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
Art
Community
Culture
5 min read

Ceremony's superpower is on show at Berwick Parade

Reinventing historic touchpoints between faith and community.

Susan is a writer specialising in visual arts and contributes to Art Quarterly, The Tablet, Church Times and Discover Britain.

A projected image of a person dressed as a mermaid being pushed on a trolley falls on the wall and windows of an old barracks.
The Maltings (Berwick) Trust, Jennifer Charlton Photography.

Watch the parade

Ceremony is beating a retreat. Although wheeled out for major life events: naming newborns, marriage and bidding last goodbyes, and for grand state and civic occasions, standing on ceremony is frowned upon in day-to-day life. Ritual is treated warily, in case it creates an ‘us and them’ chasm between participants, seen as elite, and spectators, presumed to be condemned to disempowering passivity. 

But what if, far from alienating people, the power of ritual, ceremony and spectacle could be a force for engagement? The church and military both have a history of creating, reinventing and refreshing rituals to meet changing social needs. The army chaplaincy is an invention of the late eighteeneeth century, responding to the move towards more settled communities of soldiers, requiring spiritual support. Drumhead altars, a centrepiece of November’s Festival of Remembrance, have origins going back into the mists of time, but quite how far back it is hard to say with certainty.  

Processions and festivities for holy days are more apparent in Catholic countries, with Seville’s Semana Santa parades springing to mind, but well -dressing, May Queens, harvest festivals and Remembrance Sunday reveal a continued desire for entwining of church and community rituals, across faith traditions. 

Art’s ability to step into the ceremonial space and create moments of communion, as well as giving voice to underrepresented groups, has been evident since Surrealism. British Surrealist Eileen Agar’s crustacean strewn ‘Ceremonial Hat for Eating Bouillabaisse’, 1936, attracted collective gasps when she wore it in London. In Sao Paolo in 1931, Brazilian modernist Flavio de Carvalho had to be rescued by police when he walked, hatless, in the opposite direction of a Corpus Christi procession, and the crowd wanted to beat him up. 

Artists can also create spectacles of togetherness and joy. 

Berwick Barracks is a challenging site for community arts. The massive walls and monumental stone-grey interior of Britian’s first purpose-built barracks is reminiscent of eighteenth century experiments in prison design. Even the windows on the living quarters, confirming it is not a prison, are tiny-paned and meanly spaced, like an afterthought dotted reluctantly on the overbearing grey expanse. 

But over the weekend of Berwick Parade, the barracks’ forbidding walls turned into a living portrait of the border town. Under a piercingly brilliant starlit sky – it was the night of the six planet alignment – an audience gathered in the middle of the parade ground to watch themselves, neighbours, friends and family members move across the barrack walls. Artist Matthew Rosier’s projection at x10 magnification transformed the townspeople into giants, and the forbidding military structure of Berwick Barracks into a canvas for joy and creativity. 

Berwick Parade shows you can draw community from a stone, forbidding, large grey stones at that. Paraders and audience were dazzled and dignified, seeing themselves anew. 

The dancing, riding and processing images were soundscaped by music from the repertoire of the Kings Own Scottish Borderers, who have their ceremonial base, and museum, at the barracks, accompanied by the Melrose and District Pipes and Drums. Positioned by the main gate, the musicians set the expectation of spectacle with the rousing music associated with marching bands, as Scotland the Brave gave way to Mairi’s Wedding, and then a medley of upbeat, om-papa outdoors tunes.  

Over 30 minutes, topped by veterans of the Kings Own Scottish Borderers and tailed by hi -vis vest wearing Berwick Parade production staff carrying metal barriers, a parade including processing clergy and the Bishop of Berwick, conga-ing medics in scrubs from Berwick Hospital, brownies, boys’ and girls' football teams, civic leaders in mayoral regalia, Morris, Highland and flamenco dancers, and midlife wild swimmers, shimmied across the walls. Berwick Riders Association were filmed on small ponies, so the magnified projection would not crop the riders into headless torsos. A wheelchair user crossed the expanse of barracks wall wearing a mermaid’s tail. Everybody involved was simultaneously true to life and larger than life. 

Consisting of 850 characters, some of Berwick’s residents played more than one role. “Ooh there’s Cheryl again” commented a spectator next to me, as another pageant of figures travelled across barracks’ perimeter. 

Speaking to Rossier the following morning, he revealed Parade participants had been filmed in the barracks, travelling across a10 metre stage. Magnification made these sequences large enough to cover one wall of the rectangular parade ground. Editing and projection created the appearance of participants entering at one corner and disappearing around the next.  

Movement filmed across short distances opened up participation in the Parade to people with mobility and health issues, in a way that physically journeying around the whole parade ground, repeated over three nights, never could. 

Filmed over six bitterly cold days, choreographer Chloe Sayers had to keep participants’ spirits and energy up as they devised ways of travelling across 10 metres that represented their personality, role and creativity. Sayers specialises with creating events with the public rather than professional dancers, and says that enabling people to express themselves through movement in spaces not always thought of as welcoming, breaks down barriers and creates a sense of ownership. 

Some of the funniest moments in Berwick Parade were rare breeds sheep hogging the limelight like divas, and children clowning around with policemen’s helmets and clipboards. Rosier says primary school years are a sweet spot for performance. ”I love the energy kids bring. We had all age groups, but the six- to 10-year-olds bring so much energy. They just bounce. They have no inhibitions but are good at following instructions. At 12 or 13 heads start to drop and they become more self-aware.” 

Rosier drew on his Irish Catholic mother’s tradition of ceremony and celebration with food and drinking, whether for a wedding or a funeral, to make Berwick Parade a fun place to hang out - food stalls included - beyond the performance. “I want people to have a nice time and not be subservient to the thing they have come to watch.” 

Berwick Parade shows you can draw community from a stone, forbidding, large grey stones at that. Paraders and audience were dazzled and dignified, seeing themselves anew. 

At King Charles’ coronation, the church’s ceremonial superpower was on display to the world. And as artists demonstrate, ceremony does not have to be confined to great occasions. Churches in all traditions can draw on their legacy of historic touchpoints between faith and community, to reinvent, reinstate and refresh rituals to engage with people’s contemporary concerns and hope. 

Join with us - Behind the Seen

Seen & Unseen is free for everyone and is made possible through the generosity of our amazing community of supporters.

If you’re enjoying Seen & Unseen, would you consider making a gift towards our work?

Alongside other benefits (book discounts etc.), you’ll receive an extra fortnightly email from me sharing what I’m reading and my reflections on the ideas that are shaping our times.

Graham Tomlin

Editor-in-Chief