Bob Cratchit’s and Tiny Tim’s Christmas in A Christmas Carol was as good an example of the effect of poverty on a family as has ever been written. Nevertheless the penury of the Cratchit household differed in one essential feature from the poverty that exists today. Cratchit worked all hours that God gave, but the problem was that Scrooge didn’t pay a living wage.
When I started in medical practice there were still elements of Cratchit-like poverty about. One day I visited a family having lunch; the wage earner was a cowman, exceptionally hard working but prolific with a large family. Only dad had meat; mum and the children made do with potatoes and carrots grown in the garden and flavoured by the gravy from their father’s meat.
One group, who are unacceptably poor but who have been hard-working taxpayers all their lives and many of them brave servicemen and women during the war, are pensioners. A year or two ago I congratulated one pensioner on giving up cigarettes. He said that it had been easy: he had to choose between buying tobacco and a pint each evening. He chose the beer. I would have done the same, but felt guilty that his budget was so tight that it didn’t stretch to such simple pleasures.
Financial stringency shouldn’t necessarily allow boredom to flourish. There are many ways of keeping the intellect alive and delaying the advance of Alzheimer’s.
Blood pressure must be kept low, a regular heart rhythm maintained, diets carefully chosen, cholesterol levels monitored, statins taken religiously — but it is useless to preserve a brain’s blood supply if there is nothing to stimulate it. Possibly the most important factor in preventing loss of intellect, other than having the right genes and having avoided head injuries, is to have a stimulating social life in old age. Not easy on a tiny pension.
Advertisement
Elderly people need about 15 per cent fewer calories than when younger, but even so one old person in six who is living at home has less than 1,000 calories a day. In the majority of these cases an inadequate calorie intake is likely to demonstrate a lack of protein as well as energy-giving food. An older person’s inevitably declining number of brain neurones and synapses can’t work to their best advantage — conversation and enthusiasm for life is lacklustre if they are half-starved.
If malnourished or undernourished, the elderly are more likely to suffer from a tottering gait, and falls can result in fractured hips. Their resistance to infection is lowered, their muscles unnecessarily frail and their fatigue heightened by poor nutrition as well as insomnia. Depression is one of the great bogies of an impecunious old age. The causes of senile melancholia are multiple: some are endogenous and an effect of ageing, others exogenous, such as families scattered around the world. Having too many friends who have died is difficult to avoid, but if someone living on a state pension tries to relieve it with alcohol rather than social intercourse they will be poorer, less fit and will lose weight.
Malnutrition and a loss of a sense of taste and smell can be side-effects of old age. Just as old people don’t feel the cold, although blue and chilled, nor do they always feel hungry, although they can be underfed.