Senility is not a Dirty Word

Only lately, at 86, have I become aware of a campaign to eradicate the word “senility” in association with old-age and replace it with “dementia.” I gather that effort is part of a larger view that old-age -- or the disabilities of old-age -- are not the natural result of time in this world, but rather stem from diseases which we physicians will -- sooner or later -- eradicate. I trust that the immortals taking the place of us time-limited relics will have little in common with Swift’s struldbrugs.

Turning to the venerable (circa 80 years old) Oxford English Dictionary, I looked up senility to find The condition of being senile; old age or the mental and physical infirmity due to old age. Turning then to dementia, I found A species of insanity characterized by failure or loss of the mental powers; usually consequent on other forms of insanity, mental shock, various diseases, etc.

Googling the words, in UCSF Memory and Aging I quickly found "Senility” or “senile” is an out-date term that has been replaced with “dementia” in recent years. Dementia is characterized by multiple cognitive deficits with memory impairments as an early symptom.

That assertion was followed by advice to “remain vigilant about maintaining good health,” which usually comes down to “see your doctor” and avoid excess. Good advice maybe, but health mostly comes from good luck and the Creator, in a manner of speaking. We docs are good at curing some diseases, but good health is beyond us, I fear.

The conviction that aging is a disease, however, our failing not an inevitable end, leads to attempts to repair the process rather than prepare for it. Foregoing the dream that aging is curable, sooner or later – unlikely in this time of economic chaos, -- society or its politicians might recognize senility as inevitable given the longer lives that come from medical and public health victories.

Nursery schools and kindergartens abound to care for and educate those who will become citizens. Nursing homes and retirement centers now burgeoning are not yet social enterprises sponsored by the state to care for its citizens approaching their end.

Changing terms does not alter destiny. Even that blurb from UCSF listed anatomic abnormalities that come with time, to which they seemed unwilling to ascribe any cognitive decline. Come on!

Howard Spiro, M.D.
howard.spiro@yale.edu