Too many of our current generation of older men and women have inherited an image of inevitability about the process of ageing that fails to take into account the value of approaching it with creativity, with the possibility that it can be a form of art. And here again I turn to a dictionary, this time the Oxford English Dictionary, which defines art as "skill as a result of knowledge and practice", and then skill as "ability to do something well; proficiency, expertness, dexterity; ability to do something acquired through practice or learning." It is precisely this - practice and learning - that need more emphasis.

We must study how to be old. Although such an undertaking is best begun in one's middle years, it can be done at any age. We have unknowingly begun it when we are much younger, not only by the increasing experience of life, but by deliberately reflecting on that experience so that it can be called upon when needed during the later years.

Researchers in neuroscience now tell us of what they call the brain's plasticity: its ability to absorb new information and even to change at the microscopic and biochemical level regardless of how old we are. The connections that transmit thought change for the better each time they are stimulated with new knowledge or concepts. The more the circuits are used, the more of certain protein substances are produced, which increase the number and effectiveness of brain cells, and add to the tiny blood vessels that nourish them. Even the old belief that we cannot make new brain cells has been disproved. Lost, damaged and impaired cells can be replaced, and an increased population of new nerve cells can occur in certain locations in the brain, originating in adult stem cells.

 

But none of this will happen unless we regard ageing as an art and a creative time of life. How the elderly brain is used has a profound influence on its ageing. In the absence of major organic disease, it is properly said that the brain determines its own ageing.

The benefits of deliberate constructive activity apply as much to our physical selves as our mental. Regular exercise, preferably supervised and preferably vigorous, is in itself an art form if carefully planned. In addition to allowing for a more active life, it significantly decreases the likelihood of osteoporosis and the consequent fractures that are the anxiety - and, too frequently - the assassins of the elderly. In addition, certain of the brain-building protein factors are increased by exercise, as is one's general sense of well-being, optimism and self-regard. There have even been reports that exercise decreases the likelihood of certain forms of cancer.

All of this is to say that being elderly is neither more nor less than another progressing stage of life, the one beyond middle age. Like all the preceding stages, it has its problems and its rewards. And it has its potential for growth that is much more available to each of us than has been imagined by any but a few visionaries. The era of passive surrender to what have been presumed to be its unavoidable negatives can now end. If art is properly defined as "skill as a result of knowledge and practice", to be an artist of this kind of creativity is - barring serious illness - within the reach of most of us.

Dr Sherwin Nuland is a clinical professor of surgery at Yale University. His latest book is The Art of Ageing.