The amount of food taken should be divided between three or four meals at fairly regular intervals. A sense of fullness or oppression after eating ought not to be disregarded. It indicates that the food taken has been either too abundant or of improper quality. For many elderly people the most suitable time for the principal meal is between 1 and 2 P. M. As the day advances the digestive powers become less, and even a moderately substantial meal taken in the evening may seriously overtask them. Undigested food is a potent cause of disturbed sleep, an evil often very troublesome to old people, and one which ought to be carefully guarded against.
It is an easier task to lay down rules with regard to the use of alcoholic liquors by elderly people. The Collective Investigation Committee of the British Medical Association has lately issued a “Report on the Connection of Disease with Habits of Intemperance,” and two at least of the conclusions arrived at are worth quoting: “Habitual indulgence in alcoholic liquors, beyond the most moderate amount, has a distinct tendency to shorten life, the average shortening being roughly proportional to the degree of indulgence. Total abstinence and habitual temperance augment considerably the chance of death from old age or natural decay, without special pathological lesion.” Subject, however, to a few exceptions, it is not advisable that a man sixty-five or seventy years of age, who has taken alcohol in moderation all his life, should suddenly become an abstainer. Old age can not readily accommodate itself to changes of any kind, and to many old people a little good wine with their meals is a source of great comfort. To quote again from Ecclesiasticus, “Wine is as good as life to a man, if it be drunk moderately, for it was made to make men glad.” Elderly persons, particularly at the close of the day, often find that their nervous energy is exhausted, and require a little stimulant to induce them to take a necessary supply of proper nourishment, and perhaps to aid the digestive powers to convert their food to a useful purpose. In the debility of old age, and especially when sleeplessness is accompanied by slow and imperfect digestion, a small quantity of a generous and potent wine, containing much ether, often does good service. Even a little beer improves digestion in some old people; others find that spirits, largely diluted, fulfill the same purpose. Individual peculiarities must be allowed for; the only general rule is that which prescribes strict moderation.
It is not to be inferred from the hints given in the preceding paragraphs that the preservation of health should be the predominant thought in the minds of elderly persons who desire that their lives should be prolonged. To be always guarding against disease, and to live in a state of constant fear and watchfulness, would make existence miserable and hasten the progress of decay. Selfish and undue solicitude with regard to health not only fails to attain its object, but is apt to induce that diseased condition of mind known as hypochondriasis, [“the blues,”] the victims of which are always a burden and a nuisance, if not to themselves, at least to all connected with them. Addison, in the Spectator, after describing the valetudinarian who constantly weighed himself and his food, and yet became sick and languishing, aptly remarks, “A continual anxiety for life vitiates all the relishes of it, and casts a gloom over the whole face of nature, as it is impossible that we should take delight in anything that we are every moment afraid of losing.”
Sleep is closely connected with the question of diet; “good sleeping” was a noticeable feature in the large majority of Dr. Humphry's cases. Sound, refreshing sleep is of the utmost consequence to the health of the body, and no substitute can be found for it as a restorer of vital energy. Sleeplessness is, however, often a source of great trouble to elderly people, and one which is not easily relieved. Narcotic remedies are generally mischievous; their first effects may be pleasant, but the habit of depending upon them rapidly grows until they become indispensable. When this stage has been reached, the sufferer is in a far worse plight than before. In all cases the endeavour should be made to discover whether the sleeplessness be due to any removable cause—such as indigestion, cold, want of exercise, and the like. In regard to sleeping in the daytime, there is something to be said both for and against that practice. A nap of “forty winks” in the afternoon enables many aged people to get through the rest of the day in comfort, whereas they feel tired and weak when deprived of this refreshment. If they rest well at night there can be no objection to the afternoon nap; but if sleeplessness be complained of, the latter should be discontinued for a time. Most old people find that a reclining posture, with the feet and legs raised, is better than the horizontal position for the afternoon nap. Digestion proceeds with more ease than when the body is recumbent.
Warmth is very important for the aged; exposure to chills should be scrupulously avoided. Bronchitis is the malady most to be feared, and its attacks are very easily provoked. Many old people suffer from more or less cough during the winter months, and this symptom may recur year after year, and be almost unheeded. At last, perhaps a few minutes' exposure to a cold wind increases the irritation in the lungs, the cough becomes worse, and the difficulty of breathing increases until suffocation terminates in death. To obviate such risk the skin should be carefully protected by warm flannel clothes, the outdoor thermometer should be noticed and winter garments should always be at hand. In cold weather the lungs should be protected by breathing through the nose as much as possible, and by wearing a light woolen or silken muffler over the mouth. The temperature of the sitting and bed-rooms is another point which requires attention. Some old people pride themselves on never requiring a fire in their bed-rooms. It is, however, a risky practice to exchange a temperature of 65° or 70° for one fifteen or twenty degrees lower. As a general rule, for persons sixty-five years of age and upward, the temperature of the bed-room should not be below 60°, and when there are any symptoms of bronchitis it should be raised from five to ten degrees higher.
Careful cleansing of the skin is the last point which needs to be mentioned in an article like the present. Attention to cleanliness is decidedly conducive to longevity, and we may congratulate ourselves on the general improvement in our habits in this respect. Frequent washing with warm water is very advantageous for old people, in whom the skin is only too apt to become hard and dry; and the benefit will be increased if the ablutions be succeeded by friction with coarse flannel or linen gloves, or with a flesh-brush. Every part of the skin should be thus washed and rubbed daily. The friction removes worn-out particles of the skin, and the exercise promotes warmth and excites perspiration. Too much attention can hardly be paid to the state of the skin; the comfort of the aged is greatly dependent upon the proper discharge of its functions.
Such, then, are the principal measures by which life may be prolonged and health maintained down to the closing scene. It remains to be seen whether, as a result of progress of knowledge and civilization, life will ever be protracted beyond the limit assigned to it in a preceding paragraph. There is no doubt that the average duration of human life is capable of very great extension, and that the same causes which serve to prolong life materially contribute toward the happiness of mankind. The experience of the last few decades abundantly testifies to the marked improvement which has taken place in the public health. Statistics show that at the end of the septennial period, 1881-'87, 400,000 persons were alive in England and Wales whose death would have taken place had the mortality been in the same proportion as during the previous decade. It may be reasonably expected that as time goes on there will be an increase in the proportion of centenarians to the population as a whole.
The question whether long life is, after all, desirable does not admit of any general answer. Much depends upon the previous history of the individual, and his bodily and mental condition. The last stages of a well spent life may be the happiest, the shuffling-off of the mortal coil, though calmly expected, need not be wished for. The picture afforded by cheerful and mellow old age is a lesson to younger generations. Elderly people may, if they choose, become centers of improving and refining influence. On the other hand, old age can not be regarded as a blessing when it is accompanied by profound decrepitude and disorder of mind and body. Senile dementia, or second childishness, is, of all conditions, perhaps the most miserable, though not so painful to the sufferer as to those who surround him. Its advent may be accelerated by ignorance and neglect, and almost assuredly retarded or prevented by such simple measures as have been suggested. No one who has had opportunities of studying old people can shut his eyes to the fact that many of the incapabilities of age may be prevented by attention to a few simple rules, the observance of which will not only prolong life and make it happier and more comfortable, but will reduce to a minimum the period of decrepitude. Old age may be an incurable disease, admitting of but one termination, but the manner of that end, and the condition which precedes it, are, though not altogether, certainly to a very great extent, within our own power.