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Ageing
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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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6 min read

Cost of living crisis: faith and food banks combine to tackle destitution and its causes

The Trussell Trust wants food banks in its network to reduce the need for their services. Robert Wright finds out why the trust regrets they still distribute so much food.

Robert is a journalist at the Financial Times.

 

A man stands in front of a food bank's shelves of cereals and boxes labelled by foot type.
Howard Wardle at Eastbourne's food bank.

When Howard Wardle was making plans to set up a food bank in Eastbourne, in East Sussex, he received little support from his fellow church leaders. Speaking in the industrial estate warehouse that has been the food bank’s headquarters since 2017, Wardle recalls how at a meeting called to discuss the idea he largely encountered bafflement. At the time, Wardle was pastor of the town’s Community Church. 

“They said, ‘There isn’t a need in the town – you’re wasting your time doing it’,” Wardle says of the meeting in 2011. 

Wardle nevertheless received encouragement from Eastbourne’s Citizens’ Advice Bureau, from the major of the local Salvation Army congregation, the local authority’s social services – and the Trussell Trust, the UK’s largest organiser of food banks. The food bank, of which Wardle is now chief executive, last year handed out 280,000 meals. 

Yet for Wardle and the Emma Revie, the Trussell Trust’s national chief executive, it is a matter of regret that its members are distributing so much food – organisations affiliated with the Trussell Trust handed out 2.99mn parcels in the year to March 2023. The figure was a 37 per cent increase on the year before, a rise largely down to the cost of living crisis started by the spikes in energy and food prices following Russia's full-scale invasion of Ukraine in February 2022. 

“It’s incredibly worrying and upsetting that so many people – more people – are having to come to food banks,” Revie says. 

Workers at the Eastbourne Foodbank and others nationally are following a strategy of campaigning for policies that seek to ensure no one needs to seek emergency food support. They also employ staff who help clients to navigate the benefits system, prepare for work or take other steps to find a permanent solution to their problems. 

“We were absolutely resolute that enough is enough. We needed to do whatever we needed to do to reduce the number of people needing to come to food banks.” 

Emma Revie

The Trussell Trust centrally provides organisational support for affiliated food banks but deliberately does not undertake functions such as purchasing food. 

Revie says it adopted the strategy of trying to put itself out of business five years ago, after experiencing significant growth in demand for its services. The trust was founded in 1997 in Salisbury by Carol and Paddy Henderson, a Christian couple. Christian principles have been core to the trust’s operations ever since. 

“We reached a decision point where we either had to accept that this situation was likely to increase and would always be needed or we had to decide that that was not acceptable and change the way we thought about our work,” Revie says. 

The trust recognised how inadequate food parcels were to the fundamental needs that member food banks were seeing among clients, she adds. 

“The reason people are coming to food banks is they don’t have enough money to afford the essentials,” Revie says. “They know it’s not going to put credit on the gas meter. They know it’s not going to pay for school shoes.” 

The organisation had to decide whether it accepted as inevitable that so many people needed its services or would reorient itself towards working to end that need, she adds. 

“We were absolutely resolute that enough is enough,” Revie says. “We needed to do whatever we needed to do to reduce the number of people needing to come to food banks.” 

“We’re not just here to get people on benefits. If we think they can work, we try to encourage people to get into work.” 

Robert Crockford

In Eastbourne, the strategy of reducing dependence on food banks has been in place from the start, according to Wardle. 

“When we started, we felt it was one thing to have a food bank giving out food but another to have people not need to come to food banks,” he says. 

After receiving some grant funding, the food bank took on staff to help clients to resolve their financial problems and ensure they were receiving all the welfare benefits to which they were entitled. 

“We built a welfare benefits team, a debt team and a medical benefits team so that we could help clients,” Wardle says. 

Robert Crockford, the food bank’s senior advocacy officer, says he helps food bank clients to navigate issues such as the two-child limit and the overall benefits cap that restrict the amount benefits recipients can receive. 

The two-child limit stops parents from receiving child benefit for any more than two children if the additional children were born after 2017. The benefit cap - £283.71 for a single person living outside Greater London – was introduced in 2013. It limits the total amount a person or family can receive from the system. 

Crockford explains that he seeks to help clients to explore whether they count as disabled, a carer or have some other status that might enable them to receive higher benefits. 

The group also works with People Matter, a charity that helps to prepare people for work. 

“We’re not just here to get people on benefits,” Crockford says. “If we think they can work, we try to encourage people to get into work.” 

Revie bemoans the overall inadequacy of the benefits system, pointing out that many recipients of Universal Credit – the main income-support benefit for most people who are unemployed or on low incomes in the UK – cannot afford food. 

“When almost half the people on that benefit are unable to afford food, something systematically is failing,” she says. “So do you tackle the symptoms or do you tackle the actual problem?” 

That emphasis on tackling problems is clear at another food bank affiliated with the trust – in Kingston, on the south-western edge of London. 

Ian Jacobs, director of Kingston Foodbank, says his organisation works closely with Citizens’ Advice to try to develop permanent solutions for people seeking help. 

“We do deep-dive investigations into people’s circumstances to try to see if we can get more money into people’s pockets,” he says. 

Kingston Foodbank currently operates six foodbank centres and one pantry, where referred clients can select and buy reduced-price food. Jacobs says he would like one day to reverse the proportion, so that it operates six pantries and one food bank. 

Jacobs, a member of the Doxa Deo Community Church, an independent evangelical church, also makes it clear that many volunteers are working at the food bank out of Christian conviction. 

“We’re always open to pray with clients,” he says. 

Revie says the trust is “deeply rooted” in the local churches. 

“Many of our volunteers and staff are motivated in the work that they do by their Christian faith,” she says. “Our values of community, compassion, dignity and justice are deeply rooted in the Christian faith.” 

Revie points out that the trust was founded by Christians and that its network grew through approaches by individual churches to the trust. 
"We as an organisation work with people of all faiths and none and we certainly support people of all faiths and none," she says. "But we are deeply rooted in the local churches and many of our volunteers and staff are motivated in the work that they do by their Christian faith,” she says. 
Faith has a "very special role to play" in the trust's work, Revie adds. 
 “Our values of community, compassion, dignity and justice are deeply rooted in the Christian faith," she says. 

“We don’t believe there should be food banks in today’s society,” Jacobs says. “That’s why we do all the extra work to make sure people aren’t dependent on the food bank.”