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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Snippet
Change
Development
Migration
5 min read

Travelling in a world of refugees

Reconciling the contrasting journeys of travellers and the migrant.

Steve is news director of Article 18, a human rights organisation documenting Christian persecution in Iran.

Migrants on a freight train reach for food bags held aloft by people on the track side.
Migrants on La Bestia being passed bags of food and water.
Pequeño Mar, CC BY-SA 4.0, Wikimedia Commons.

I’ll never forget the sight, 10 years ago this month, as I hitchhiked north through Mexico, of dozens of migrants hanging off the side of a goods train as they made their own journeys towards their Promised Land. 

Like me, these migrants - of whom there must have been at least 30 - were heading for the United States. Unlike me, they were doing so not for fun but for their futures. 

“Come with us!” some shouted, as my wife and I lugged our backpacks towards what we hoped would be our next successful hitchhiking post, having begun our journey seven months prior at the southern tip of Argentina. 

We declined the offer, but I wondered then - and still do - whether they had known we were in a different position to them, or had simply assumed us to be in the same metaphorical boat. 

Around the same time, a new wave of refugees were making their way westward across Turkey and Europe, in a reversal of my first hitchhiking adventure, which took me eastward from the UK to Malaysia. And again, I found the contrast between the respective circumstances of our two journeys confronting. 

There I had been, a post-university thrill-seeker, taking to the road with my best mate to open my eyes to the big wide world beyond these shores, and now six years later, these poor souls were moving in the opposite direction - again, not for fun, but through sheer desperation. 

Many were fleeing ISIS, who took control of Mosul while I was hitchhiking through Brazil at the time of the 2014 Football World Cup. My chief concern during those days were the occasions hitchhiking proved less straightforward. On some days, we had to wait hours for a ride. Sometimes, night would set in as we waited, and we were forced to call it a day. 

There were times, too, when we fell foul of the law, such as in the States, where a policeman told us off for hitchhiking on the freeway. But undoubtedly the most challenging moment of that trip was the time we ended up back in the same hotel we had been in two days prior, having done a 1,000km round trip only to find ourselves right back where we started. 

This came about in Prince George, Canada, after we had been encouraged by a trucker on the so-called “Highway of Tears” to take a different route to our final destination: Alaska. I can still remember the feeling, as I woke up early the next morning, in the very same room of the very same hotel, of such a lot of effort wasted and a deep desire to get moving again as swiftly as possible, if only to enjoy a sense of progress. 

No doubt, there have been many refugees who have experienced the same emotions - only, one imagines, with much greater intensity. Perhaps they have been deported back to where they began their journey, or simply sent back to the last country from which they arrived, in the process undoing in their minds and hearts all of the efforts that went in to getting them there. 

No doubt, many of these refugees will also have fallen foul of the authorities. Some, will have been detained; others deported. Perhaps some will also have been told off for walking on a highway, or illegally crossing a border, as I myself tried to do between Bangladesh and Myanmar back in 2008 - only to be picked up by a border patrol and taken back to where I’d started again. 

Yet, unlike me, I doubt many refugees were offered helping hands by strangers along their way, or at least not so frequently, and I expect many more of them experienced harsh words from passersby than the few jokey thumbs-downs or shouts of “gringos!” that I received on my own journeys. 

And while I, with my Great British passport, was able finally to arrive at my goals and to feel the joy of that completion, many refugees will not have been so fortunate. And while I was able eventually to return home and continue my life - in whatever way I saw fit - for many refugees, their own journeys will still be ongoing, and there will still be a lack of clarity regarding what the future may hold. 

I always used to say, standing beside the side of the road, that if only we knew how long it would be until the next ride, we needn’t worry. If someone could tell us that in four hours we’d be picked up, or that although we wouldn’t get another ride that day, that on the very next we’d be adopted by a lovely family who would end up taking us with them for 10 days (as happened in northern Argentina), then all our worries would melt away. 

I felt the same way during the years in which my wife and I struggled to conceive, post-adventure. Were someone to have told us then that in a few years, we’d have three beautiful boys, we need never have suffered such heartache. 

So too for refugees: if only someone was able to tell them when, where and how their journeys would end, they would be able to come to terms with what lay ahead, and to stop feeling so anxious about the many unknowns. 

But of course that’s not how life works - whether you’re lucky enough to have been born with a British passport that enables you to see all the world has to offer without a second thought, or whether you’ve had the misfortune of being born in a country within which you find yourself unable to remain. 

I have long wrestled with the question of whether my travels were simply a selfish waste of time. Not that they didn’t bring me great joy and truly opened my eyes to the big wide world - they most surely did - but whether I might instead have used that time in some nobler endeavour. 

I find encouragement today in knowing that my love of people of different countries - and especially Iran - was birthed during those travels, and that I probably would not be doing the job I am now, had it not been for those experiences. But it doesn’t make it any easier to reconcile the contrasting journeys of travellers and refugees, which although they may share many parallels, also exhibit some stark differences.