I don't expect to be reincarnated,
so I'll blog about dying and death (with appropriate irreverence) while I'm still alive.

Tuesday, March 8, 2011

Is 90 the new 50?

(By Susan Jacoby -- Reposted with appreciation but without permissaon from the New York Daily News.)

A surprise appearance at this year's Academy Awards ceremony by the frail 94-year-old actor Kirk Douglas, his speech slurred by the effects of a stroke, offered a rare revelation about the American public's real attitude about advanced old age. A contributor to a movie blog could not decide whether the appearance was "classy or crass." The word "embarrassing" was most frequently used in living rooms.

Indeed, Americans should be embarrassed on their own behalf for being disturbed by a glimpse of what embattled "old old" age really looks like - a sharp contrast to the relentless propaganda of longevity hucksters who claim that we can all enjoy an "ageless" life well into our 90s. If we are unsettled by the sight of a valiant old man with the will to regain his speech after a catastrophic stroke, that only underscores our denial about the challenges associated with an aging population.

In just 20 years, the sprightly baby boomers now turning 65 to the tune of "Forever Young" will be leaving the relatively hardy country of what sociologists call the "young old" - those under 85 - for the much harsher terrain of the "old old."

The boomer fantasy is that we will die of a heart attack in our ninth or tenth decade, without ever having been sick a day, and while blissfully engaged in love making, skydiving or paragliding.
Now, the truth: Most Americans who live beyond 85 - there will be 8.5 million by 2030 - will die after a period of extended mental or physical disability. Nearly half of those now over 85 suffer from dementia, of which Alzheimer's is the leading cause. Half will spend some time in a long-term care institution before they die.

And yet anyone who has not been confined to a cave without Internet access is surely aware of the media blitz touting the "new old age" as a phenomenon that will let boomers enjoy the kind of healthy, sexy, adventurous old age that their ancestors could never have imagined.

The myth of a radically new old age is based partly on faith in imminent medical miracles. At a panel titled "90 is the New 50," held at the World Science Festival in New York several years ago, an audience with the fervor of an old-time religious revival meeting was told that advances to conquer the most feared age-related diseases - and even to reverse aging itself! - would arrive in time for this generation.

No one has more confidence than I do in science, especially in the promise of embryonic stem cells and other cutting-edge biomedical research. But it is clear that the more scientists learn about genetically complicated, age-linked diseases like Alzheimer's, the more they realize that the quest for effective treatment, much less a cure, is likely to be a long-term effort. The dreaded brain disease progresses inexorably for years or decades before most people experience symptoms. And it is hardly the only illness that afflicts the elderly.

The second element in the myth of agelessness is the belief that the aging process can be "defied" by habits such as exercise, eating right, not smoking and drinking moderately. Such behaviors do promote healthier lives at any age and enable people to cope more successfully with diseases, like diabetes, that can be treated but not cured. But good health habits are no magic shield against the worst vicissitudes of age. To think that jogging and orange juice will stave off the corrosion of time is a pleasant belief - but ultimately a false one.

Finally, a major obstacle to a satisfying old age is money - or, rather, the lack of it. According to the most recent figures supplied by the nonpartisan Congressional Research Service, three-quarters of households with a head over 65 live on less than $34,0000 annually. Half of such households get by on less than $19,000 a year - and Social Security accounts for 80% of that depressing figure. Income drops precipitously with every decade, because the vast majority of the oldest survivors are women. Most widows become poorer when their husbands die, and women generally retire with lower pensions and Social Security benefits. Douglas offers an excellent example of what money means in old age. As one of the leading actors of his generation, he had the resources to pay for expensive rehabilitation needed to make the most of life after a stroke. Medicare pays only a fraction of the cost. If he were poor, such care would have been out of his reach.

Amid talk about cutting Social Security, Medicare and Medicaid, no one is talking realistically about how to pay for the much longer lives that the generation now blowing out 65 birthday candles can expect.
The fantasy of a new old age - which denies the physical degeneration that eventually overtakes everyone and the cost of real old age - is a dangerous and seductive delusion. If 90 really were the new 50, (or even the new 70), society could rest easy as baby boomers worked, played and shopped into eternity. But that's just a fairy tale.

Susan Jacoby is the author of the recently published "Never Say Die: The Myth and Marketing of the New Old Age."

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