Article
Ageing
Care
Change
5 min read

Delicate, fragile, frail: how we cope when we age

The insights and analogies that help.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

An old woman wearing a shawl looks pensive.
Valentin Balan on Unsplash.

“Who could dissect a portion of the human frame without marvelling at its delicacy, and trembling at its frailty?” mused preacher Charles Spurgeon in the nineteenth century. Songwriters, artists, authors and surgeons alike are fascinated by frailty. Within, beneath and beyond that fragile frame though, could there be a deeper reality, waiting to arise – and endure? 

Fragile Lives is the ‘heart-stopping memoir’, operation by operation, of heart surgeon Professor Stephen Westaby. “The finest of margins,” he writes, “separates life from death, triumph from defeat, hope from despair – a few more dead muscle cells, a fraction more lactic acid in the blood, a little extra swelling of the brain. Grim Reaper perches on every surgeon’s shoulder.” 

To what shall we compare this fragility of frame? - which means we can shatter sudden as glass, our “breath becoming air” in the blink of an eye? (Paul Kalanithi, a young neurosurgeon, called his memoir When Breath Becomes Air as he fought his own battle with cancer). A snowflake? A spider’s web? A butterfly wing? In Dutch still life paintings, the transience of life is variously depicted in dry, fallen withering petals, rotting fruit, and a glass vessel, like a vase. At some funeral services, it is said that we are made from dust, and to dust we shall return. Elsewhere in the Bible, we are likened to a mist that appears for a little while and then vanishes, or to a flower that withers away, a fleeting shadow that does not endure. Our days are a mere handbreadth, our life but a breath, writes one Bible songwriter. 

Medics talk more commonly of frailty than fragility – and it’s not just a byword for old age. According to the British Geriatrics Society, not all old people live with frailty; not all people living with frailty are old, though age is a recognised risk factor, with nearly 40 per cent of adults aged 85-90 being frail. Described as a vulnerability to external stressors which can result in sudden marked deterioration in function, frailty might feature as a combination of falls, immobility, delirium, incontinence, and increased side effects of medications, suggesting the body is struggling to cope. “A minor infection or minor surgery results in a striking and disproportionate change in health state – from independent to dependent, mobile to immobile, or lucid to delirious,” writes a team of doctors in The Lancet

Frailty is a sign of advanced biological rather than chronological age. Often, it’s an unwelcome term, with consultant physician Patricia Cantley noting that, “from a patient or relative’s point of view, the word frailty seems to be at best somewhat vague and at worst, derogatory and demotivating”. She prefers to talk in terms of paper boats. Picturing young healthy patients as little tugboats of wood and steel, built to withstand storms, she likens the frail patient’s clinical situation to a paper boat, which can sail the sunny seas, but is soon buffeted and may be brought down by ‘medical winds’. 

Encompassing also psychological and cognitive symptoms alongside the physical, frailty is not a fixed state, nor is decline in mind and body inevitable once frailty begins. Seen increasingly as a dynamic spectrum, reversal of frailty is sometimes possible; the paper boat being, to a degree, storm proofed and made to chart a different course. According to Dr John Travers, professor of public health at Trinity College, Dublin, twenty minutes of daily exercise can reverse physical frailty and build resilience in over 65-year-olds, while others suggest that movement based mind-body therapies such as tai-chi and yoga can strengthen both mind and body. Could there also be something of a spiritual strengthening in the frail patient? As the body decays and declines, could the soul, the spiritual self, enlarge, emerge and ultimately endure as life ebbs away? This was certainly the sentiment of Paul, one of the early church leaders, in the Bible, who, after much suffering, wrote: “Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day…we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.” 

Her late Majesty Queen Elizabeth II was seen on our television screens to diminish physically in her last days, her purple hands, tiny frame and walking cane causing concern among viewers. She was, at her funeral, described simply as “our sister Elizabeth”, her small coffin dwarfed by pageantry and a crowd of 2,000 including presidents and kings. And yet, the former Moderator of the Church of Scotland has revealed that she talked much of her Christian faith in her dying days, while her funeral was an explosion of scripture, hymns and sermons that expressed the strength of her personal faith. “It was her way of eloquently, beautifully and powerfully speaking to me and 4.1 billion other people of her Christian faith,” writes Pastor Skip Heitzig. For me, the funeral brought to mind the tides (continuing with the theme of the sea). As the tide recedes, the waters move away from the shore, in what is known as an ebb current. As the tide rises, water moves toward the shore in a flood current. As our Queen’s life ebbed away physically, her spiritual self arose, roaring like a mighty flood. Ocean motion, in currents, waves and tides, is driven by the sun, moon and the planets. Our late Queen also looked upwards, to her God, for spiritual succour that would turn life’s ebb to a soul-flood.  

Hymnwriter Timothy Dudley-Smith sought a similar exchange, from the physical to the spiritual, the mortal to the immortal, in yet more words about boats, in his hymn “My boat so small”, based on the Breton Fisherman’s Prayer. 

“Adrift when strength and courage fail, O Spirit, breathe to fill my sail” 

And, happily, he trusts a safe voyage, finishing with - “My voyage done, all trouble past, to haven bring my soul at last.” 

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Review
Care
Community
Culture
Film & TV
5 min read

Amandaland's portrayal of falling social standing is spot on

What happens when motherhood is no longer rich, powerful, and terrifying.

Beatrice writes on literature, religion, the arts, and the family. Her published work can be found here

On the sidelines of a pitch a well-dressed mum hands a coat to a sceptical looking mum beside her.

Nobody likes mums. Not really. We talk about our kids all the time, we’re bossy, we’re interfering, we’re no fun. The stereotypes abound. Not even mums like other mums. We should help each other, but we often end up mercilessly judging each other instead. If you work, you’re a cruel, neglectful mother; if you’re a stay-at-home mum, you’re lazy, weak, and probably boring.  

Even worse than being disliked, though, is not being taken seriously. I thought motherhood would bestow a certain level of respect, a kind of admission, from society at large, that if you can keep a human being alive – let alone several – you must be somewhat competent at least. I can now see that’s only the case in older motherhood, once your children are grown up and you can prove to the world that you did, in fact, do a good job of raising them. Before then, while your kids are still loud toddlers or moody teenagers, being a mother is a decidedly low-status affair.  

That’s exactly what Amandaland, the new Motherland spin-off, gets right. In Motherland, the original show, the character of Amanda is a confident, terrifying alpha mum, a modern anti-heroine and a foil to the frazzled, overwhelmed protagonist Julia. As a stay-at-home mum, Amanda holds on to her high social status by a combination of displaying her husband’s wealth and a careful strategy of putting other mothers down at every possible occasion. 

By the end of Motherland, however, Amanda is lost: she opens and very quickly closes a lifestyle shop, she’s about to lose her house in the divorce, and her ex-husband is about to remarry. She’s not quite so terrifying anymore; she’s more human, more fragile. Her insecurities begin to show. 

It’s only in Amandaland, however, that her alpha-mum persona fully breaks down. She’s had to downsize and – gasp – move from Acton to a less affluent part of London; her ex-husband is refusing to pay for their kids’ private school or for her car; she has no career and no prospects. While materially still more privileged than many, in the eyes of society she’s lost any claim to admiration.  

As she meets a host of mums and dads from her kids’ new school after her move, it’s obvious that Amanda is trying to conceal this drastic change. She refers to all the furniture which she’s hording from her old, much bigger house – in her mother’s garage – as ‘curated items from my style archive’. When her mother nudges her to get rid of said ‘curated items’ in the school’s car boot sale, she deflects by declaring, in a suitably dramatic way, ‘I’m so ready to streamline all these investment pieces’. In the next episode she starts showing off, at her kids’ football practice, that ‘this big-shot interiors firm just begged me for a meet at their flagship store’. What she means is that she’s got a job interview at a kitchen and bathroom showroom. Which job she does get, by the way, and proceeds to refer to it for the rest of the show as her ‘collab’.  

I said that nobody likes mums. I should have said, more accurately, that most people don’t find caregivers interesting. 

There’s a reason Amanda speaks in cringeworthy euphemisms half of the time, and it’s not because she delights in being irritating. It’s because she’s feeling the full force of her fall in social status. We can judge her for being shallow enough to care about wealth and appearance so much. But it’s impossible for me not to feel an enormous amount of sympathy for her. I know what it’s like to see someone’s gaze at a social event drift away as you mention that you’re a stay-at-home mum. I know the agonizingly overnice look that often meets you when you say you’ve been trying to get back to work after having kids.  

And to be clear, I’ve been referring to ‘mothers’ throughout, but consciously being perceived as low status is an experience common to all primary caregivers. In Motherland, Kevin, the stay-at-home dad of the group, was often mocked and dismissed as insignificant for looking after his two daughters full time. I said that nobody likes mums. I should have said, more accurately, that most people don’t find caregivers interesting.  

There are two ways to respond to the plain fact that caregiving is seen as low status and low value, and Amanda learns both over the course of the show. The first is to realise we have an innate value that cannot be determined by social approval. We must become comfortable with being sneered at; there’s no way around it. Without spoiling what happens in later episodes, Amanda does grow in virtue by valuing status less and less, eventually rejecting the opportunity to return to wealth and high status for the sake of her family and her own integrity. 

The second way is to find fellowship. The friendships which Amanda forms, especially with the wonderful Anne, also an original Motherland character, are what save her from herself in the end. Anne and the other parents show her that they, at least, don’t care that she’s no longer rich, powerful, and terrifying. They chip away at her armour until she realises that she doesn’t need to be adored in order to be loved.  

We cannot control how people perceive us, but we can control how we respond. At the beginning of the show, Amanda’s response to the challenges of motherhood was to sink into self-absorption. In the end, she’s redeemed by the kindness of her friends. Motherhood will, perhaps, always be a thankless, low status job. But it’s also, and will always be, an irreplaceable one.  

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