I’m going to die. You’re going to die, too.
Yes, we are living longer than ever. But we are not immortal.
With advances in science and medicine, some of us will live what can seem like another lifetime. I’m joyful about the opportunity.
Maybe, you are too.
But a simple truth we may resist (myself included) is that many of us will not live our bonus years with health and vitality.
Nothing chirpy about that.
As pioneers in this brand new world of living long and productively, our gratitude is best paid to live well – for ourselves and as role models for future generations.
But we can’t just yahoo about an extra thirty years thinking we’ll have it all – health, vitality, creativity and loved ones. The majority of us won’t even come close to that kind of life.
So let’s be smart, realistic and open to what could befall us.
As we craft a Post50 life, each fact and factoid, possibility and challenge are just as essential in our planning as our hopes and dreams.
That’s How Long I Want to Live -75 Years
Living into our 80s, 90s and beyond often comes at the expense of quality of life.
It’s a deal breaker for scholar Zeke Emanuel, 57. In his essay for The Atlantic, “Why I Hope to Die at 75,” his reasoning is simple and concise:
“By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives, I will have seen my grandchildren born and beginning their lives, I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations.”
When Emanuel reaches age 75, he won’t actively end his life. He is a vociferous opponent of euthanasia and assisted suicide.
But he will stop seeking medical treatments to prolong it: no cancer screenings or treatments after 75, no pacemaker or bypass surgery, either. Not even flu shots or antibiotics.
His essay attracted widespread outrage (and 4,019 online comments). In a PBS interview, Emanuel states half of the people he heard from, including physicians and healthcare professionals, violently disagree with his premise. The other half, also physicians and healthcare professionals, think “I’ve got it right.”
No one would pay much attention if Emanuel were a Jerry Springer crackpot. But he’s not.
Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who served as a special adviser to the White House on health care reform, is one of the country’s most respected voices on bioethics and heath care.
Emanuel’s decision isn’t about the burden of old age to others (the cost or care); this is strategy to instill his legacy into others’ memories.
He believes a legacy of spirit is just as powerful as good deeds and achievements. If we agree, we can start a new conversation with ourselves.
If you and I want to be recalled with vigor and sensibility, joy and pleasure, as independent and industrious, how might we ensure this?
For Zeke, the data dictates that along or about 75 is the start of real decline. He wants nature to stake his mortality; for certain, he does not want a chance on the modern medicine roulette wheel.
Is that a decision you’d be willing to make?
He does not want his grandchildren to recall him as frail, drooling or passing days with a vacant stare sitting in a wheelchair. He wants those children and the rest of his family to evoke images of him with vitality.
“doing crazy things on the playground, kayaking with them in the Everglades.”
I’ve been thinking about how I remember loved ones.
My mother died swiftly of a brain aneurysm in her mid-70s so I have no images of her in decline. Recollections fill with her laughter, oomph, and sense of adventure. After a successful working life (despite four children), she was off to Vegas to relieve the cold and grey winter skies of Ohio and to the Derby each May, was active in her card club and a bit of a bi-weekly Bingo fanatic. Although she didn’t ask to accompany me on business trips to wonderful places, she was fond of saying, “Don’t forget, Barbara. I can be ready in about fifteen minutes.”
My father lived to be 95 with a sound mind, but to remember him fit and energetic is to slowly sift back through time. I work hard to recall this avid gardener as he hoes and bends for long hours to tend a bumper crop of zucchinis or multitudes of colorful zinnia’s. Old photos of a man trim and smiling in a dirty white t-shirt and dirtier pants under a weeping willow, remind me of afternoons he zigzagged a push lawnmower on a Kentucky hillside stopping often to remove his cap and wipe the sweat off his forehead with a handkerchief from his back pocket.
No, these aren’t my ‘immediate’ memories. Instead, I see him in a wheel chair, frail and trying his best to feed himself after a breaking a shoulder in a fall. And I hear his firm but embarrassed voice saying, “Barbara, can you get me that plastic thing over there because I have to pee.”
I think Emanuel’s point that memory often connects to our last images of people is spot on. You may or may not agree.
Certainly you might not be inclined to refuse medical procedures when you are 75. You might even be appalled at the idea.
Still, Emanuel has a message about our expectations for longevity that could change the course of that Post50 life you are designing.
“The numbers for Sickness American may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me.
Living long renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society and the world. It transforms how people experience us, relate to us and most important remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.” – Ezekial Emanuel
Will You Spend the Last Third of Your Life Getting Dressed on Your Own?
Are you an American immortal? I believe I was.
In that NPR interview, Emanuel confronts those of us who invest in healthy lifestyles and assume that blessings come with our “bonus years.”
“The American immortal are people who want to put off death as long as possible, want to live as long as possible and get the most out of every day out of it…it’s almost a religion for them to live as long as possible thinking they will be as vital as when they were 50 all the way ‘til the end.”
Why might people like you, me and the media focus on longevity as a kind of fountain of youth until the ever-receding time of death?
The answer lies in a quintessentially American idea and theory I never heard of until now – “compression of morbidity,” a theory proposed in 1980 by James Fries, a professor of medicine at Stanford University School of Medicine, that states “if the age at the onset of the first chronic infirmity can be postponed more rapidly than the age of death, then the lifetime illness burden may be compressed into a shorter period of time nearer to the age of death.”
The “compression of morbidity” tells us exactly what we’d like to believe; that we will live longer lives and die abruptly with hardly any aches, pains or deterioration.
According to Emanuel, it is this dream- or fantasy – that drives the American immortal and has fueled interest and investment in regenerative medicine and replacement organs.
Emanuel holds the view that as the age of countries’ populations increases over time, they will become increasingly infirm.
He argues, “Compared to our counterparts 50 years ago, seniors today are less disable and more mobile. But over recent decades, the increase in longevity seems to have been accompanied by increases in disability – not decreases.” (Italics are mine.)
This current data is Emanuel’s fuel for debunking the idea that most of us will live vibrant physical and mental lives as we age.
In the simplest of terms:
American may live longer than their parents, but are likely to be more incapacitated.
Not the sort of information I find wildly exciting to share, but in your Post50 life perhaps prioritization and taking action should be more highly prized.
No One Dies of Old Age Any More
As people age there is a progressive erosion of physical function. That’s not much of a surprise.
It’s just that devils lurk in the details:
Studies show a loss of ‘functional limitation’ of American men at 80 increased to 42% and for women result was even worse: more than half of women 80 and older had functional limitations.
The definition of ‘functional limitation’ boggles my mind.
Functional Limitation is determined by your ability to walk a quarter of a mile; climb 10 stairs; stand or sit for two hours; stand up, bend, or kneel without using special equipment.
So at 80, I’ll have more than a 50% chance of not being able to stand up without help. I knew there were good reasons I spend six hours a week building my core.
Studies also show not just physical but mental disabilities such as depression and dementia.
The conclusions found NOT a compression of sickness and disease but in fact an expansion – “an increase in the absolute number of years lost to disability as life expectancy rises.”
How can this be?
The contemporary dying process has been elongated. You won’t die of old age. No one has done this since 1950. Death usually results from complications of chronic illness – heart disease, cancer emphysema, stroke, Alzheimer’s, diabetes.
According to the CDC, about 88 percent of adults over age 65 have one chronic condition, and 50 percent have at least two.
Emanuel states, “Longevity renders many of us, if not disabled, then faltering and declining.” He argues that in their oldest years, people tend to see their creative output decline and contribute less to society.
Here’s a small sample of current statistics that made me sit up straight and pay attention:
- Over next 15 years there will be a 50 percent increase in the number of American suffer from stroke-induced disabilities. Unfortunately, the same phenomenon is repeated with many other diseases.
- Right now approx. 5 million Americans over 65 have Alzheimer’s; one in three American 85 and older has Alzheimer’s prospect of changing in the new few decades is not good. Numerous recent trials of drugs supped to stall Alzheimer’s – much less reverse or prevent it- have failed so miserable that researches are rethink the whole disease. Many are warning of a tsunami of dementia – nearly 300 percent increase in the number of older American with dementia by 2050.
- Half of people 80 and older have functional limitations; a third of 85 and older suffer from Alzheimer’s.
I Want To Be Just Like That When I’m Old
What I find compelling in Emanuel’s arguments is his targeted response to the longevity optimism you and I perhaps buy too readily.
“American immortals operate on the assumption they will be outliers. But the fact is that by 75, creativity, originality and productivity are pretty much gone for the vase, vast majority of us.”
We hold onto outliers for hope according to Emanuel while he prefers to deal in data.
A typical response to Emanuel’s premise of a drop in the quality of life after 75 is to start to name all the people we know who are leading productive, vital and engaging, aged-be-damned lives.
A list that could include:
- Jimmy Carter, 91, advances human rights through Carter Center, makes furniture, paints and is writing his 28th book
- Betty White, 92, star of the hit show, “Hot in Cleveland”
- James Earl Jones, 83, starring on Broadway in a revival of “You Can’t Take It With You.”
- Angela Lansbury, 88, now starring in “Blithe Spirit” on London Stage
- Charles Osgood, 81, host of CBS Sunday Morning
- Queen Elizabeth, 88, Head of State of the UK and 15 other Commonwealth realms has reigned for over five decades
- Dianne Feinstein, 82, Senator from California
- Tony Bennett, 88, appearing with Lady Gaga in London (first show sold out; they added a second) to promote their new album, ‘Cheek to Cheek’
It is true people can continue to productive past 75 to lead, perform, write and publish, draw, carve, sculpt and compose. Along with these recognizable individuals, each of us has our own personal list of people living in productive longevity.
These stand-out older people – famous or not – are fun to watch and follow. We’re buoyed in spirit for our future and perhaps less mindful that these individuals are winners in the lottery of the bell curve for physical and mental vibrancy.
Individuals with good health and vitality are “outliers” according to Emanuel. Plain and simple fact.
With the population of the United States at 316 million, Emanuel says you can give him of thousands and it won’t change that bell curve which stipulates not everyone will end up there.
‘Outlier’ – add this to your list of scary words.
Dreams and the Data
Want to thank me the doom and gloom? You’re welcome.
With less time than ever ahead, Emanuel’s provocative essay should be in your card catalog of valuable information as you craft a Post50 life.
But will you absorb and use the evidence to adjust your mindset and, perhaps more importantly, your plans?
The likelihood of losing vitality, health and creativity is information that can be processed in two ways:
- Ignore it and Tootle Happily into Your Future of Anticipated Health and Vitality. This choice will fit many people. I’m not against it. The American immortal philosophy combined with a three-times a week senior kettlebell workout could get you on and off a Mongolian trek and to a completed first draft of your first novel. Demise? Deal with it if it comes.
- Give Thoughtful Consideration, Spotlight and Rank Options. Choose this option and your Post50 life design takes on more motivation to stack ideas against one for clarity and priority. The plan for your life focuses on chosen actionable items within a time frame that emphasis sooner not later.
All of us will act on an uncertain future. Neither of these options ensures a spot on the winning right, flattened end of the bell curve.
But if you’re working with me to craft a future life, you’ll now pause to consider the data and tell me which of these two operating philosophies you want to guide your work.
Personally, my dreams and this current data are colliding.
Plans for living/working in the northeast corner of Argentina for my annual three- month get-away in 2015, will stretch my budget and logistics,as well as housing, have challenges.
Salta is so very intriguing, but seemed best deferred for another time.
That is past-tense information processing. Two months instead of three can ease the budget and perhaps a B&B instead of my own place this year might work.
Now, I lean toward making this happen.
You know, in case I don’t end up as one of the ‘green people’ on that bell curve.
What do you think?
Photos: Salta Catedral Basilica by Victor Ruiz Caballero for The New York Times; Others by B. Pagano