This ambitious and inspiring book describes itself as a ‘manifesto for old age’. It sets out to challenge the myriad conscious and unconscious ageist assumptions that the public in general, and more particularly policy makers and health professionals, hold about old age. Its ‘call to arms’ includes demands for the right to continue working into old age, adequate pensions and benefits without the need to beg for them, open access to learning, appropriate and wide choices for housing and healthcare, and for the right to die well.
The first chapter instructs the reader not to ‘make assumptions about [the author's] age’. The tendency to define successful ageing purely in terms of absence of illness or disability is discussed critically in the context of the demonstrable capacity of many old people to experience high levels of well-being despite multiple illnesses. Similarly, the chapter on work challenges the assumption that older people can and should only be recipients of support paid for by their younger successors. The argument is cogently made that the potential for many older people to continue to be work-active (within the paid or voluntary sectors) needs to be expanded. The need for initiatives by government and financial institutions to enhance pension-related products is also emphasised, as is the underlying theme that it is older people themselves whose work and contributions should pay most or all of what they later draw as pensioners.
It is perhaps disappointing that so little of the book addresses mental health issues directly. The debate about National Institute for Health and Clinical Excellence guidelines and access to cholinesterase inhibitors is discussed in detail and the need to support carers well argued, but the notion that dementia can (like chronic physical illness) be associated with high levels of wellbeing is not mentioned at all. The very short section on depression in old age focuses mainly on suicide (important, but rare). The increasing evidence base for cognitive–behavioural therapy, problem solving and antidepressants for older people is not discussed apart from an unsubstantiated claim that ‘at best they get antidepressants’.
One of the book's greatest strengths (and at the same time its weakness) is the wide range of scholarly and journalistic material that is sometimes uncritically invoked. Julia Neuberger is clearly a highly intelligent and voracious reader. Its other great strength is its passion and willingness to provoke about a topic that, while unfashionable, will inevitably interest each of us more and more as the years roll by.
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