nurses may work in clinical settings where the war on ageing is waged and enacted, where the medical procedures associated with fighting ageing are performed, notably cosmetic surgery clinics and those offering non-surgical interventions such as Botox injections. Nurses also are not immune to the values and ideas of the societies in which they live. Given that the vast majority of nurses in the UK are female and that one strand of the war on ageing impacts women more so then men, it is arguable that some nurses will be resisting ageing themselves, in whatever ways they choose.