I’ve been thinking about growing old quite a bit recently. Some may say too late, you’re already there. But funnily enough, I don’t see myself that way. As a child born in the 1950s, I am technically old and certainly middle-aged. But you know what? When it comes to living I say that glass, she is still half full so I give the two-fingered salute to old father time. But how long can I, should I, expect to live? Well, if your name is Ezekiel Emmanuel and you happen to be President Barack Obama’s health advisor, then the answer is 75. That’s how long Emmanuel wants to live, or so he says. He wrote an extremely provocative essay in the Atlantic Monthly, titled: Why I Hope To Die At 75, an argument that society and families and ourselves would be better off if nature takes its course swiftly and promptly.
Emmanuel writes: “Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value. But here is a simple truth that many of us seem to resist: living too long is also a loss. It 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, 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. 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. Dying at 75 will not be a tragedy. “
Already I am thinking Ezekiel Emmanuel is, quite frankly, talking through his hat. I mean on what basis is 75 an arbitrary cut off point? But for the sake of a debate let’s humor him. Emmanuel says over recent decades there was an increase in longevity but also a significant downside. That increase was accompanied by an increase in disability. In other words, we’re living longer but becoming more incapacitated. To bolster his argument, Ezekiel cites research from Eileen Crimmins, a researcher at the University of Southern California, who assessed the physical functioning in adults, and analyzed whether people could walk a quarter of a mile; climb 10 stairs; stand or sit for two hours; and stand up, bend, or kneel without using special equipment. The results show that as people get older, there’s a progressive erosion of physical functioning. More importantly, Crimmins found that between 1998 and 2006, the loss of functional mobility in the elderly increased. In 1998, about 28 percent of American men, aged 80 and older had some form of functional limitation; by 2006, that figure was nearly 42 percent. It’s even worse for women. More than half of women aged 80 and older had a mobility issue. Crimmins’s conclusion: There was an “increase in the life expectancy with disease and a decrease in the years without disease.” As people live longer their ability to function with normal mobility gets shorter. According to Emmanuel, health care hasn’t slowed the aging process, it has slowed the dying process. As far as Ezekiel Emmanuel is concerned, old age is just bad news that keeps getting worse. He writes: “ Even if we aren’t demented, our mental functioning deteriorates as we grow older. Age associated declines in mental-processing speed, working and long-term memory, and problem-solving are well established. Conversely, distractibility increases.
“We cannot focus and stay with a project as well as we could when we were young. As we move slower with age, we also think slower. It is not just mental slowing. We literally lose our creativity.” But having argued the point in quite extensive detail, Emmanuel comes to the end of his piece and does the full cop out. He says: “ Seventy-five years is all I want to live. I want to celebrate my life while I am still in my prime. My daughters and dear friends will continue to try to convince me that I am wrong and can live a valuable life much longer. And 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.”
It’s called having a bet each way. Emmanuel, a bioethicist, says he hopes to be dead by 75, having lived in his words a complete life. He won’t medicate, take a flu injection or even swallow an antibiotic, but then reserves the right to change his mind, which he is perfectly entitled to do. But what is the point of advocating being dead by 75 if you don’t really mean it? And, all of these ideas coming from a senior Obama advisor, implies that he must be trying to influence Government health care policy. But even if he isn’t, Ezekiel Emmanuel, will in all probability, change his mind when he creeps closer to that magic figure of 75, assuming he lives that long. Interestingly, he has identified an important issue. Despite what Emmanuel says, I firmly believe age is a state of mind. And depending on which state, that mind happens to be in, has a large bearing on how well you will fair as you get older. But you are fighting an uphill battle. A fair and humane society should respect an individual at every age. But that can’t be the case when Governments and economists and even the media talk about the problem of old age. An Australian researcher, Doctor Patricia Edgar, has written extensively about the issue of aging. She says American National Institute of Ageing studies show that negative stereotypes about ageing, images of the elderly as “senile”, “frail”, or confused, can become debilitating, self-fulfilling prophecies. “ Seeing or hearing gloomy examples about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular system, affecting health and longevity,” Edgar says.
She points out the result is hardly surprising. Tell anyone, at any age, they are a burden, with nothing to contribute and they will begin to believe and act accordingly. Here’s something that might surprise. Despite many of the resounding, negative observations, a significant percentage of older Australians and I suspect people from other countries as well, are living, breathing testimonies of how wrong you can be. They are living fulfilling lives , increasing their contribution to the work force. I’m not just talking about my generation of baby boomers who seem to be a unique social experiment. It’s the group directly following the baby boomers, which represents a larger demographic and will create an even larger bulge in the paid labour force. So what is the best way to correct the myths and develop responsible and productive policies that actually benefit older people? According to Patricia Edgar we should start with a new definition of ageing.
When is someone said to be old? Research says life expectancy above 30 is a very modern phenomenon driven by public health measures and falling infant mortality. Life expectancy at birth was 35 in Sweden shortly before 1700; in Italy around 1880; and in Russia around 1910. In Australia today, life expectancy for men who are now 65 is 85 and for women it’s 89. Older people represent the fastest growing demographic in society.
Yet, as Edgar points out we are still mired in the perception that 50 is the beginning of old age. South Australia’s Ageing Plan is based on interviews with Australians over 50. At that age we are entering “the second half of life”, not heading for God’s waiting room.
According to Edgar, by treating this stage as a period of aged obsolescence, we create a non-existent problem and undermine a resource, which could have significant benefits for society. She says in the 1950s, Americans identified adolescents or teenagers as a group distinct from children, with special needs. It also made sense to split the childhood demographic into two distinct groups with children living with their parents for longer, entering the workforce later, marrying later and life expectancy increasing proportionally. Edgar says it’s time to recognise that middle age, like childhood, is now lived in two stages. We’ve evolved to a point where the first stage involves work and the second, activity before old age. We don’t simply stop work, and then die as we did in the early 1900s. Retirement is from the paid work force but it doesn’t mean you also retire from life. Edgar says it’s a time of maturity, broadened by experience. A time for giving something back and finding satisfaction in a range of activities, like volunteering, childcare and mentoring. Contributions, that should be recognised and valued. It’s a generation that might not figure in measuring a country’s GDP, but strong communities can’t exist without them. Patricia Edgar claims the media doesn’t help by frequently getting it wrong in promoting the concept of some kind of intergenerational war. It is a rare for a family not to view the interests of the young as the over-riding concern of parents and grandparents. Income flows from the old to the young more so than the other way around, a fact that is often conveniently ignored. Edgar says it isn’t difficult to see that the attributes of the very old are being dismissed way too early. And given our increased life expectancy, the term “old” should mean someone over 85, not 65 and certainly not 55.
According to Edgar, social, medical and cultural policy needs to catch up with this dramatic change in our life cycle. We should stop talking about retirement and “having a well-deserved rest”. Working until the age of 70, if the jobs are there, and there’s no discrimination in the workforce, makes perfect sense. And the reason for continuing to work doesn’t have to only be as a way of earning an income. It can prevent decline. For too many people, retirement leads to cognitive, emotional and physical obliteration.
Edgar says people living an active life after 55 have much to give. As a society we need to think about redesigning our long life journey. There is a growing body of research suggesting that health and satisfaction post 50 plus, is an opportunity to re-invent ourselves. We have become used to thinking that education is solely for the young. Instead we need to think about education as a life-long process.
According to Edgar, the choice is ours to make. We are experiencing a longevity revolution. And if we have enough will and imagination, it has exciting potential. Yes even for you Ezekiel Emmanuel. And, you should tell your boss in the White House.