Because the benefits of vigorous activity as well as other remedies such as cessation of smoking, proper diet, and certain medical means (daily vitamins, calcium supplements, and perhaps a baby aspirin, for example) have been known for decades and have been adhered to by millions of Americans, these benefits should by now be measurable statistically. Have the benefits, in fact, resulted in compression of morbidity? Evidence from a series of surveys in which researchers followed older adults from 1982 until 1999 indicates that they have. An article published in the Journal of the American Medical Association in December 2002 reports that physical, cognitive, and sensory limitations in those who are vigorously active are beginning to decrease. Not only that, but the proportion of people over the age of sixty-five living in institutions for the debilitated elderly has dropped from 6.3 percent to 4.5 percent during the seventeen years of the studies. There are plenty of journal publications demonstrating similar results, including a well-known one in which a large group of University of Pennsylvania alumni averaging sixty-eight years of age at the beginning of the study were found to have postponed disability by an average of 7.75 years if they exercised, avoided cigarettes, and had normal body mass, compared to their counterparts who did not.
As so frequently happens when changes in large populations are studied, the statisticians have the last word. In the case of the elderly, they have expressed it most recently in a United States government report issued jointly by the Department of Health and Human Services and the Department of Commerce, entitled 65+ in the United States: 2005. Published in December of that year, the report utilizes information garnered by the Census Bureau to present an overview of both the current and coming elderly American population, which can be extrapolated, it is probably safe to say, to most industrialized nations of the world.
The entire report can be epitomized by a single sentence that appears on its very first page: “The older population is on the threshold of a boom.” By this is meant not only a boom in numbers but a boom in health, education, prosperity, and even optimism. And as is obvious to any but the most superficial observers of the present-day scene, the boom has been under way for some time. In fact, the word “boom” would seem to be particularly appropriate, since the proximate cause of some of the increase in numbers is the graying of the baby boomers, a generation that began its existence in1946. The health and socioeconomic profile of the average older American of today is markedly different from that of his or her predecessor in earlier generations, and it will be even more so as the coming decades arrive. Though most of the information in 65+ in the United States: 2005 deals with length of life, it is sprinkled throughout with evidence of life’s increasing quality as well.
According to the report, the number of Americans over sixty-five is projected to be 72 million by 2030 (nearly 20 percent of the population at that time) and 86.7 million in 2050, as compared to 36 million in 2003. Even without boomers, the number of the oldest old has also been growing rapidly, already being 4.7 million in 2003, projected to almost 10 million in 2030 and 21 million in 2050. Much the same can be said of centenarians, whose number, as already noted, has already gone from about 37,000 in 1990 to 50,000 in 2000. At present, 64 percent of Americans can expect to live to at least seventy-five, and 35 percent to at least eighty-five. Not only that, but the number of years of remaining life expectancy is also going up for all of the elderly. The average seventy-five-year-old American man of today can anticipate more than another ten years on this earth, while his twin sister will be around for more than twelve.
The growth in size of the population that is sixty-five and older is far outpacing that of people younger than that age, and at present accounts for one in eight Americans. All of this reflects, of course, increases in the average life expectancy, which has gone from 47.3 years in 1900 to an average of 77.9 years in 2004, meaning that the average girl born in that year will live to be eighty, and the average boy to seventy-five. Much of the change has been due (and this is remarkably different from the cause of earlier increases, which were in greatest part due to lessened mortality among infants and the young) to reductions in mortality among the elderly population.
These numbers are abetted by the fact that the first of the baby boomers will turn sixty-five in 2011, but that cohort is far from the numbers’ entire basis. In the words of the report, “People in the United States are living longer and healthier lives than ever before.” The frequency and mortality of the leading killer, heart disease, continues to drop; this decline is, in fact, the most important reason for the overall decline in death rates among the elderly. Moreover, studies of the type described in the previous pages of this book reveal considerable decline in rates of general disability and in limitations of functioning. “In order to address quality of life, the concept of active life expectancy (ALE) is used to measure the number of years that people can expect to live on an average without disability. Using various measurements and methods of analysis, including ALE, recent studies conclude that in addition to living longer, the current generation of older people are [sic] healthier and less disabled than their predecessors.”
These changes are due to such factors as higher socioeconomic status and net worth (for example: 35 percent of the elderly population lived below the poverty line in 1959, as compared to 10 percent by 2003. Moreover, the median household income in homes with a householder over sixty-five has risen from $12,882 in 1967 to $23,787 in 2003, adjusted for inflation); improved diet (due to such factors as higher standards of living as reflected in income, better education, and increased knowledge of nutrition both by medical science and the general population); more understanding of the importance of physical and intellectual activity and other positive behavioral changes; decreased smoking (cigarettes are more dangerous for the elderly than for younger smokers, not only because they add to pathology already made significant by long-standing addiction to nicotine, but also on account of cigarettes’ effect on the chronic diseases so often found among older people); and continuing scientific research on the biology and medical consequences of aging. As noted earlier, by far the most important factor in increasing longevity and general vitality during the first half of the twentieth century was improvements in the public health by such means as immunizations, water purification, more adequate housing, better clothing, and enhanced sanitation. During more recent decades, medical progress benefiting individual patients has become a bigger factor and holds the promise of more effective treatment for cancer, lung disease, stroke, and such chronic debilitating diseases as diabetes, hypertension, osteoporosis, kidney failure, Alzheimer’s and other dementias, and arthritis. The campaign against chronic disease is particularly important for quality of life, because about 80 percent of the elderly have at least one chronic health condition and 50 percent have at least two.
Factors other than healthful lifestyles and improved attention to fitness have quite obviously contributed to these salutory statistics. Nevertheless, there can be little doubt that relatively simple measures to encourage these two factors, such as those being recommended by gerontologists and their clinical colleagues, the geriatricians, play a major role in their attainment. There is reason for optimism in these figures, and hope that in future decades even fewer of our nation’s elderly will be confined to nursing homes or will be dependent on others for the needs of daily living.
In a time of finite resources—and when have we lived in a time when resources were not finite?—we would do well to expend far more of our intellectual and fiscal capital on improving the quality of our later lives than on the self-absorbed and very likely fanciful goal of lengthening our lives beyond that 120 years allotted by natural selection. An enlarging pool of the elderly have much to offer our society, if we can but help them to remain sufficiently vital to bring their potential benefits to the rest of us. Instead of spending vast amounts of money on today’s version of Brown-Séquard’s fantasy—rejuvenation clinics, where hormones and fetal cells are injected, and
fistfuls of antioxidants are swallowed—instead of spending vast amounts of money supporting eager scientists who promise life everlasting by molecular sleight-of-hand—instead of such folly, we should look at the aged among us and realize their need, and ours.
Some of those aged are already showing us the potential value of such investments in the quality of their lives. The compressed morbidity and postponement of disability that has benefited so many of them—as well as the increased longevity—are becoming enough that we see examples of it every day. A mere look around us confirms those statistical studies that give scientific objectivity to a phenomenon visible to anyone who thinks about it. The older men and women we encounter as we go about our daily routines do look and act much younger than their predecessors did a generation ago. And we see far more instances of individuals whose lives are in many respects just as useful to society and rewarding to themselves as they were at the height of their working careers. They exemplify what could be done, if only the knowledge and the resources were made available to everyone.
Emanuel Papper, who died at the age of eighty-seven in December 2002, was my closest and most admired friend. An air force medical officer decorated with the Silver Star for heroism, he emerged from World War II with internal injuries to the diaphragm and stomach sustained when his bomber was shot down, and from which he never fully recovered. Realizing that the field of anesthesiology was still in a relatively primitive state, he determined to do something about it. He was able to accomplish his goal by introducing the principles of basic science research into clinical care and the training of residents, an approach that he and only a few other pioneers brought to academic medical centers in the 1950s. As chairman of the department of anesthesiology at his alma mater, Columbia University, he organized a program that attracted colleagues from all over the world, who came to learn his methods and bring them back to their own hospitals and medical schools.
After twenty-five years of directing one of America’s premier departments in his specialty, Manny Papper accepted the position of dean of the medical school at the University of Miami. His tenure there lasted fourteen years, during which he made vast improvements in the institution’s academic standards before retiring at the age of seventy. Though he continued to teach residents and students in anesthesiology, his inquiring mind demanded new challenges, and he enrolled in the university’s doctoral program in English literature, and was awarded his Ph.D. degree when he was seventy-six. The dissertation he wrote on the Romantic poets provided grist for his multi-focused intellectual mill for the rest of his life, and he continued to pore over the works of early-nineteenth-century authors and to acquire first editions of their works for his increasingly formidable collection. His intellectual interests were broad, including the study of religions, classical music, the masterpieces of painting of virtually every style, and a great curiosity about the undertakings of the wide variety of men and women with whom he came into contact.
Though essentially living a life of the mind, Manny Papper never neglected his body. He exercised regularly and strenuously, and was an avid tennis player until only a few years before his death. Anyone traveling to visit him in Miami was likely to be taken to the gym, and later invited to join him on one of his long, vigorous walks, which tired many a younger man or woman before their host was noticeably affected.
As Manny approached his middle eighties, he gradually developed shortness of breath and began to become more easily fatigued than he had previously. A major abdominal operation to treat a life-threatening emergency caused by the old war wounds added to the magnitude of these problems, but he recovered rapidly and resumed his usual program of exercise, never having slackened off in his intellectual pursuits. When medical evaluation showed the breathing difficulties to be the consequence of a leaking heart valve, he resolved to undergo the hazardous surgery that would be required to repair it, because the respiratory limitations had begun to infringe on his enjoyment of life, which still included a regimen of weight training and walking, though he had reluctantly abandoned tennis a few years earlier due to a shoulder injury.
The events of September 11, 2001, reignited Manny’s long-standing interest in Islam, which he began to study with the same intensity that he had always applied to every other of his pursuits, going so far as to organize a conference on the subject at the Aspen Institute, of whose board he was a member of long standing. Late one afternoon in early December 2002—a few weeks before the scheduled heart surgery—while exploring the Internet in hope of finding the answer to some abstruse problem in Islamic history, Manny suddenly complained of blurriness of vision, and then fell unconscious to the floor. He died in the hospital seven hours later, of a massive cerebral hemorrhage.
Of course, the story of Manny Papper represents an extreme example of what is possible, given the will and the wherewithal. He had the background, the personal drive, and the financial resources to live his years in a way that fulfilled his greatest hopes. But the important lesson to be learned from his tale’s telling is that this kind of thing is possible, even if not very often to the extent that he was able to enjoy. What is required is for the public to understand the rather simple principles that prevent disability while increasing the quality of life, and probably its quantity as well. And what is also needed is continued intensive research into the causes of disability, which would encourage prevention by the aging themselves, a category that each of us joins the moment we leave the womb. Better to spend our nation’s money in such ways than to waste it in the vainglorious search for immortality.
And if a few of our elder citizens believe that a more youthful outlook is attained by wearing a toupee or a wig, it is not for the rest of us to ridicule. Instead, we should consider that such stratagems are only a manifestation of the wish to remain young, and are perhaps the first step toward changing the long-standing self-destructive habits and buying the gym membership that will really do the job. Vanity is like the raisins that draw a kid to the cereal, and pride is the richness of flavor that keeps him eating it. And as for the penile implant that my former classmate is planning: Am I the only old codger who is beginning to think that it may not be such a bad idea after all?
WISDOM, EQUANIMITY, CARING—PRINCIPLES FOR EVERY AGE
In a book on aging, it would seem a worthy undertaking to reflect on wisdom. And so, as a man of now considerable years and therefore some prerogative, I will not hesitate to do just that, accompanied by the hope that I can avoid the great temptation of waxing ponderous.
Every culture associates being wise with older people, though it is well known that merely being old does not in itself confer wisdom, nor does being young prevent it. Plenty of elders have never achieved it, perhaps most. And plenty of elders are foolish, even long before they become senile. If we are to extract wisdom from our years as they are being lived, we must begin early to acquaint ourselves with wisdom’s qualities, and absorb them into all that we are trying to become.
Like aging itself, the having of wisdom is a stage of ongoing development, whose degree of success depends upon every other stage that came before it. Because its evolution in any individual ordinarily requires the long passage of time, it is in general safe to say that seniors are more likely to be wise than their juniors, though an abundance of exceptions do occur among the young. Whatever its degree of justification, the belief that wisdom is the province of age is reflected in many cultures, but in no language more directly than in Hebrew, where the word for “old,” zaken, is an acronym formed from the expression, zeh kanah hokhmah, literally “this one has acquired wisdom.”
Though age may not necessarily bring wisdom, age nevertheless demands it. At earlier stages of our lives, things tend to take care of themselves. They do not require the consistent attention and watchful circumspection we come to need in order to negotiate our later decades. When we are young, errors are more easily retrieved and false steps more easily retaken. As we age, we must learn to do without the second or third
chances and the compensatory readjustments that have worked so well in the past to maintain the balance and forward motion of our lives. As Michael DeBakey would surely point out, we can replace the automatically stabilizing gyroscope with wisdom, if we have it. But we will not have it if we assume that it is necessarily the reward of age, without our having prepared for it—without our having accumulated it along the way. We are aided in wisdom’s pursuit by the length of our days, but our days must have been well used in the decades before they have grown long.
Asked to designate the most direct path toward wisdom, I would unhesitatingly point to the conscious and unconscious modeling of ourselves on those whom we believe wise. Who among us has not more than once approached a vexing problem by thinking back on how it might have been solved by someone whose judgment we have admired and attempted to emulate? We come to recognize such men and women when we encounter them, just as we recognize wisdom from whatever source it may spring.
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