The Greying Of Everest...



Posted by Jeremy Windsor on May 21, 2021

Within 20 years it is believed that almost a quarter of the UK population will be aged over 65. According to the Office of National Statistics this could amount to as many as 20.4 million people by 2037. Many will be venturing into the mountains and want to know what they can safely do. In this post we’ll try to answer a question about how ageing impacts upon the chances of summiting Mt Everest. To help us think through the wider implications of this question, we've also asked several experts for their thoughts...


“I retired in my late 50’s with a good pension. Much of my time since has been spent in the outdoors and I’ve really enjoyed exploring the mountains of the UK and Europe. I have kept myself pretty fit and rarely trouble my GP. What I want to know is, will my age (61) count against me at high altitude (and in particular, on Mt Everest)?”

 

Sometimes a mountain medicine question comes along that is possible to answer with evidence. This is one of them! Last year, a team from the University of Washington published a study looking at the impact of age upon the chances of safely summiting Mt Everest. Using the brilliant Himalayan Database to source their data, the researchers were able to show that climbers on the mountain were getting older*. Prior to 1989, only 16.7% were aged over 40. Between 2006 and 2019 this had increased to 54.1%. An even more dramatic increase was seen in those climbing over the age of 60 with a rise from 0.1% to 16.7% over the same time period.

 

The oldest person to climb Everest is Yuichiro Miura who reached the summit on the 23rd May 2013 at the age of 80 years and 223 days. Unfortunately, he was unable to descend from 6500m and needed to helicopter evacuation


Given the “greying” of Everest, what impact does age have upon the chances of reaching the summit? To answer this, the team compared the results of 1626 who climbed between 1990 and 2005 and 2255 who climbed between 2006 and 2019. In both groups the probability of summiting, for both men and women, started to decrease rapidly from about the age of 40.  However it’s not all bad news for older climbers. Those who visited Everest between 2006 and 2019 were almost twice as likely to summit than their predecessors. This was seen across all age groups!

 

The probability of summiting Mt Everest according to age. The lines show the probability of summiting in the years between 2006-2019 (blue) and 1990-2005 (red)

 

Of course, summiting Everest is only part of the story. What effect does age have upon the chances of dying on the mountain? Irrespective of age, the incidence of death on Everest is steadily falling. Overall, for the period between 1990-2005 and 2006-2019 the researchers found that death rates fell from 1.6% to 1.0%. These tended to be commoner in older climbers. For 2006-2019, those aged 60 or older were approximately 5 times more likely to die than younger climbers. However, it’s worth pointing out that the risk of death is falling even in older climbers. The researchers illustrate this by highlighting that, “a generic 60 year old climber in the recent sample (2006-2019) has roughly the same death probability as a generic 48.5 year old in the early sample (1999-2005)”.

 

The probability of dying on Mt Everest according to age. The graph highlights the finding that a generic 60 year old climber in the recent sample (2006-2019) has roughly the same probability of death as a generic 48.5 year old in the early sample (1999-2005). The lines show the probability of death in the years between 2006-2019 (blue) and 1990-2005 (red)

 

So, to answer the question, the University of Washington team found that age is an important factor on Mt Everest - the likelihood of summiting falls and death increases once you’re over 40. Whilst these have declined in recent years they are nevertheless still apparent. We asked several experts what it was about age that increases these risks and what older individuals can do to help themselves enjoy the wider mountain environment. Here's what they wrote...


Andy Luks is a respiratory physician and intensivist. He is lead editor of the definitive textbook High Altitude Medicine and Biology (6th Edn)...

“Age, in and of itself, should not preclude activity in the mountains and, in particular at high altitude. I suspect there are several key factors that will determine how well someone of advanced age will tolerate being in this environment. The first is exercise capacity.  Whilst maximum exercise capacity does decline with age, there is a bell curve distribution. Therefore, there will be a range of performance around the average VO2max for a given age and, as a result, some individuals will still retain enough exercise capacity with ageing to be able to perform meaningful physical work at high altitude. 


VO2 max is defined as the maximum amount of oxygen that can be utilised by the human body over a given period of time. It is typically measured in mls of oxygen per kg body weight per minute and is often used as a marker of aerobic fitness. Whilst VO2 max falls markedly with age, this can be offset by exercise. Mariko Yugeta recently set a new women's marathon record for her age group. Her time? A dazzling 2 hours and 52 minutes. Her age? 62


The second is the presence of underlying medical conditions. As individuals age the likelihood that they have some medical condition that could affect performance at high altitude increases. The more severe and/or the greater the number of problems that affect cardiopulmonary responses to hypobaric hypoxia, the higher the likelihood they will not tolerate high altitude travel very well. Conversely, the absence of any significant disease, particularly when paired with above average exercise capacity, would lead one to expect better tolerance of and physical performance  at high altitude".


 This graph from John West's landmark AMREE** study shows just how precipitously VO2 max falls with an ascent of Mt Everest. The x axis is the partial pressure of oxygen and was measured on 4 occasions during the study. As altitude increased the partial pressure of inspired oxygen and VO2 max (y axis) fell precipitiously. If VO2 max is already reduced at sea level, during summit day on an 8000m peak this may tread perilously close to the basal oxygen requirements needed to sustain life


Jon Morgan is an anaesthetist and UIAGM guide...

"My feeling is that the increase in morbidity and mortality amongst ageing mountaineers is multifactorial, with often subtle factors compounding each other. As well as the obvious effects of increasing incidence of comorbidities, there are a number of other factors that I think all affect older climbers, to a greater or less degree. Sarcopenia (1% muscle mass loss per year after age 45-50) becomes highly significant after 2-3 decades and if you combine this with deteriorating vision, slower reaction times, less good balance, worsening cold tolerance and delayed recovery time, then I think it is entirely unsurprising that older mountaineers do less well. I also think older people are sometimes more stoic and reluctant to take breaks, perhaps because they aware of moving more slowly, resisting the temptation and the need for frequent nutrition and hydration."


At 85, Min Bahadur Sherchan, a former British Gurkha soldier, was the oldest climber to attempt Mt Everest. Unfortunately, Min died at Base Camp before he was able to make his bid for the summit


Picking up on Jon's comments about stoicism, here's expedition doctor and GP Hannah Lock...

“In my experience, the people who have not summited (mostly due to moderate altitude illness or exhaustion) have all been under 35 years old! The older group members generally seemed to pace better, took more rest opportunities, generally seemed more stoic and were happier to tolerate a bit more suffering than our younger members. (There were of course exceptions to this!)

However, in terms of risk of not submitting and even death with increasing age on Everest, my thoughts include:

- Increasing comorbidities with age (including undiagnosed issues) therefore higher risk of medical problems related to altitude, cold, exhaustion etc.

- Generally less fit than younger climbers, therefore have less physiological reserve to push further/faster if required e.g. if they need to get down quicker due to bad weather or because they don't feel well.

- Possible differences in psychology - in my experience there is less risk taking behaviour in older climbers (especially compared to much younger climbers). Older ones are more likely to back off if circumstances change and when they reach their agreed time limit, compared to younger climbers who may be more inclined to push further therefore achieve summit success.”


In the 5th edition of High Altitude Medicine and Physiology, the editors pithily concluded that, "anyone who can manage a full day walking on hills at low altitude without undue strain is likely to be able to enjoy a standard Himalayan trek..."


Tom Richardson, mountaineer and leader of countless expeditions...

“I can't really comment on what it is about age that increases the risks, other than to guess physical deterioration, not acknowledging physical deterioration, mental deterioration, a sense that the clock is ticking and it is a last chance etc.

Here are some thoughts on what individual's do and can do...

1.Deny Ageing 

Denying ageing is usually thought of as not making practical provision for old age. Governments are interested from a cost of personal care needs angle, for maybe the last 3 years or so of life.

A positive reason why people deny ageing though is that all other life stages are aspirational, whilst the stage after old age - death, is not.

Mountaineering, particularly on Everest may be a bit of denying ageing by being able to do it and trying to live forever (by being known to have done something supposedly worthwhile). Also I suppose nobody has died of old age on Everest!


Pete Boardman was one of the outstanding mountaineers of his generation and a highly accomplished writer. His "The Shining Mountain", an account of climbing the extraordinary west face of Changabang, is arguably one of the greatest books in mountaineering literature


2.Legacy and the Value of Experience.

Mountaineering and climbing achievements of several decades ago may be perceived by others now to be easier or less than they seemed at the time and /or they actually are less.There is much more prior knowledge, more people doing it and better gear etc. For example, a HVS rock climb in say 1973 was quite something. To climb a major alpine north face unheard of (I never met anyone who had climbed an alpine north face until I met Pete Boardman, a hero, not a contemporary). The first ascent of a non technical 6K Himalayan peak was newsworthy and potentially reputation forming in the appropriate circles. Now it could be part of a package holiday. So, if a person's history becomes of less value, it can drive them to continue to try to achieve /prove things that are somehow perceived to be of value or status.

Everest is an obvious choice and symbol, but perhaps not the most suitable. Going to the Moon may be another such ambition in the future. I don't think it works. Doing either will not make anyone Ed Hillary or Neil Armstrong. It will still be an expensive package holiday and not go down in the history books if that is the aim.

Just going to places, choosing and doing loads of stuff for oneself that gives satisfaction, a sense of achievement and pleasure would I think give most people a lot more meaning.

 Some people write an autobiography to "set the record" for what their life was worth. Chris Bonington, Jim Curran and Doug Scott all come to mind. I took a chap called Ken Hanson to Rongbuk and celebrated his 73rd birthday when he was on a personal project to produce a book of black and white full format images of all the 8000m peaks. Two years later we went to Cho Oyu. His book won awards at Banff. It is his legacy. He was pleased to receive acknowledgement but probably hardly sold any books.

An autobiography does not need to be published though, just written.

Another option is of course not to worry too much about what other people think.


A review of Ken Hanson's "Himalayan Portfolios - Journey's of the Imagination" concluded, "Most people know that the Himalaya are the grandest mountains on earth, but even with the familiarity we have with them, they never fail to astound when captured by the right photographer. Ken Hanson has done us all a great service by putting this book together"


3.Delaying Decay

Although people are living longer there is a period when life changes from being plentiful to being finite and drives people to do things while they can, hence the famous "Golden Years" of retirement. This is often a small window of opportunity in which lots can be enjoyed and achieved. I have had quite a few very newly retired people coming to climb in Ruwenzori, Mongolia, Nepal or trek to see K2 for example on the first few weeks of retirement somehow capturing the elusive moment. Knowing when the window is closing is difficult to identify the more you do.

Another time stopping strategy is to do things that are not necessarily at your limit. I'm in the great, but odd position, of having the opportunity to climb some of the same mountains every year for Karakoram Expeditions. In doing so I can assess any decline on reclimbing Mera Peak. It will eventually lead to failure/disappointment. It is impossible to know that there is a mind and body incongruity until you are testing both.

Of itself, redoing previous activity is also not enough, it is just mind and body maintenance and the springboard to doing new things...”


With almost 20 expeditions to 8000m peaks under her belt, here's Monica Piris with her thoughts...

“Since my first ever Everest expedition in 2007, my personal experience of the demographics of the teams coincides with what you’d expect: on the commercial trips I have worked for, it is no longer unusual to have one or more team members in their 60’s, sometimes close to 70.

To be honest, the age itself doesn’t actually catch my attention that much as I look through the medical information of potential participants. The presence of chronic medical conditions is more relevant, and of course, this is more likely as people get older, but in general, those with aspirations to climb Everest tend to have a fairly clean bill of health. I’ve had many climbers  succeed seamlessly on Mt Everest with prosthetic joints, well controlled hypertension and other conditions that we normally associate with patients older than 50. If there is a PMH, each condition needs to be carefully considered in the context of ascent to extreme altitude, how things may change, possible side effects of medication or interaction with medicines that may be used to treat altitude illness. Insurance companies must be thoroughly briefed to ensure they will provide cover.


Since turning 60, Carlos Soria has climbed 11 of the world's 8000m peaks. He was recently quoted as saying, "I've lost some stability in my legs, a bit of strength, a bit of mental sharpness ... But when I've been to the Himalayas I've never felt like the old guy who is just going to see if he can manage." He added, "Elderly people have this idea that it's game over for them ... there are lots of people who say 'well, I'm already 70', but so what? That's a wonderful age!"


In my opinion, the things that will positively affect the chances of success are actually fairly independent of a climber’s age. Alongside meticulous and diligent preparation, the most important thing is for the climber to be absolutely honest about how much support they will need on the mountain, and then to ensure that they choose an appropriate guiding company that can meet those needs. This is true for climbers of all ages; delusions of grandeur and mountaineering savoir-faire do not do well above 8000m!  If this decision is taken carefully, the chances of success are unlikely to be negatively affected by age. There are 30 year olds who need maximum support, and 70 year olds who can independently climb unclimbed Himalayan peaks. Give me a fit, experienced 60 year old over and above an arrogant, inexperienced 30 year old any day! 

Just to add some anecdotal encouragement to the more mature Everest aspirants:  this year two very close friends of mine, both mountain guides, one a few months off 60 and the other over 70, will be guiding teams on  K2. Both of them are in fantastic health and have the strength, reserve and experience to be two of the strongest guides on that mountain. Age is just a date of birth, a number…it’s what you’ve done with that number over the years that will predict what you will continue to do with it as it enlarges! As far as Mt Everest goes, humility begets success. Age is largely irrelevant! 


As far as high altitude illness goes, Robyn Johnston agrees...

"If I was asked whether age increases or decreases risk of Acute Mountain Sickness (AMS) I would probably say that in my experience it is actually often the young males who tend to get sick. It's the fit, healthy 20-30yr old who want to be at the front of the group all day and push hard despite advice to take it easy, are the ones who suffer!  So I found this study on Everest fascinating. There are other studies that have looked at age and altitude that have found no correlation and I wonder if this study at an extreme of altitude, holds true at more moderate heights such as 3000-5000m? 

There is definitely a link between exertion at altitude and the risk of altitude illness and, as we often tend to lose fitness as we age, I wonder if this might be one of the factors that comes into play. With decreased muscle strength and decreased cardiorespiratory reserve maybe the older person has to exert themselves more to achieve the same objective, therefore putting themselves at higher risk of AMS? Similarly, as we age we are more likely to have medical conditions which might impact our fitness or acclimatization and make us more sensitive to changes in physiology. For example a very mild and usually insignificant renal impairment might suddenly become very significant if dehydrated. 

I think the advice remains the same no matter the age. In order to get the most out of your mountain experience aim to keep yourself active and moving in your daily life, before the trip make sure to include some training on uneven ground wearing a pack (and the other gear you'll take) and when you do head out into the mountains (especially at altitude) maintain a conversational pace and stay well hydrated and nourished!"  


Finally, the last word has to go to David Hildebrandt...

“It is ominous when one is invited to comment on mountaineering for the ageing population. Knowing I am not an academic expert in care of the elderly this must mean Jeremy just sees me as a declining mountaineer. This may be true but I remain a happy mountaineer!

To look at this question one has to consider what one really values in mountaineering. For me it is the friendships, the excuse to explore remote places, the beauty of nature and wild places, the peace, the challenge of crossing complex terrain in safety, the subtlety of a series of technical rock moves away from protection, the satisfaction of a new rock or ice route or an unclimbed summit. The beauty can be in a stream trickling down a Dartmoor valley, the wild Atlantic reflecting Cornish granite, the view from an Alpine peak or the storm clouds over a Munro as one drags a knackered body home from an ice route.

Being a diligent blogger and aware of the medical interest of our readers I took Jeremy's request seriously. I read his blog and clicked on to the link to the paper on Everest. Climbing is about pleasure and excitement but within a few paragraphs I was bored. Everest was reduced to statistics and analysis. It was not based on the ethos of mountaineering but on summit success and death on what has sadly become a trophy peak. Most of those now attempting the peak are not actually mountaineers and will soon move onto their next indulgent project. This data has little relevance to mountaineers. Many mountaineers have joined an expedition, never reached the summit and had a fantastic trip.   


“Four Against Everest" is an account of a small expedition's attempt to make only the 4th ascent of the mountain. The author, Woodrow Wilson Sayre wrote, "We made three basic decisions in planning for Everest. We were going without permission, we were going without Sherpas, and we were going without oxygen...". Sayre's book has provided inspiration to generations of climbers who have struck out on their own and tested themselves on the world's highest peaks


Enough rambling from a grumpy old man. Let's look at some key points when advising the older mountaineer who will almost certainly have known or unknown pre-existing medical conditions: 

If they are on a commercial expedition determine if they are actually experienced mountaineers or simply ticking the bucket list? Their appreciation and attitude to risk will be totally different.

Are they at peace with the idea of dying on the trip possibly of an age related co-morbidity. Have they been climbing so long their family understand their attitude?  

If on a mates trip have they considered their increasing age in relation to the objective? Beware if they are living on memories and dreams.

As a mountain medic are you able to advise on suitable objectives? With arthritic joints an ice route near a road in Norway may be more suitable than a remote Scottish crag. With angina a low virgin summit in Patagonia may be more realistic that an unclimbed 6000m peak.

Your job is to enable people once you are convinced they understand the medical and objective risks.

 

Please allow the old man the indulgence of a reference:  

Szawarski P, Hillebrandt D. Patient-Centred Mountain Medicine. Postgrad Med J 2016;0:1–2. doi:10.1136/postgradmedj-2016-134096"


Piotr and David's article is well worth a read. Let me know if you need a copy!

Thanks to all those who contributed to this post - very much appreciated!


*A quick note on the methodology - the study only included those making their first attempt on Mt Everest by a commercial route in the Spring season and excluded all high altitude porters and guides. In addition, "we excluded all records for 2014, when the Nepalese side was closed after an avalanche killed 16 high-altitude porters, and for 2015 when the mountain was again closed after an earthquake". 

**In the autumn of 1981 well known physiologist John West led a group of researchers on an expedition to Mt Everest. During their ascent, volunteers underwent VO2 max testing at 6300m. Using gas mixtures of 16 and 14% oxygen, it was possible to simulate higher altitudes on the mountain. The latter provided an inspired PO2 of 42.5mmHg - a value comparable with that found on the summit.


Want to read more about climbing Mt Everest? Take a look at this! Or more on practising medicine in Nepal? Here! Dengue fever is a growing problem in Nepal. Take a look at this for more information.

NEW DATE...

The Birmingham Medical Research Expeditionary Society (BMRES) and the British Mountain Medicine Society (BMMS) have joined forces to organise the 2021 Altitude Research Conference. The face-to-face event will take place in Birmingham on the 11th September. Speakers will include Peter Bartsch, Jo Bradwell and Chris Imray. There will also be presentations from members of the UK's leading research groups as well as ample opportunity for researchers, young and old, to present posters and short talks about their work.

Further details can be found here.

If you would like to find out more about mountain medicine why not join the British Mountain Medicine Society? See this link for details.


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