My last post concerned death. This one does as well. Lest you think I have changed my blog to Death in the Boomer Lane, let me assure you this isn't the case. After today's post, I will return once again to less weighty issues, in which I can incorporate satire, immaturity and coffee Haagen Dazs (which involves weight, but is not "weighty.")
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Ezekiel Emanuel has written a provocative piece in this month's Atlantic, titled "Why I Hope to Die At 75." Emanuel, age 57, makes it clear that he has no plans to end his life at age 75. His piece simply presents, in a pretty compelling way, the reality of life after 75 for most people and the consequences of extending life farther and father beyond that point. His message is clear: Death at age 75 is a loss. So is life after age 75.
Lest you are now sputtering and foaming at the mouth, either because you are rapidly approaching age 75 or because you have lots of evidence of people around you who are well older and still living the good life, I say, settle down. Yes, our lives are getting longer, and yes, both society and pharmaceutical companies promote the idea of seniors living healthily and happily until some moment in the distant future, when they will vanish in some kind of pain-free poof, most likely while salsa dancing on a Caribbean cruise ship. But the reality is a bit different.
As Emanuel says,
It is true that compared with their counterparts 50 years ago, seniors today are less disabled and more mobile. But over recent decades, increases in longevity seem to have been accompanied by increases in disability -- not decreases... health care hasn't slowed the aging process so much as it has slowed the dying process. And, as my father demonstrates, the contemporary dying process has been elongated. Death usually results from the complications of chronic illness -- heart disease, cancer, emphysema, stroke, Alzheimer's, diabetes.
That's the nutshell. We have the ability to cheat death, but there is a cost. And sometimes that cost is high, both in terms of dollars and personal comfort. As Emanuel puts it, "So American immortals may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me."
Here are some hard facts, according to Emanuel: Right now approximately 5 million Americans over 65 have Alzheimer's; one in three Americans 85 and older has Alzheimer's. And the prospect of that changing in the next few decades is not promising. We still have no cure. Instead of predicting a cure in the foreseeable future, many researchers are warning of a tsunami of dementia -- a nearly 300 percent increase in the number of older Americans with dementia by 2050.
Half the population over age 80 have functional limitations. Most have experienced a major erosion of their creative and productive abilities. Again, according to Emanuel,
We accommodate our physical and mental limitations. Our expectations shrink. Aware of our diminishing capacities, we choose ever more restricted activities and projects, to ensure we can fulfill them. Indeed, this constriction happens almost imperceptibly. Over time, and without our conscious choice, we transform our lives. We don't notice that we are aspiring to and doing less and less. And so we remain content, but the canvas is now tiny. The American immortal, once a vital figure in his or her profession and community, is happy to cultivate avocational interests, to take up bird watching, bicycle riding, pottery, and the like. And then, as walking becomes harder and the pain of arthritis limits the fingers' mobility, life comes to center around sitting in the den reading or listening to books on tape and doing crossword puzzles. And then ..."
I hear some of you shouting and see you foaming at the mouth, hurling examples of elderly people you know who are still driving and working and creating and being vital. I know those people, as well. I am in awe of them, and I want to be them at that age. But they are in the minority. And I am still 10+ years away from the ages Emanuel speaks of. But if I am very honest with myself, I can sit back and take stock of the things I can no longer do. It's a long list. It's getting longer.
Has my own life diminished? Physically, absolutely. Creatively, thank goodness not. In all other ways that count? Mostly not. I simply avoid stairs and inclines when I can. I can no longer dance all night. I hesitate to get down on the floor with my young grandchildren. I can no longer carry the volume of clients I used to. I am finding it more difficult to remember the material I read. The bottom line is that I can see clearly exactly what Emanuel is saying. The future used to be a bright and shiny object. It is now a bit dark and scary. And it is getting closer. Every single day.
Like Emanuel, I have no plans to end my life at age 75. If I am one of the lucky ones, I will continue to make concessions. But I will still be independent and my health issues will not severely compromise the quality of my life. On the other hand, I know certain things. I know that given the opportunity to extend my life for a few months or a year by taking a debilitating form of chemo, I would choose to not take it. I know that in the face of extreme pain and suffering, with no possible relief, and with continuing decline a certainty, I would choose to end my life. I know that a diagnosis of Alzheimer's would result in some hard thinking.
Unlike Emanuel, I will continue to get flu shots, have diagnostic tests and see a specialist if my internist advises. But in the face of negative results, I may well choose not to go forward with treatment. For me, it comes down to having a choice about the quality of my life and my ability to leave this life with as much dignity as I can.
Obviously, I can only speak for myself. I respect those of you who know vibrant, healthy old people. I respect those of you who care for parents with dementia or other debilitating diseases and would never consider ending their lives. I respect those of you who know cancer patients who endured horrific treatment and are now cancer-free. I respect those of you who say you are healthier, more vibrant, more creative, more intellectually sharp than you have ever been before. I applaud all of you.
Like Emanuel, "I retain the right to change my mind and offer a vigorous and reasoned defense of living as long as possible. That, after all, would mean still being creative after 75."
For me, personally, the greatest losses would be my creativity, my sense of humor, and my ability to read. So as long as my blog posts pop up on your screen every now and then, I'm still here.