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Queen Elizabeth II at 90: does old age affect a monarch’s ability to reign?

Queen Elizabeth II at 90: does old age affect a monarch’s ability to reign?

Modern British monarchs may have it easier than their forebears – but strength, intelligence and a hearty constitution are just as necessary today as they were in the Middle Ages. This may seem surprising. After all, as a constitutional monarch, Elizabeth II reigns but does not rule. She may have been given the Sword of State at her Coronation “for the terror and punishment of evildoers” but she isn’t expected to swing it herself.

By contrast, Richard the Lionheart (1157-1199) did so enthusiastically until a crossbowman eventually shot him. However Lionheart wasn’t expected to attend about 400 engagements a year, give out the Queen’s Award for Enterprise or chat to loyal subjects. Although separated by almost a millennium, both monarchs have had to manage Royal Estates as part of the job. The Queen seems the better of the two at this. Lionheart once said he would sell London if he could find a buyer.

So how well can a nonagenarian do the job of being a monarch – or, to be slightly more egalitarian, discharge the role of a constitutional head of state?

Fit for the job

Looking at her diary it seems to be a slow day when Elizabeth II doesn’t have some official duties to perform. There’s a lot of travel and standing around involved, so she need to be physically fit. She’ll need to stay mentally alert for all those constitutional briefings and regular meetings with the prime minister. And, if she’s to survive all those visits to hospitals, Elizabeth II needs a reasonable immune system.

Therefore, in social gerontology terms, the Queen needs to have the appropriate level of “work ability”. In essence this is a proper balance between the capacities of the individual and the work he or she does. Work ability subsumes a wide range of factors including the right values, attitude, knowledge and skills to discharge the job (compared to most of us the Queen has the benefits of extensive prior training and considerable work experience). However health is a major determinant of work ability in general and the royal role in particular. So just how healthy are Britain’s very old people?

At first sight the data is not encouraging. The Newcastle 85+ study of about 1,000 men and women which is roughly representative of the population of the UK found that about 90% of participants had at least three distinct clincial conditions (out of a possible score of 18). Women were between six and ten times more likely than men to have rheumatoid arthritis, osteoporosis and thyroid problems and overall had significantly higher levels of disability.

Many of the problems reported by 20-40% of this cohort could compromise the discharge of royal duties including incontinence, falling and visual impairment. Given that listening to politicians is an important part of the role, readers may wish to decide for themselves if advancing age has conferred an advantage or a disadvantage on the two-thirds of the cohort who report hearing difficulties.

High-class health

Thus, if she wishes to continue working, it might seem that Elizabeth II has the odds stacked against her. However she does have three potential advantages. Firstly she has blue blood, and in the general population there is an (approximately) linear relationship between healthy life expectancy and social class.

Women from social class I (doctors, chartered accountants, professionally qualified engineers, etc) can expect to live about 80 years in a fairly good state of health. In contrast, healthy life expectancy at birth for unskilled women is only about 69 years. Thus Elizabeth II has a good chance of being healthier than one of her average subjects.

Immortalised youth. Alastair Grant / AP/Press Association Images

Secondly, data from the 85+ study indicate there is a good chance that she feels positive about her health in general (and indeed the same study shows she is less likely than a man of the same age to develop atherosclerosis or cancer). Thus, palace coup d'état being a thing of the past, she may feel she can continue working.

Lastly, unlike those of her ancestors who continued to reign into old age such as Edward I (who died at 68) or Elizabeth I (who died at 70), Elizabeth II lives in the era of science. We now know that ageing occurs because the fundamental mechanisms which keep us in good health start to fail. Enough is already known about these to use that knowledge to improve vaccination responses in the elderly using a selective inhibitor of the TOR protein which may also be beneficial for cognitive impairment. A major study aimed at improving late life health using a cheap and simple drug – metformin – is also planned.

While an enhanced immune system is certainly a bonus to a older monarch who spends a lot of time opening hospital wards, it is equally valuable to those of us who would rather avoid them. Indeed if the full potential of the new science of ageing can be translated into clinical practice, then a time in which inclination, rather than ill health, is the primary determinant of remaining in work may be nearer than you think.

Which may or may not be good news for the Prince of Wales.