Daf Ditty Shabbes 152: Ageing

Grow old along with me!

The best is yet to be,
The last of life,
for which the first was made.

Robert Browning

At forty wisdom; At fifty able to give counsel; At sixty old age; At

seventy fullness of years; At eighty the age of “strength”; At ninety a
bent body; At one hundred, as good as dead and gone completely
out of the world.
Ethics of the Fathers 5:21

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The Gemara again addresses old age: Rabbi Yehuda HaNasi said to Rabbi Shimon ben
Ḥalafta: For what reason did we not greet you during the Festival the way that my fathers
greeted your fathers?

This was a polite way of asking Rabbi Shimon ben Ḥalafta why he had not come to visit Rabbi
Yehuda HaNasi.

He said to him: Because I have grown old, and the rocks on the road have become tall, and
destinations that are near have become far away, and my two feet have been made into three
with the addition of a cane, and that which brings peace to the house, namely, the passion
drive which motivates a couple to make peace, is no more.

RASHI

Because I have aged…

That which is near appears far..

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Two becomes three, since I need support (cane)..

This refers to the organ of generation (impotence)…

Alternatively, because of the general decline in functions because of weakness and balance
issues, I can no longer rest my weight on one leg alone (see Rashi Chullin 24b).

Expounding the on Kohelet verse:

,‫ד ְוֻסְגּרוּ ְדָלַת ִים ַבּשּׁוּק‬ 4 And the doors shall be shut in the street, when the
‫ִבְּשַׁפל קוֹל ַהַטֲּחָנה; ְוָיקוּם‬ sound of the grinding is low; and one shall start up at
‫ְבּנוֹת‬-‫ ְו ִיַשּׁחוּ ָכּל‬,‫ְלקוֹל ַהִצּפּוֹר‬ the voice of a bird, and all the daughters of music
.‫ַהִשּׁיר‬ shall be brought low;

Eccl 12:4

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The Gemara continues to expound the verses of the final chapter of Ecclesiastes. The verse
states: “And the doors shall be shut in the marketplace when the sound of the grinding is low,
and one shall start up at the voice of a bird, and all the daughters of music shall be brought low”
(Ecclesiastes 12:4).

The Sages expounded: “And the doors shall be shut in the marketplace”; these are a
person’s orifices, which cease to function normally.

The interpretation continues: “When the sound of the grinding is low”; because the stomach
is not grinding and digesting one’s food.

“And one shall start up at the voice of a bird”; because one is unable to sleep deeply such
that even a bird will wake him from his sleep.

“And all the daughters of music shall be brought low”; this means that even the voices of
male and female singers will seem to him like mere conversation, and he will no longer derive
pleasure from song.

The verse is fragmented into 4 sections, which are parsed into four (levels?) disabilities:
1. Incontinence of body orifices
2. Poor digestion
3. Insomnia
4. Hearing loss or loss of auditory perception of music
Rashi (op cit) adds:

And muffled will be the daughters [sounds] of song. All the sounds of musical instruments seem
to him like conversation. Its apparent meaning is its simple interpretation, ‘‫ ’ ִיַשּׁחוּ‬is like ‫ִיְשְׁפּלוּ‬
[=will be brought low]. All the singers and songstresses will be low in his eyes, and as Barzily of
Gilad said to Dovid,

‫ְשֹׁמ ִנים ָשָׁנה ָא ֹנִכי ַהיּוֹם ַהֵאַדע‬-‫לו ֶבּן‬ 36 I am this day fourscore years old; can I discern
‫ֲאֶשׁר‬-‫ ֶאת‬o‫ ִיְטַﬠם ַﬠְבְדּ‬-‫ ִאם‬,‫טוֹב ְלָרע‬-‫ֵבּין‬ between good and bad? can thy servant taste what I eat or
,‫ֶאְשַׁמע עוֹד‬-‫ ִאם‬,‫ֲאֶשׁר ֶאְשֶׁתּה‬-‫ֹאַכל ְוֶאת‬ what I drink? can I hear any more the voice of singing
o‫ְבּקוֹל ָשׁ ִרים ְוָשׁרוֹת; ְוָלָמּה ִיְהֶיה ַﬠְבְדּ‬ men and singing women? wherefore then should thy
.x‫ֲאֹד ִני ַהֶמֶּל‬-‫ ֶאל‬,‫עוֹד ְלַמָשּׂא‬ servant be yet a burden unto my lord the king?

“or can I still listen to the voice of singers and songstresses?”7II Shmuel 19:36.

RASHI
When the sound of the grinding is low. The sound of the mill grinding the food in his intestines,
and that refers to the stomach.

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Ibn Ezra

The only orifice Ibn Ezra sees as being closed is the oral cavity suggesting that speech
articulation like aphasia or dysarthria is the tell-tale sign of aging.

The gemoro continues:

And even Barzilai the Gileadite said to David: “Today I am eighty years old, can I discern
between good and bad? Can your servant taste what I eat or what I drink? Can I hear any more
the voice of singing men and singing women?” (II Samuel 19:36).

The Gemara explains: “Can I discern between good and bad”; from here we derive that the
minds of the elderly change and they no longer discern properly. “Can your servant taste what
I eat or what I drink”;

from here we derive that the lips of the elderly crack and wither. “Can I hear any more the
voice of singing men and singing women”;

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from here we derive that the ears of the elderly become heavy.

Kohelet Rabba 12:4

..And the voice of the bird arose, and the voice of his voice was heard, and he heard the sound of

the trumpet, saying, And all the daughters of the song, these are the tongues. Rabbi Chaya in Rabbi

Nehemiah said these are the kidneys they think, and the heart…

Aging in our tradition:

RABBI DANIEL GOLDFARB writes1

The world is getting older; not just the cosmos, but also the people in it. In the West, at least,
younger people are reproducing less, and older people are living longer, so that in North America,
Europe and Israel, the percentage of people over 65 is expected to rise markedly in the coming
decades.
It was recently projected that in Europe by 2025, there will be as many people over 65 as there
will be in the workforce. Jews, as usual, are part of these trends. The “senior” segment in Jewish
communities (US, Israel and Europe) is about 20%, slightly higher than the general populations,
and growing rapidly.
Medical advances help life expectancies to rise, and with people settling all over the globe, leaving
parents alone in their hometowns or in retirement areas or facilities, the care of the elderly has
become both a big business and a big headache, for families, community organizations and
governments.
The Bible presents pictures of old age both idyllic and starkly realistic. Leaving aside “mythical”
characters like Methuselah, who lived 969 years, we are told that Abraham lived till the ripe old
1
https://www.aju.edu/sites/default/files/sites/default/default/docs/Walking%20With%20God/Walking%20With%20Life/12%20-
%20WwLIFE%20Ageging%20and%20Retirement%20%5Bunit11%5D.pdf

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age of 175, marrying another woman and having six more children after Sarah died. The zekainim
(“the elders”) were an important group for the social/political hierarchy and a source of guidance
for the individual. Yet the infirmities of age were also well known.

The Psalmist’s painful plea Al tashlikheni l’et ziknah…… (“Cast me not off in the time of old age;
when my strength fails, forsake me not”) is included in the Yom Kippur Liturgy five times.
There are people and industries, from branches of the medical profession to major pharmaceutical
companies, which thrive on the desires of people to disguise grey hair, to remove wrinkles, and to
keep bodily appearance and functions youthful.

Interestingly, the Torah offers three prescriptions for long life – honoring one’s parents; not taking
a bird’s eggs in the mother’s presence; and the use of honest weights and measures. The Torah is
concerned more about how we behave towards others than how we look to them.

THE ORIGINS OF AGEING IN JUDAISM: Sanhedrin 107

Apropos the death of Elisha, the Gemara says: Until the time of Abraham there was no aging,
and the old and the young looked the same. Anyone who saw Abraham said: That is Isaac, and
anyone who saw Isaac said: That is Abraham. Abraham prayed for mercy, that he would
undergo aging, as it is stated: “And Abraham was old, well stricken in age” (Genesis 24:1).
There is no mention of aging before that verse. Until the time of Jacob there was no weakness,
i.e., illness. Jacob prayed for mercy and there was weakness, as it is stated: “And one said to
Joseph: Behold, your father is ill” (Genesis 48:1).

Sanhedrin 107b
If we take the Talmud literally, we have only our own forefathers Abraham and Jacob to blame.
“Before Abraham there was no old age and before Jacob there was no illness.” Until Abraham
people simply lived their lives, features constant, until their time came. “People who saw Abraham
thought he was Isaac,” the Talmud continues, “and people who saw Isaac thought he was
Abraham, so Abraham prayed for old age, as it says, ‘and Abraham was old, advanced in years.’”
.‫ ַבֹּכּל‬,‫ַאְבָרָהם‬-‫ ֶאת‬x‫ ָבּא ַבָּיִּמים; ַויהָוה ֵבַּר‬,‫א ְוַאְבָרָהם ָזֵקן‬ 1 And Abraham was old, well stricken in age;
and the LORD had blessed Abraham in all
things.

Gen 24:1

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Abraham was doing just the opposite of trying to stay young. Looking old invited respect, age was
a sign of wisdom: Remember the days of old, consider the years of many generations; Ask your
father and he will inform you, your elders and they will tell you.
Jacob prayed for illness, the Talmud explains, because he wanted a period of notice before death
to call his sons in and “bless” them. Little could Jacob have imagined that the few days that he
requested could, by our time, extend to many years, with physical and mental deterioration, often
accompanied by pain and misery, for the elderly themselves and those who love them.
Modern medicine can take credit for many miracles, but for the incapacitated, often in nursing
homes cared for by strangers, these advances have extended old age, not life.
Jacques says in Shakespeare’s As You Like It, “…And one man in his time plays many parts/His
acts being seven ages.” Man becomes elderly in the sixth, where he begins to lose his charm, both
physical and mental, and shrinks in size and stature. “Last scene of all/That ends this strange
eventful history/Is second childishness and mere oblivion/Sans teeth, sans eyes, sans taste, sans
everything.”

Images of each of the seven ages of man, based on Jaque’s ‘Ages of man’ monologue and
taken from photos of stained-glass windows in the Shakespeare Memorial Theatre

‘All the world’s a stage,

And all the men and women merely players.
They have their exits and their entrances,
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurse’s arms.
Then, the whining schoolboy with his satchel

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 And shining morning face, creeping like a snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then, a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honour, sudden, and quick in quarrel,
Seeking the bubble reputation

Even in the cannon’s mouth. And then, the justice,

In fair round belly, with a good capon lin’d,
With eyes severe, and beard of formal cut,
Full of wise saws, and modern instances,
And so he plays his part. The sixth age shifts
Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose, well sav’d, a world too wide
For his shrunk shank, and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.’
The idea of the world as a stage was not original but it was a metaphor Shakespeare appreciated,
being an actor, stage writer and theatre proprietor. He uses it frequently and, of course, it fits in
nicely with the metaphor of human life as a play with actors. Another of Shakespeare’s favourite
soliloquies is the ‘Tomorrow and tomorrow and tomorrow’ passage where Macbeth compares his
life to that of a short, emotional performance by an actor on a stage:
‘A walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.’

The rabbis predated Shakespeare by over a millennium. In Pirkei Avot they delineate fourteen
stages, the last five devoted to the “Third Age” and reaching the finish line: …at fifty [one can
give] counsel [etzah]; at sixty [one is] elder/ly [ziknah]; at seventy [one reaches] old age [sevah];
at eighty [one has] renewed vitality [gevurah]; at ninety [one has] a bent body; at one hundred
[one is] as good as dead, having passed and ceased from the world. The numbers here are a literary
device; the physical and mental states alluded to can happen at any age.
In our world, insurance companies and social welfare agencies have “ADL (Activities of Daily
Living) tests” to determine disability or who “needs assistance,” e.g. the ability to dress oneself,
feed oneself, use the toilet, etc. (I routinely fill our functional assessment forms for the social
security department on behalf of patients of mine seeking disability)

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Until when is one considered a young person? Rabbi Ela says that Rabbi Ḥanina says: Anyone
who is able to stand on one of his legs and remove his shoe or put on his shoe is considered
young. They said about Rabbi Ḥanina that he was eighty years old and would stand on one of
his legs and remove his shoe or put on his shoe. Rabbi Ḥanina says: The hot water and oil that
my mother smeared on me in my youth benefited me in my old age.

Chullin 24b
The Talmud did, too. One is considered “young and healthy,” as opposed to “sick and old,” if he
can “stand on one foot and put on and take off his shoes.”

Midrashic comparisons to Aggadah in Talmud on aging

Avital Hochstein (from the Hartman Institute) compares two midrashim on aging:2
A midrash looks at the story of Avraham as providing an etiology of the enduring human
phenomenon of aging. Avraham and Sarah are the first biblical figures who are described as old.
This appears in Gen 24 (see above) “Avraham was old, advanced in age”.
In Bava Metzia 87a, a midrash comes to the simultaneously logical and fascinating conclusion
that since no one in the Bible is described as old, zaken, until this point, then “there was no old
age until Avraham.”
The midrash continues to make the claim that Avraham actually asked for aging. What does this
tell us about the nature of aging and its importance to being human, like the other etiologies in
Genesis? How is old age portrayed, and what does the text come to suggest regarding how we
should relate to aging ourselves? We will explore these questions through the lens of two
parallel midrashim that describe Avraham’s request for aging.

Gen. Rabbah (Theodor-Albeck) Parashat Vayehi #97

R. Yudah son of R. Simon said: Avraham demanded aging. He said before [God], “Master of the
universe, a father and his son go into a place and no one knows whom to honor more. From Your
crowning the father with aging, one can know who to honor more.” The Holy One Blessed be He
said to him, “By your life! you have asked for a good thing and I am starting it from you.” From
the beginning of the book until this point aging was not written, Avraham rose, and aging was
given to him, “Avraham was old and advanced in years.”
A fascinating implication of the world prior to aging becomes apparent in this version: Fathers and
sons who looked alike, including Avraham and Yitzhak, were actually identical, indistinguishable.
In other words, human physical development stopped at a certain point. Without aging, there was

2
https://www.hartman.org.il/chayyei-sarah-when-did-humanity-begin-to-age-and-what-is-the-value-of-aging/

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no outward indication of the passing of time, of life’s experiences, or generational gaps. In this
version of the story, Avraham makes his request in a straightforward, blunt, manner: Avraham
wants the respect that comes with age. His reasoning reveals his longing for respect, status, and
hierarchy. This also reveals an insight of Avraham’s regarding aging: that people of age are worthy
of status and honor.
In the Talmud (referred to above) there is a different version of the story. A careful look at the
version found there indicates that Avraham’s motivation for the request is quite different.

Babylonian Talmud Baba Metzia 87a

Until Avraham there was no old age. People who wanted to speak with Avraham [ended up]
speaking with Yitzhak; [people who wanted to speak] with Yitzhak [ended up] speaking with
Avraham.
Avraham came, requested mercy (i.e. prayed), and there was aging, as it says: “and Avraham was
now old…” (Genesis 24:1).
This short text has three components. The first is a description of the status quo, what the world
looked like before Avraham. Old age did, of course, exist, but it left no physical impression; there
was advanced age, but there were no signs of aging. One of the most basic human phenomena was
not part of the human experience in the period predating Avraham. This opening establishes, as
we mentioned, the very brief verse about Avraham’s age as a hint to one of the great foundational
myths that serve as an explanation of the human condition as we recognize it today.
The second part is Avraham’s request, a request that leads to a change in reality: He prayed for
aging and there was aging. Since the request is preceded by Avraham praying for it, we can assume
that it is perceived by Avraham as an experience that he wants, or at least as having implications
that he desires.
The last component of the midrash is the quotation of the verse from Genesis which reads:
“Abraham was now old, advanced in age, and God had blessed Avraham with everything”
(Genesis 24:1). The story that the midrash tells explains the repetition of the descriptive words
“old” and “advanced in age”. One of these adjectives describes how many years Avraham has
lived, his chronological age, and the other describes his physical state: that of aging. (what I call
biological aging)
The midrash may also be trying to account for the statement in the verse that God blessed Avraham
with “everything.” Beyond the usual – happiness, money, property and so on – God also blessed
Abraham with his own idiosyncratic wish: to age. Not only does Avraham not try to escape from
old age, he requests it.
This account reveals an understanding regarding the meaning of aging and its implications which
may offer an explanation for Avraham’s request. This is revealed in the way reality is portrayed in
the era prior to aging. One who wanted to talk to Avraham ended up talking to Yitzhak, and vice
versa, because they were identical. In the Talmudic version Avraham’s request for aging is actually
a longing for distinction and uniqueness. This is so also according to Rashi’s interpretation (on the
Talmud there), “In order that people would recognize the difference between him and his son.”

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Avraham wants to be recognized for who he is – Avraham. The lack of physical manifestation of
age is a loss of a part of himself, enabling only a partial recognition of who he is when the passing
of time is not manifest.
In both versions of the request, both in Bereishit Rabbah and in the Talmud, Avraham longs for a
world in which he will be differentiated from his son, a world in which parents and their offspring
are different versions of one another, rather than replicas. But there is a difference between the two
requests: In Bereishit Rabbah, Avraham wants to be more distinguished than his son, whereas in
the Bavli, Avraham wants to simply be distinguished from his son.
In the context of parent-child relationships, the request for distinction can be loaded. It seems that
Avraham got what so many parents dream of and long for – a child who is an exact replica, a
descendant who can help him overcome his mortality. But this dream has a downside. If Yitzhak
is a true replica, then Avraham’s existence can feel redundant. As Yitzhak becomes a repetition of
Avraham and is treated as such, Avraham realizes that his own presence loses value. In a world
where people cannot distinguish between the generations, the existence of an older generation
loses its meaning. At a certain point in development this can inhibit innovation; development has
no meaning since we can’t distinguish between the old and the new.
Old age is often perceived as a stage of stagnation, a stage of life in which one slows down or even
stops moving entirely. This short Talmudic passage explains that in truth, there is no growing up
without growing old. Without aging, the next generation can hope only to walk its predecessors’
footsteps. Aging is what enables the shift from past to present and from present to future; it is what
enables the continuity of change and development. Avraham’s request allows people to see him as
experienced, so they can learn from his life’s journey. And Avraham’s request allows people to
see him as old, so that they can depart from his path.
It seems that In the Bavli Avraham’s request is not a request solely for self-respect, as apparent in
Bereishit Rabbah, but rather it has a philanthropic side.
The request for dissimilarity is not only a request for oneself but also for one’s offspring. It is in
fact a universal request regarding progress. Avraham is asking to be able to change the future, a
future he will not be a part of, and God’s response is to bless Avraham “with everything.”
I think often about my kids and what we are passing on, what legacy, not of what we profess but
the example they have seen as we pass through the challenges of life. What they see of me, my
faults, my rage, my addictions, beyond the surface of middle class life and civility and what we
would like them to see of us….what they see of inner conflict and marital conflict once the thin
veneer of civility has been stripped away by the wounds of childhood bearing down, the pain
inflicted upon us by others (when we were powerless) manifesting in our outbursts.

Midrashic validation of Aging

Rabbi Bradley Artson writes3

3
https://www.myjewishlearning.com/article/bearing-fruit-even-in-old-age/

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Most of our lives are darkened by the shadow of aging. We mock the old, laughing at their physical
condition, joking about being in wheelchairs, in old-age homes, in hospital beds. We associate the
old with the incompetent, with a state of permanent boredom and irrelevance. By bleaching our
hair, lifting our faces, breasts and calves, sucking off our fat, and dressing in the gaudiest apparel
possible, we hope to “stay young” forever.

Our fear of age trails us everywhere, urging middle-aged women to undergo cosmetic surgery and
middle-aged men to find a mistress. It whispers to us of “our last chance” — whatever the vice in
question. There is a frenzied quality to our recreation, our relationships, and to our acquisition of
property, since we expect all of them to ward off the inevitable — death.

Warding Off Death

There is one way to ward off death, but it doesn’t lie in the distractions and the stuporifics offered
by today’s fashion magazines. We can ward off death, prevent its encroachment into the realm of
life, only by truly living each and every day, only by refusing to see the elderly as the walking
dead, or to view aging as equivalent to dying.

We can put off death by honoring the old among us. Look, for a moment, at how our Jewish
tradition speaks of age. In Ex , Moses and his brother, Aaron, receive God’s command to appear
before Pharaoh to demand the freedom of the Jews. In what looks like an unnecessary digression,
after discussing the conversation between the brothers and God, the Torah records that “Moses
was 80 years old and Aaron was 83, when they made their demand on Pharaoh.”

Why does the Torah stoop from the drama of statesmanship and diplomacy at the highest levels to
reveal something so mundane, so irrelevant as the age of these two leaders?

According to Ibn Ezra this reference to advanced age is unique. “We don’t find prophets anywhere
else in Scripture for whom the text points out that they prophesied while elderly, except here.”

‫ָשׁ•שׁ‬-‫ ֶבּן‬,‫ ְוַאֲהֹרן‬,‫ְשֹׁמ ִנים ָשָׁנה‬-‫ ֶבּן‬,‫ז וֹּמֶשׁה‬ 7 And Moses was fourscore years old, and Aaron
{‫ }פ‬.‫ַפּ ְרֹעה‬-‫ ֶאל‬,‫ְבַּדְבָּרם‬--‫וְּשֹׁמ ִנים ָשָׁנה‬ fourscore and three years old, when they spoke unto
Pharaoh.

Ex 7:7

Moses and Aaron Were Old as a typology of aging

Only for Moses and Aaron does the Torah go out of its way to tell us that they were old. Why?
“Because it attributes greatness [to Moses and Aaron] beyond all other prophets, for only to them
did God appear…for only to them was the Torah given, and thus through their hands do the
righteous inherit the Coming World, while all other prophets either chastise or predict the future.”

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Ibn Ezra noticed a distinction in the functions of these brothers and all subsequent Jewish
prophets. Only Moses and Aaron transmitted new teaching to the Jewish people, and their
teachings became our portal to eternal life and higher purpose. All the other prophets, as great as
they indubitably were, worked to remind us of the ethical and spiritual core of the Mosaic
revelation.

While Rabbi ibn Ezra’s insight is itself remarkable, for our purposes what stands out is his
evaluation of age. He sees the statement of Moses and Aaron’s old age as highly complementary.
Not only do they not hide their age, but it is a source of pride.

In the words of the Talmud, “at 80 — the age of strength.” What is the strength of 80 years? Surely
a teenager is stronger physically, and a child can run farther and packs more energy! The acumen
of a 40-year old is quicker and defter, and a 60-year old is keener to the ways of the world.

The strength of 80 is the wisdom that comes from experience and completion. Having run much
of the course of life, having seen the follies and passions of the human heart rise and subside,
having seen their own and their friends’ dreams, limitations and achievements, an adult of 80 years
is finally able to look at the human condition with compassion and some skepticism. At 80 years
of age, we need no longer serve either passion or ambition.

In our youth, each one of us was cared for by someone older. As links in the chain of the
generations, we also care for others who depend on us to transmit what they need to establish lives
of purpose, accomplishment and belonging. Judaism is the warm water, and Torah the oil with
which to anoint our children and ourselves, the bath to keep away the chill.

Then, even in old age, we will flourish like a cedar. Planted in the courtyards of our God, we shall
bear fruit, even in old age.

“The tragedy of old age is not that one is old, but that one is young.”
Oscar Wilde

The Tragedy of Ageing

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An editorial in a medical journal 4 written in 1914, these sentiments were mirrored a millennium
before, From Ecclesiastes to the Greek philosophers, aging was part of the ending of life.
Dr Mark Williams MD writes:5
Ancient Greece

4
Can Med Assoc J. 1914 May; 4(5): 418–419.
5
https://www.psychologytoday.com/us/blog/the-art-and-science-aging-well/201704/growing-old-in-ancient-greece-and-rome

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The ancient Greeks generally abhorred aging as it represented a decline from highly prized youth
and vigor. However older warriors, elder philosophers and statesmen were typically well treated.
Ironically, the Spartans who valued the physical ideal most also were those who most valued
the wisdom of elderly citizens. In the 7th century B.C. they set up the Gerousia, a counsel of 28
men and two kings who were all over age 60 to control the city-state and manage community
affairs.

In the sixth century, Pythagoras popularized the idea that four elements (earth, fire, air, water)
with corresponding qualities (dry, hot, cold, wet) and seasons (autumn, summer, spring, winter)
formed the foundation for the four bodily humors: blood, phlegm, yellow bile and black bile. The
essence of the theory was that the four humors were balanced in health whereas an imbalance
would produce a change in temperament or illness. Later, Theophrastus (who succeeded Aristotle
in the Peripatetic School of ancient philosophy) linked personality to the humors: those with
excess blood were sanguine, those with an abundance of phlegm were phlegmatic, too much
yellow bile produced a choleric personality, and those with too much black bile were melancholic.

In about the fourth century B.C. Hippocrates developed a theory of aging positing that each
individual has a finite quantity of innate heat or vital force. Each person uses this force at a unique
rate and the heat can be replenished but not fully to the previous level. Thus, the reserve diminishes
until death and the manifestations of aging are the result of this loss. The loss of innate heat was
looked upon not as the result of supernatural influences or a process that can be halted, but rather
as the natural and normal course of things. Hippocrates felt that one must assist nature rather than
work against it, and his advice for longevity was moderation and the maintenance of daily
activities.

About a century later Aristotle (384-322 B.C.) expounded (in his typically interminable detail) a
theory of aging and death in his book On Youth and Old Age on Life and Death and on Respiration.
His theory builds on Hippocrates’ view of heat as an essential quality of life. According to Aristotle
everything that lives has a soul whose seat is in the heart and which cannot exist without natural
heat.

16
The soul is combined at birth with innate heat and requires heat to survive in the body. Life consists
of maintaining this heat in its relationship to the soul. Aristotle likened the innate heat to a fire
which is maintained and provided with fuel. Just as a fire can run out of fuel or be put out, innate
heat also could be extinguished or exhausted. Continuing to produce the heat requires fuel and as
the fuel is used up the flame diminishes as in old age. A feeble flame is more easily extinguished
than the strong flame of youth. Left undisturbed the flame goes out as the fuel is exhausted and
the person dies of old age.

Ancient Rome

The Ancient Romans were aware of the many lines of thought on aging and death held elsewhere
in the world. Marcus Cicero (106-43 B.C.) acknowledged that old age can mean exclusion from
the young: "What I find most lamentable about old age is that one feels that now one is repulsive
to the young." But he also saw older people as a source of great wisdom ("States have always been
ruined by young men and saved by the old.") and believed that a stable old age was based on a
stable youth.

The height of ancient contributions to conceptions of aging and health was reached with Galen, a
Roman physician who lived about 200 A.D. In essence Galen reconciled the theory of the four
humors (Pythagoras) with the idea of inner heat (Hippocrates and Aristotle), as well as monotheism
and notions of the spirit.

In Galen’s view the body is the instrument of the soul. The soul is maintained in the body by heat
which is in turn derived from the humors. Over the course of life, we gradually dehydrate, and the
humors evaporate. In youth and midlife, this dehydration causes all of our vessels to increase in
width and thus all the parts become strong and attain their maximal power. However, as time
progresses, and the organs become even drier we experience a gradual loss of function and vitality.
This drying also causes us to become thinner and more wrinkled and our limbs to become weak
and unsteady in their movements. This condition of old age is the innate destiny of every mortal
creature. When at last the dryness is complete and the humors evaporate, the body’s vital heat is
extinguished.

Christians, Jews and Islamic Arabs adopted the philosophical basis of Galen’s theory. His grand
synthesis represents the culmination of all previous ideas on aging and his whole medical system,
including his approach to aging, was the authoritative influence on medical thought and practice
for more than 19 centuries.

17
 MRI showing T1-weighted MRI images.

Coronal section through the hippocampus. AD patients have shrunken

hippocampi and enlarged ventricles relative to healthy age-matched controls.

These changes result from cell dysfunction and cell death.

(Image by Prof. Suzanne Corkin.)

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Aging in Literature

A different view by Maria S. Haynes 6concerning the idealized literary view of old age and the
reality on the ground most likely parallels the literary view of the Talmudic texts and the realia.

Perhaps because it is the common fate of humanity, the themes of aging and the passage of time
have captured the imagination of writers from William Shakespeare to Grace Paley. While
medicine has sought to explain and deter the effects of aging, literature has served as a creative
vehicle for exploring the inevitability of aging. The physical, psychological, and interpersonal
changes that accompany the passage of time affect both author and characters alike, creating a
literary dynamic that is an integral part of understanding the drama of human existence.

Arthur Krystal write on the changing notion of aging:7

In days of old, when most people didn’t live to be old, there were very few notable works about
old age, and those were penned by writers who were themselves not very old. Chaucer was around
fifty when “The Merchant’s Tale” was conceived; Shakespeare either forty-one or forty-two when
he wrote “King Lear,” Swift fifty-five or so when gleefully depicting the immortal but ailing

6
The Supposedly Golden Age for the Aged in Ancient Greece (A Study of Literary Concepts of Old Age:
https://academic.oup.com/gerontologist/article-abstract/2/2/93/610088?redirectedFrom=PDF
7
https://www.newyorker.com/magazine/2019/11/04/why-we-cant-tell-the-truth-about-aging

19
Struldbruggs, and Tennyson a mere twenty-four when he began “Tithonus” and completed
“Ulysses,” his great anthem to an aging but “hungry heart.”

One might think that forty was not so young in Shakespeare’s day, but if you survived birth,
infections, wars, and pestilence you stood a decent chance of reaching an advanced age no matter
when you were born. Average life expectancy was indeed a sorry number for the greater part of
history (for Americans born as late as 1900, it wasn’t even fifty), which may be one reason that
people didn’t write books about aging: there weren’t enough old folks around to sample them. But
now that more people on the planet are over sixty-five than under five, an army of readers stands
waiting to learn what old age has in store.

Reading through a recent spate of books that deal with aging, one might forget that, half a century
ago, the elderly were, as V. S. Pritchett noted in his 1964 introduction to Muriel Spark’s novel
“Memento Mori,” “the great suppressed and censored subject of contemporary society, the one we
do not care to face.” Not only are we facing it today; we’re also putting the best face on it that we
possibly can. Our senior years are evidently a time to celebrate ourselves and the wonderful things
to come travelling, volunteering, canoodling, acquiring new skills, and so on. No one, it seems,
wants to disparage old age. Nora Ephron’s “I Feel Bad About My Neck” tries, but is too wittily
mournful to have real angst. Instead, we get such cheerful tidings as Mary Pipher’s “Women
Rowing North: Navigating Life’s Currents and Flourishing as We Age,” Marc E. Agronin’s “The

20
End of Old Age: Living a Longer, More Purposeful Life,” Alan D. Castel’s “Better with Age: The
Psychology of Successful Aging,” Ashton Applewhite’s “This Chair Rocks: A Manifesto Against
Ageism,” and Carl Honoré’s “Bolder: Making the Most of Our Longer Lives”—five chatty
accounts meant to reassure us that getting old just means that we have to work harder at staying
young.

Pipher is a clinical psychologist who is attentive to women over sixty, whose minds and bodies,
she asserts, are steadily being devalued. She is sometimes tiresomely trite, urging women to
“conceptualize all experiences in positive ways,” but invariably sympathetic. Agronin, described
perhaps confusingly as “a geriatric psychiatrist” (he’s in his mid-fifties), believes that aging not
only “brings strength” but is also “the most profound thing we accomplish in life.” Castel, a
professor of psychology at U.C.L.A., believes in “successful aging” and seeks to show us how it
can be achieved. And Applewhite, who calls herself an “author and activist,” doesn’t just inveigh
against stereotypes; she wants to nuke them, replacing terms like “seniors” and “the elderly” with
“olders.” Olders, she believes, can get down with the best of them. Retirement homes “are hotbeds
of lust and romance,” she writes. “Sex and arousal do change, but often for the better.” Could be,
though I’ve never heard anyone testify to this. Perhaps the epicurean philosopher Rodney
Dangerfield (who died a month short of his eighty-third birthday), having studied the relationship
between sexuality and longevity, said it best: “I’m at the age where food has taken the place of sex
in my life. In fact, I’ve just had a mirror put over my kitchen table.”

Applewhite makes an appearance in Honoré’s book. She tells Honoré, a Canadian journalist who
is now fifty-one, that aging is “like falling in love or motherhood.” Honoré reminds us that “history
is full of folks smashing it in later life.” Smashers include Sophocles, Michelangelo, Rembrandt,
Bach, and Edison, who filed patents into his eighties. Perhaps because Honoré isn’t an American,
he omits Satchel Paige, who pitched in the majors until he was fifty-nine. Like Applewhite, who
claims that the older brain works “in a more synchronized way,” Honoré contends that aging may
“alter the structure of the brain in ways that boost creativity.”

These authors aren’t blind to the perils of aging; they just prefer to see the upside. All maintain
that seniors are more comfortable in their own skins, experiencing, Applewhite says, “less social
anxiety, and fewer social phobias.” There’s some evidence for this. The connection between
happiness and aging—following the success of books like Jonathan Rauch’s “The Happiness
Curve: Why Life Gets Better After 50” and John Leland’s “Happiness Is a Choice You Make:
Lessons from a Year Among the Oldest Old,” both published last year—has very nearly come to
be accepted as fact. According to a 2011 Gallup survey, happiness follows the U-shaped curve

21
first proposed in a 2008 study by the economists David Blanchflower and Andrew Oswald. They
found that people’s sense of well-being was highest in childhood and old age, with a perceptible
dip around midlife.

Lately, however, the curve has invited skepticism. Apparently, its trajectory holds true mainly in
countries where the median wage is high and people tend to live longer or, alternatively, where the
poor feel resentment more keenly during middle age and don’t mind saying so. But there may be
a simpler explanation: perhaps the people who participate in such surveys are those whose lives
tend to follow the curve, while people who feel miserable at seventy or eighty, whose ennui is

22
offset only by brooding over unrealized expectations, don’t even bother to open such
questionnaires.

One strategy of these books is to emphasize that aging is natural and therefore good, an idea that
harks back to Plato, who lived to be around eighty and thought philosophy best suited to men of
more mature years (women, no matter their age, could not think metaphysically). His most famous
student, Aristotle, had a different opinion; his “Ars Rhetorica” contains long passages denouncing
old men as miserly, cowardly, cynical, loquacious, and temperamentally chilly. (Aristotle thought
that the body lost heat as it aged.) These gruff views were formed during the first part of Aristotle’s
life, and we don’t know if they changed before he died, at the age of sixty-two. The nature-is-
always-right argument found its most eloquent spokesperson in the Roman statesman Cicero, who
was sixty-two when he wrote “De Senectute,” liberally translated as “How to Grow Old,” a valiant
performance that both John Adams (dead at ninety) and Benjamin Franklin (dead at eighty-four)
thought highly of.

Montaigne took a more measured view. Writing around 1580, he considered the end of a long life
to be “rare, extraordinary, and singular . . . ’tis the last and extremest sort of dying: and the more
remote, the less to be hoped for.” Montaigne, who never reached sixty, might have changed his
mind upon learning that, in the twenty-first century, people routinely live into their seventies and
eighties. But I suspect that he’d still say, “Whoever saw old age, that did not applaud the past, and
condemn the present times?” No happiness curve for him.

There is, of course, a chance that you may be happier at eighty than you were at twenty or forty,
but you’re going to feel much worse. I know this because two recent books provide a sobering
look at what happens to the human body as the years pile up. Elizabeth Blackburn and Elissa Epel’s
“The Telomere Effect: Living Younger, Healthier, Longer” and Sue Armstrong’s “Borrowed
Time: The Science of How and Why We Age” describe what is essentially a messy business.
Armstrong, a British science and health writer, presents, in crack Michael Lewis style, the high
points of aging research along with capsule biographies of the main players, while Blackburn, one
of three recipients of the 2009 Nobel Prize in Physiology, focusses on the shortening of telomeres,
those tiny aglets of DNA attached to our chromosomes, whose length is a measure of cellular
health. Basically, most cells divide and replicate some fifty-plus times before becoming senescent.
Not nearly as inactive as the name suggests, senescent cells contribute to chronic inflammation
and interfere with protective collagens. Meanwhile, telomeres shorten with each cell division, even
as lifestyle affects the degree of shrinkage—data now suggest that “married people, or people
living with a partner, have longer telomeres.”

23
Walt Whitman, who never married, made it to seventy-two, and offered a lyric case for aging.
“YOUTH, large, lusty, loving—youth full of grace, force, fascination,” he intoned. “Do you know
that Old Age may come after you with equal grace, force, fascination?” It’s pretty to think so, but
the biology suggests otherwise. The so-called epigenetic clock shows our DNA getting gummed
up, age-related mitochondrial mutations reducing the cells’ ability to generate energy, and our
immune system slowly growing less efficient. Bones weaken, eyes strain, hearts flag. Bladders
empty too often, bowels not often enough, and toxic proteins build up in the brain to form the
plaque and the spaghetti-like tangles that are associated with Alzheimer’s disease. Not
surprisingly, sixty-eight per cent of Medicare beneficiaries today have multiple chronic conditions.
Not a lot of grace, force, or fascination in that.

In short, the optimistic narrative of pro-aging writers doesn’t line up with the dark story told by
the human body. But maybe that’s not the point. “There is only one solution if old age is not to be
an absurd parody of our former life,” Simone de Beauvoir wrote in her expansive 1970 study “The
Coming of Age,” “and that is to go on pursuing ends that give our existence a meaning—devotion
to individuals, to groups, or to causes—social, political, intellectual, or creative work.” But such
meaning is not easily gained. In 1975, Robert Neil Butler, who had previously coined the term
“ageism,” published “Why Survive? Being Old in America,” a Pulitzer Prize-winning study of
society’s dereliction toward the nation’s aging population. “For many elderly Americans old age
is a tragedy, a period of quiet despair, deprivation, desolation and muted rage,” he concluded.

Four years later, the British journalist Ronald Blythe, who must be one of the few living writers to
have spoken to the last Victorians (he’s now just shy of ninety-seven), had a more sanguine
perspective. His “The View in Winter,” containing oral histories of men and women at the end of
their lives, is a lovely, sometimes personal, sometimes scholarly testament that reaches “no single
conclusion. . . . Old age is full of death and full of life. It is a tolerable achievement and it is a
disaster. It transcends desire and it taunts it. It is long enough, and it is far from being long enough.”
Some years after that, the great Chicago radio host Studs Terkel, who died at ninety-six, issued an
American version of Blythe’s wintry landscape; in “Coming of Age” (1995), Terkel interrogated
seventy-four “graybeards” (men and women over the age of seventy) for their thoughts on aging,
politics, and the American way of life.

24
 .

Normal aging is bad enough, but things become dire if dementia develops, the chances of
which double every five years past the age of sixty-five. Applewhite, however, citing recent
research, no longer thinks that dementia is “inevitable, or even likely.” May she live long and
prosper, but, for those of us who have cared for spouses or parents with dementia, it’s not
always a simple matter to know on whom the burden falls the heaviest. (One in three
caregivers is sixty-five or older.)

Obviously, I’m not a candidate for the Old Person’s Hall of Fame. In fact, I plan to be a tattered
coat upon a stick, nervously awaiting the second oblivion, which I’m reasonably certain will not
have the same outcome as the first. Nonetheless, I like to think that I have some objectivity about
what it’s like to grow old. My father lived to be almost a hundred and three, and most of my friends
are now in their seventies. It may be risky to impugn the worthiness of old age, but I’ll take my
cane to anyone who tries to stop me. At the moment, we seem to be compensating for past
transgressions: far from devaluing old age, we assign it value it may not possess. Yes, we should
live as long as possible, barring illness and infirmity, but, when it comes to the depredations of
age, let’s not lose candor along with muscle tone. The goal, you could say, is to live long enough
to think I’ve lived long enough.

25
One would, of course, like to approach old age with grace and fortitude, but old age makes it
difficult. Those who feel that it’s a welcome respite from the passions, anxieties, and troubles of
youth or middle age are either very lucky or toweringly reasonable. Why rail against the
inevitable—what good will it do? None at all. Complaining is both pointless and unseemly.

Existence itself may be pointless and unseemly. No wonder we wonder at the meaning of it all.
“At first we want life to be romantic; later, to be bearable; finally, to be understandable,” Louise
Bogan wrote. Professor Small would agree, and though I am a fan of her book, I have my doubts
about whether the piling on of years really does add to our understanding of life. Doesn’t Regan
say of her raging royal father, “Tis the infirmity of his age: yet he hath ever but slenderly known
himself”? The years may broaden experience and tint perspective, but is wisdom or contentment
certain to follow?

A contented old age probably depends on what we were like before we became old. Vain, self-
centered people will likely find aging less tolerable than those who seek meaning in life by helping
others. And those fortunate enough to have lived a full and productive life may exit without undue
regret. But if you’re someone who—oh, for the sake of argument—is unpleasantly surprised that
people in their forties or fifties give you a seat on the bus, or that your doctors are forty years
younger than you are, you just might resent time’s insistent drumbeat. Sure, there’s life in the old
boy yet, but certain restrictions apply. The body—tired, aching, shrinking—now quite often
embarrasses us. Pipher and company might simply say “Gesundheit” and urge us on. Life, they
insist, doesn’t necessarily get worse after seventy or eighty. But it does, you know. I don’t care
how many seniors are loosening their bedsprings every night; something is missing.

The Neurology of Aging

26
I am often asked in my practice the difference between normal aging
brain and early onset dementia…
Almost 40 per cent of people over the age of 65 experience some form of memory loss. When
there is no underlying medical condition causing this memory loss, it is known as "age-associated
memory impairment," which is considered a part of the normal aging process.

Brain diseases like Alzheimer’s disease and other dementias are different.

Age-associated memory impairment and dementia can be told apart in a number of ways. Below
are some examples.

Note: this is not a diagnostic tool.

Normal Aging Dementia

Not being able to remember details of a Not being able to recall details of recent
conversation or event that took place a year events or conversations
ago

Not being able to remember the name of an Not recognizing or knowing the names of
acquaintance family members

Forgetting things and events occasionally Forgetting things or events more frequently

Occasionally have difficulty finding words Frequent pauses and substitutions when
finding words

You are worried about your memory, but your Your relatives are worried about your
relatives are not memory, but you are not aware of any
problems

What is normal aging?

Signs of aging can start as young as age 30. The process of aging includes many changes in the
body including:

• Heart and blood vessels: Stiffening of arteries and blood vessels makes the heart work
harder. Physical activities such as walking long distances or walking uphill may become
more difficult.

27
• Bones: Bones shrink and reduce in density, making them more fragile and likely to break.
Cartilage in joints may start wearing away, which can cause some pain or stiffness.
• Muscles: Muscles lose strength, flexibility, and endurance over time. Muscle mass
decreases 3-5% every decade after 30 years of age, and that rate increases over age 60.
• Bladder and bowel: The ability for the bladder to stretch and then go back to its normal
shape may be reduced. This may cause the bladder to hold less urine than before, resulting
in more frequent trips to the bathroom. Changes in bowel can lead to constipation.
• Skin: Skin loses elasticity too, resulting in wrinkles in some people. It also thins and
becomes more delicate, making it easier to get bruises and cuts.
• Vision: Changes in vision can include far-sightedness, a result of the hardening of the lens.
Cataracts, a clouding of the lens in the eye that affects vision, may develop. This can cause
blurry vision and ultimately blindness if not treated.
• Mental health: Aging is a process with many changes, and it may take a little getting used
to. Some people may be depressed, although others may have a sense of fulfillment and
feel happy with their lives.
• Memory and Thinking (Cognition): Normal aging may mean slower processing speeds
and more difficulty with multitasking, but routine memory, skills, and knowledge are stable
and may even improve with age. It’s normal to occasionally forget recent events such as
where the keys were last placed or the name of the person you just met.

28
 Age-associated clinical terms show distinct pathological
clusters. T-distributed Stochastic Neighbor Embedding (t-SNE)
clustering of z-score normalized data.

Dementia is a term for a collection of symptoms of cognitive decline including disruptions in

language, memory, attention, recognition, problem solving, and decision-making that interferes
with daily activities. Although 5.8 million people in the U.S. have dementia, it is not normal aging
of the brain.8

Other signs of dementia include:

• not being able to complete tasks independently

• difficulty with naming items or close family members
• forgetting the function of items
• repeating questions
• taking much longer to complete customary tasks
• misplacing items frequently
• not being able to retrace steps and getting lost

Causes

The causes for memory issues and aging is still unclear, even after the many theories have been
tested. There has yet to be a distinct link between the two because it is hard to determine exactly
how each aspect of aging effects the memory and aging process. However, it is known that the
brain shrinks with age due to the expansion of ventricles causing there to be little room in the head.
Unfortunately, it is hard to provide a solid link between the shrinking brain and memory loss due
to not knowing exactly which area of the brain has shrunk and what the importance of that area
truly is in the aging process9 (Baddeley, Anderson, & Eysenck, 2015)

Attempting to recall information or a situation that has happened can be very difficult since
different pieces of information of an event are stored in different areas. During recall of an event,
the various pieces of information are pieced back together again, and any missing information is
filled up by our brains, unconsciously which can account for ourselves receiving and believing
false information (Swaab, 2014).10

Memory lapses can be both aggravating and frustrating, but they are due to the overwhelming
amount of information that is being taken in by the brain. Issues in memory can also be linked to
several common physical and psychological causes, such

8
https://www.cdc.gov/aging/publications/features/dementia-not-normal-aging.html
9
Baddeley, A. D., Anderson, M. C., & Eysenck, M. W. (2015). Memory. East Sussex: Psychology Press.
10
Swaab, D. F. (2014). We Are Our Brains : A Neurobiography of the Brain, From the Womb to Alzheimer’s (Vol. First edition).
New York: Spiegel & Grau.

29
as: anxiety, dehydration, depression, infections, medication side effects,
poor nutrition, vitamin B12 deficiency, psychological stress, substance abuse,
chronic alcoholism, thyroid imbalances, and blood clots in the brain.

Some memory issues are due to stress, anxiety, or depression. A traumatic life event, such as
the death of a spouse, can lead to changes in lifestyle and can leave an elderly person feeling unsure
of themselves, sad, and lonely. Dealing with such drastic life changes can therefore leave some
people confused or forgetful. While in some cases these feelings may fade, it is important to take
these emotional problems seriously. By emotionally supporting a struggling relative and seeking
help from a doctor or counselor, the forgetfulness can be improved.

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31
Genetics and predisposing factors11

Aging represents the largest risk factor for chronic diseases and a significant and growing
socioeconomic challenge for most societies worldwide. Nevertheless, what constitutes the
human phenotype of aging is not well characterized, likely due to the highly complex and
heterogeneous nature of human aging. Indeed, aging is probably caused by the stochastic failure
of a myriad of different biological processes leading to increased susceptibility to disease and
death.

Due to the role of aging in numerous diseases, interventions leading to healthy aging are being
heavily investigated. Clinical trials for aging interventions are challenging due to the possibility
of long trial times and/or the necessity to investigate large cohorts. The generation of biomarkers
that may predict the age and health of an individual has therefore received significant interest.
Importantly, several recent breakthroughs have allowed us to discover complex biomarkers, or
aging clocks, which are able to predict the age and risk of death and/or age-associated disease of
individuals. Nevertheless, it is unclear how these biomarkers predict the multitude of phenotypes
associated with aging. To this end, having a well-defined phenotypical description of human
aging and an understanding of how different aging phenotypes associate with each other will
enable us to better understand aging, design trials and discover drugs targeting the aging process.

Herein, we used a previously incomplete list of phenotypes associated with human aging to mine
millions of PubMed articles for co-occurring phenotypes, allowing us to better define what we
term the human aging phenome. We used this computationally unbiased approach to generate a
list of approximately a thousand terms and then manually curated this list to extract features
associated with aging. We then validated these features manually against the description of more
than 75 million individuals from published studies. Notably, these parameters cover all tissues
in the human body and illustrate the heterogeneity of the human aging phenotype. Collectively,
our results allow us to propose a description of what human aging is.

11 Søren Norge Andreassen1, * , Michael Ben Ezra1, * , Morten Scheibye-Knudsen11 Center for Healthy Aging, Department of
Cellular and Molecular Medicine University of Copenhagen, Copenhagen, Denmark https://www.aging-
us.com/article/102166/text

32
 A defined aging phenome shows functional
clustering. Agglomerative hierarchical clustering of 105 clinical
terms describing human aging based on z-score normalized
representation in the literature. Colors represent different clusters.
The approximately unbiased value is shown in red while the
bootstrap probability value is shown in blue.

33