The Time of Our Lives: Why Ageing is Neither Inevitable nor Necessary
Orion Books Ltd, London, 1999; 277 pages with index
Reviewed by: A Mark Clarfield, MD, FCFP, FRCPC
As a geriatrician, I did not expect to learn a lot from a book on aging written for the intelligent layman. But I was wrong.
Tom Kirkwood, one of the world's foremost researchers into the study of human gerontology, has written a book that looks deeply and clearly into this fascinating subject--which he rightly calls "one of the last great mysteries of the living world." And, as I tell my medical students, whoever unlocks this secret will no doubt be a candidate for the Nobel Prize in Medicine.
In the preface of this slim volume [Time of Our Lives: Why Ageing is Neither Inevitable nor Necessary] Kirkwood lists the questions that he promises to answer: Why do we age? How does aging happen? Why do some species live longer than others? Do some parts of the body wear out sooner than others? Why do women live longer than men? Why do women have a menopause half way through their life span?
Even if the above-listed puzzles interest neither you nor your patients, this final one should exercise us all, "Can science slow my aging process, or help me age better?" We may not want to grow old, but as a wag once put it, "I prefer old age to the alternative." And, if most of us will try to postpone this particular alternative for as long as possible, how can we hope to age "successfully?"
On the latter subject, the self-help shelves of your local Chapters outlet fairly groan with books touting all kinds of nonsense on the subject. But if you want a clear, concise and scientific answer to the last question for you and your patients, read this book.
Early on, Kirkwood dispels a pernicious notion that unfortunately many gerontologists milk for all it's worth; that is, that the demographic changes we are observing constitute some kind of a catastrophe. That soon the world will comprise a majority of balding cripples demanding an ever increasing portion of the health and social services budgets. As Kirkwood puts it, "There is an unfortunate tendency to see the graying of the world's population as a disaster in the making instead of the twofold triumph that it really is. Firstly, we have managed --not a moment too soon--to begin to bring soaring population growth numbers under control. Secondly, we have succeeded --through vaccination, antibiotics, sanitation, nutrition, education and etc-- in bringing death-rates down."
One of his major points is that despite the rapid increase in the growth of the 80 plus age group, there is increasing evidence (originally from the United States but now supported by Canadian and European data)1 that the period of sickness and disability concentrated at the end of life is actually getting shorter, not longer, as life span increases. These new data add further support to the optimistic prognostications of Crapo and Fries' "Squaring of the Curve" hypothesis.2 In sum, this theory suggests that while maximum life span has not changed much over the past few millenia, average life expectancy (at every age) has increased in the last two hundred years. More to the point, healthy life expectancy has lengthened so that more and more old people are living longer and healthier lives, with the period of end-of-life disability shrinking concomitantly.
One of the most interesting chapters, entitled "What's in a Name?", attempts to define aging and to distinguish it from disease--not an easy task. And Kirkwood admits that despite our supposed familiarity with the process, " the precise