When I attended the celebration of Mike Bury’s career and writings last Thursday (3/9/26), there was much discussion of the concept of ‘frailty’. Dictionary definitions refer to physical weakness or a loss of bodily resilience that makes a person vulnerable to sudden health declines from minor stresses. It is of course associated most readily with ageing. The British Geriatric Society (BGS) proffers the following definition:
‘frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. Around 10 per cent of people aged over 65 years have frailty, rising to between a quarter and a half of those aged over 85.’
The same body declares that ‘older people living with frailty are at risk of adverse outcomes such as dramatic changes in their physical and mental wellbeing after an apparently minor event which challenges their health, such as an infection or new medication.’ Frailty, the BGS insists, is not the same as either a long-term condition or disability, although there can of course be overlaps.
But the purpose of this ‘autobiographical’ blog is not to dwell on the ins and outs to be found in academic and (bio)medical discourse. It is rather to communicate some personal reflections.
I am 77 and approaching 78 at the time or writing. Am I frail? Is it a ‘label’ I’d accept from a doctor or apply to myself? Certainly I am running down: my bodily systems are reluctant to function with the enthusiasm they showed in past years. If I tried to sprint now – and my brain switched off in disgust – my torso would advance at pace but within a metre or two my legs would shout ‘fuck that’ and I’d topple down like a leaf in autumn. I’d also probably fail to break my fall. In other words, a whole cluster of past capacities have disappeared almost without trace. Capacities and habits alike that were familiar until fairly recently have now become memories. Of course I couldn’t do at 30 what I could at 20; in other words, processes of decline set in early. But as the third age morphs into the fourth things seem to both speed up and become more intrusive, or as Bury would say, disruptive of one’s biography.
When I reflect on the lot of friends and colleagues who are either no longer with us or coping with much more severe chronic complaints or disabilities I remain grateful. I had a nasty bout of polymyalgia a few years ago but it was treatable, time-limited and is now gone. Everybody seems to have type 2 diabetes these days and I’ve just agreed to take statins (so, a total of seven pills a day). Any ongoing impediments are probably mostly down to iatrogenesis in one or another of Illich’s trio of forms (once doctors get their hands on you and you become reliant on them tests follow tests and treatments follow treatments). It’s about balance, equilibrium and informed decision-making on our part. But I’m ok and reconciled to … what? … frailty?
As I’ve said this is not an academic blog. It’s not an attempt to theorise and contextualise the variety of concepts that are suggested by the word ‘frailty’. It’s a personal note.
I would stress the following:
- Doctors can ‘diagnose’ frailty in me if they wish: they have their criteria, although I entertain doubts about the relation and true interface between ‘decline’ and ‘frailty’;
- I reserve the right to contest cultural stereotypes of frailty that might be deployed to try to limit my engagement with activities, others or the world around me;
- In another more oblique reference to cultural stereotypes, I most certainly will continue to resist any presumptive notion that my mind is no longer fit for purpose (my memory is not what it was, but I’m as yet able to think, give talks, write and so on);
- I hope that I have in place mechanisms, reflexive and courtesy of others, that will allow me to reach an appropriate judgement when I can no longer ‘think, give talks, write and so on’;
- Thinking and writing, if not giving talks, remains intrinsic to who I am and to my ongoing projects, and I will therefore persevere for as long as it’s physically and mentally viable to do so;
- I acknowledge that I am in decline but not that this is yet sufficient reason to abandon all or indeed any projects that I enjoy, remain salient and are still viable.
- Call me frail if you want, but I’ll reach my own conclusions thank you very much.
- I maybe sit somewhere between Laslett’s third and fourth ages; I am certainly not yet into a fourth age he characterised in terms of ‘dependency, decrepitude and death’. In the unlikely event of my ‘third-ager’ stance translating into requests for advice, I’d say:
- Don’t deny the ageing process and attendant or coincidental altered circumstances, whether through illness or disability;
- Don’t submit to public and cultural stereotypes that you don’t agree with or that are used to constrain rather than enable;
- Don’t become passive when consulting doctors and remain insistent on taking your own decisions;
- Resist and contest any artificial or unjust constraints put upon people like you by the state;
- Remember Sartre’s argument that you are always in a state of ‘becoming’ and retain a degree of agency until all’s said and done;
- Formulate viable personal projects that you deem worthwhile, can engage with and can invest time in;
- Ignore any advice you don’t agree with, including (a) – (e)!
You calling me frail!