loader image
Close this search box.

The circle of the old old

Dr. Joanne Paul- MBBS (UWI), FRCPCH (UK), FRCP (Edin)



So, I must admit I really have a soft spot for children, even the adolescents but especially the younger ones with their ready innocence and heart melting smiles. I guess the same for older persons in the vein of once a man, twice a child. I see them like children also. The look is no longer innocent but more wizened and the smile can be melting once they trust you and get to know you. After living long lives, taking care of their children, working hard to support the community and general society, I think just their years of experience and living demands a certain starting level of respect and appreciation.

Dr Ian Sammy, Geriatric Emergency Medicine Physician who has his office at Lowlands Medical Centre in Tobago, speaks about the young old (65 to 74 years), middle old (75 to 84 years) and the old old (above 85 years). For the young old, many would have just retired and are starting a new phase in life. The key thing Dr Sammy says, to retiring, is to not retire. In its official sense when you retire you are supposed to stop work. When you do that though, there is physical and cognitive decline. You lose your sense of purpose and suddenly you move from a managing director to watching the non-ageing Victor on Young and Restless and wondering what bacchanal will unfold now. The trick is not to stop work but change your work. Maybe become part time instead or focus on family caretaking or mentorship or charity. Or teach. Or read. Or write. Or start something totally new. Make the work be about something else but still find that contribution to make, whether paid or unpaid.


For the middle old, one common issue is of reduced autonomy. With the increased fragility, reduced cognitive speed and general physical slowing down, close family members stop listening to the voice of that elderly person. They think they are taking care of them, and that they only know what is best for them. For the middle old person, it may seem easier to relinquish your sense of self and independence and be almost like a child again, dependant and controlled with minimal voice. The balance here is to listen to the middle old who are still aware of who they are and what they want. Value their experience and let them have a voice, let them express their needs and wants whilst at the same time taking care of them with the slowing down, slower pace and simpler needs.

For the old old the major issue is probably being alone. With men having a shorter life expectancy than women, in many societies, more than 70% of the population above 85 years old, are women. The old old person is typically a woman whose husband would have died, most friends would have been lost, children would have grown up and left the home, and now they are mostly alone.



My great aunt on my biological father’s side is more than 95 years old. She had nine children, a good few who are no longer in the country, and she lives mainly with a carer whilst the children who live nearby alternate visiting and carer duties. I went to visit her a few weeks ago. She is a short woman with strong Amerindian lineage. She walks slowly now and requires help to manoeuvre the short stairs. Her hands now shake on their own. Her short- and long-term memory connections were still strong and as she spoke slowly and purposefully, pursing her lips, she regaled us of stories of her long life and of the large family. I stroked her hair. It was almost like that of a baby. The family members liming around asked her what was the key to her long life. Bush tea she said. She would have bush tea often. And provisions. Almost every day she would eat some provisions.


At some point she had to go to the bathroom. Myself and her daughter went with her. Almost like a toddler, she walked slowly and hesitantly. She required help with her clothes and help to go on to the toilet.

When it was dinner time, she was drinking her lemongrass tea with a sandwich.

‘And Joanne,’ she said, ‘the most important thing for living a long and good life is appreciation. Just remember to thank people and appreciate their love and kindness. Just having all of you all visiting today is real good. I thank you’

Hold on. You mean the answer to life, the universe and everything is not 42 (reference the hitchhiker’s guide to the galaxy). You mean it is not a roti and a red solo. It may just be bush tea, provisions and appreciating people around you.

At that moment, I saw the circle. The child. The woman. The old old child again. I looked around. The pictures on the walls spanned lives and generations. Her children and grandchildren were chatting in the next room. Maybe the answer was just bush tea, provisions, appreciation, AND family. I felt the love and wanted to give back in return.

If only I could be half the old child that she is. Thanks Aunty Amy!

Dr Joanne F Paul is a Lecturer, a Paediatric Emergency Specialist, and a member of TEL institute



More Posts

Ask Us a Question

Choose desired payment currency.


Choose desired payment currency.