SECOND OPINION:Two recent movies underline how ageing has become mainstream in popular culture. Amour, from Austrian director Michael Haneke, is a sobering experience, combining the warmth of a close relationship of two older people with a deeply negative ending.
The couple, retired music teachers, are played by actors Jean-Louis Trintignant (Georges) and Emmanuelle Riva (Anne) who are in their 80s in real life. Our first encounter is at a concert by one of their pupils, followed by their return home on public transport.
However, Anna suffers from a significant stroke and Georges cares for her with love and affection, navigating with kind resignation the peevishness and irritability that she expresses over her changed circumstances. A further stroke leads to language problems and dementia, and we embark on a pathway where Georges’ loving attention is punctuated by carer stress (leading at one point to him slapping Anne), elder abuse by a paid carer, and an eventual dénouement of euthanasia and suicide.
Endgame
What struck me most, however, was his isolation from support and comfort from both professionals and family. The French were early pioneers of home care, with a fairly extensive package of support available to older people.
Yet we see Georges struggling largely on his own, using his own resources to pay for care support, for example, paying €800 when firing the care attendant/ nurse who was rough with Anne, and making no call on adult protective services. A part of this is the irony well recognised in geriatric medicine that the income and social milieu of comfortable middle class may distance them from the public services best placed to respond to complex needs.
In the final scene, Anne signals distress through the repeated cry of “mal”, a word that signals not only pain but also other layers of suffering. Could she be suffering from a pulmonary embolus, or the mundane but unexpressed pain of leg cramp or even constipation? Without support or guidance, the endgame plays out, and I felt not only their pain, but intense frustration at what might have been, and sadness that the final events might be construed as noble or beautiful in this context.
Happier days
The portrayal of death against a background of inadequate care is reminiscent of the euthanasia of the quadriplegic woman boxer by her coach at the ending of the film Million-Dollar Baby. This arose at the end of an extraordinary catalogue of poor care. Her pressure sores and infected leg leading to amputation indicated substandard care, she clearly had a severe untreated depression and unresolved family strife, and no effort was made to provide a more domestic and personalised environment in her “care” facility.
A happier experience arises with Skyfall. A key challenge of teaching gerontology is to liberate ageing from the confines of later life and to view it as a continuous process across the life-course.
No neater (or more unlikely) support can be found than the themes of ageing, utility and retirement permeating the latest Bond movie. Its celebration of 50 years of the franchise also unwittingly reflects the age at which the World Health Organisation considers one to be an older adult.
Shot with wit and style, there is no lack of excitement, extended chases or exotic locations. Yet not only do we have constant reminders of the past through droll references to earlier Bond movies, but we encounter an older and wiser hero.
Daniel Craig portrays a vulnerability far removed from the glib sangfroid of his celluloid predecessors and has retired to an exotic bolthole after he is assumed to have died during a botched operation. His moral descent (and subsequent ascent) is tracked by transitions between dry Martinis and proletarian lager.
Old tune
Roused to return to active service by a threat to world security, a combination of his age, recent dissipation in lifestyle and a new generation in MI6 threaten his reinsertion. Equally M, in a sterling performance by Judi Dench, is viewed as “past it”, especially when the forces of evil gain the upper hand early on in the movie.
This early exposure to the protean nature of ageism, which can affect us well short of traditional retirement age, is amplified in a lovely scene in the National Gallery where Bond meets an alarmingly youthful Q in front of The Fighting Temeraire, their dry repartee counterpointing Turner’s glowing images of obsolescence and retirement.
There follows a wonderful parallel of how our standard assessments of cognition and ability may underestimate function, experience and vitality as we age. James Bond fails all of his tests – marksmanship, psychology and other arcana – to which he is subjected on his return to the Secret Service. Yet M sees past this, and together they prove that age and guile beat youth and innocence, teaming up with an ancient family retainer for the final explosive encounter.
This subtle, entertaining and sometimes dark movie succeeds in giving an intergenerational flavour and complexity to a genre not usually known for reflectiveness.
With Skyfall, we are shaken from uncritical negativity about the effects of ageing, and hopefully stirred to reject ageism when we next encounter it in our daily practice.
Prof Des O’Neill is a consultant in geriatric and stroke medicine